Aboriginal mothers, breastfeeding and smoking

Objective : To document the smoking practices of Aboriginal mothers living in Perth during pregnancy and during the subsequent year while feeding their infants.
Method : A cohort of mothers was followed from the time of delivery for 12 months to obtain details of infant feeding practices. A total of 455 mothers delivered between May 2000 and July 2001 and 425 completed the baseline questionnaire.
Results : Prior to and during pregnancy, 67% of the mothers smoked regularly. While the rate appeared to decline slightly with the length of breastfeeding, the trend was not significant. The rate of smoking of Aboriginal mothers was significantly greater than for an earlier study of non-Aboriginal mothers in Perth, where the rate was 28.4%. Among Aboriginal women there was no difference in the percentage of smokers and non-smokers who initiated breastfeeding. While fewer women who smoked were still breastfeeding at 24 weeks postpartum, compared with non-smokers (58% vs. 64%), this difference was not significant.
Conclusions : The percentage of women smoking in this study is consistent with rates reported in the 2001 National Drug Strategy Household Survey. In other studies, smoking is associated with lower rates of breastfeeding initiation and duration, but this was not the case in the Aboriginal mothers.
Implications : Although the high prevalence of smoking identified in this study did not appear to adversely affect breastfeeding, smoking during and after pregnancy does contribute to increased rates of low birth weight and other health problems in early childhood. Targeted antenatal smoking cessation programs are needed for Aboriginal mothers.     

Aboriginal mothers, breastfeeding and smoking

OBJECTIVE: To document the smoking practices of Aboriginal mothers living in Perth during pregnancy and during the subsequent year while feeding their infants. METHOD: A cohort of mothers was followed from the time of delivery for 12 months to obtain details of infant feeding practices. A total of 455 mothers delivered between May 2000 and July 2001 and 425 completed the baseline questionnaire. RESULTS: Prior to and during pregnancy, 67% of the mothers smoked regularly. While the rate appeared to decline slightly with the length of breastfeeding, the trend was not significant. The rate of smoking of Aboriginal mothers was significantly greater than for an earlier study of non-Aboriginal mothers in Perth, where the rate was 28.4%. Among Aboriginal women there was no difference in the percentage of smokers and non-smokers who initiated breastfeeding. While fewer women who smoked were still breastfeeding at 24 weeks postpartum, compared with non-smokers (58% vs. 64%), this difference was not significant. CONCLUSIONS: The percentage of women smoking in this study is consistent with rates reported in the 2001 National Drug Strategy Household Survey. In other studies, smoking is associated with lower rates of breastfeeding initiation and duration, but this was not the case in the Aboriginal mothers. IMPLICATIONS: Although the high prevalence of smoking identified in this study did not appear to adversely affect breastfeeding, smoking during and after pregnancy does contribute to increased rates of low birth weight and other health problems in early childhood. Targeted antenatal smoking cessation programs are needed for Aboriginal mothers.     

Breastfeeding mothers consume more vegetables and a greater variety of fruits and vegetables than non‐breastfeeding peers: The influence of socioeconomic position

Aim: This study compared the diets of breastfeeding and non‐breastfeeding mothers from socioeconomically diverse regions of Melbourne to determine whether breastfeeding is a marker for healthier maternal dietary intakes. Methods: This cross‐sectional study obtained information via self‐reported questionnaire from 529 first‐time Melbourne mothers. Breastfeeding status was determined when the children were 3.9 months. Diet information was obtained using a validated Food Frequency Questionnaire. Maternal diet was assessed by seven indicators: average daily intake of fruit, vegetables, non‐core drinks, non‐core sweet snacks, non‐core savoury snacks, variety of fruit and variety of vegetables eaten in the preceding 12 months. Associations between breastfeeding status and each dietary variable were assessed using linear regression analyses. Socioeconomic position, maternal body mass index and the cluster‐based sampling design were controlled for. Results: Of the 529 subjects, 70% were breastfeeding their child. Compared with non‐breastfeeding mothers, breastfeeding mothers were found to consume more serves of vegetables (P= 0.001), a greater variety of fruit and vegetables (P= 0.001 and P≤ 0.001 respectively), and sweet snacks were consumed more frequently (P= 0.006). Differences were observed between low and high socioeconomic position mothers for fruit serves (P= 0.003), vegetable serves (P= 0.010) and fruit variety (P= 0.006). These associations persisted after controlling for socioeconomic position and maternal body mass index. Conclusions: The association between infant feeding (breastfeeding) and some aspects of maternal diet provides further evidence suggesting a link between maternal and child diets from a younger age than previously examined.     

A longitudinal study of breastfeeding and weaning practices during the first year of life in Dunedin,New Zealand

OBJECTIVE: To investigate infant feeding practices during the first year of life in a group of white infants in Dunedin, New Zealand. DESIGN: Prospective study of infants from birth to 12 months of age. PARTICIPANTS: A self-selected sample of 74 white mothers and their infants born in Dunedin, New Zealand, between October 1995 and May 1996. Statistical analyses Regression analyses were performed to determine factors associated with successful breastfeeding initiation and duration. RESULTS: Among mothers, 88% (n=65) initiated breastfeeding, 42% (n=31) were exclusively breastfeeding at 3 months, and 34% (n=25) were partially breastfeeding at 12 months. Intention to breastfeed increased the likelihood of successful breastfeeding initiation. Mothers who reported that they did not have enough breastmilk tended to exclusively breastfeed for a shorter period of time. Tertiary education and exclusively breastfeeding at 1 month were associated with a longer duration of breastfeeding. Perception of breastfeeding in public as embarrassing was associated with a shorter duration of breastfeeding. Among infants, 45% (n=33) were given nonmilk foods before 4 months of age, and 69% (n=51) were given unmodified cow's milk as a beverage before 12 months. APPLICATIONS: Breastfeeding rates in this study, although higher than in many Western countries, were still lower than current recommendations. Our findings suggest that women should be taught how to increase their breastmilk supply. Parents should also be informed of the importance of delaying the introduction of nonmilk foods until their infant is 4 to 6 months of age and cow's milk until they are 12 months of age. Society also needs to address the social issue of embarrassment many mothers feel when breastfeeding in public.     

Position of the American Dietetic Association: Promoting and Supporting Breastfeeding

It is the position of the American Dietetic Association that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life and breastfeeding with complementary foods from 6 months until at least 12 months of age is the ideal feeding pattern for infants. Breastfeeding is an important public health strategy for improving infant and child morbidity and mortality, improving maternal morbidity, and helping to control health care costs. Breastfeeding is associated with a reduced risk of otitis media, gastroenteritis, respiratory illness, sudden infant death syndrome, necrotizing enterocolitis, obesity, and hypertension. Breastfeeding is also associated with improved maternal outcomes, including a reduced risk of breast and ovarian cancer, type 2 diabetes, and postpartum depression. These reductions in acute and chronic illness help to decrease health care-related expenses and productive time lost from work. Overall breastfeeding rates are increasing, yet disparities persist based on socioeconomic status, maternal age, country of origin, and geographic location. Factors such as hospital practices, knowledge, beliefs, and attitudes of mothers and their families, and access to breastfeeding support can influence initiation, duration, and exclusivity of breastfeeding. As experts in food and nutrition throughout the life cycle, it is the responsibility of registered dietitians and dietetic technicians, registered, to promote and support breastfeeding for its short-term and long-term health benefits for both mothers and infants.     

Food consumption and feeding patterns of Czech infants and toddlers living in Prague

OBJECTIVE: To describe feeding patterns during first two years of life and their relation to sociodemographic factors. DESIGN: Longitudinal study. SETTING: Prague, Czech Republic. SUBJECTS: Ninety-seven full-term healthy singletons enrolled at maternity ward, of which 90.7% completed the study. METHODS: Diet was assessed at 9, 12 and 24 months of age using a structured 3-day dietary record. Additional information was obtained from questionnaires completed at birth and at 6 months. RESULTS: The median duration of exclusive breastfeeding was 5 months, and that of total breastfeeding 9 months. Breastfeeding rate 47.4% at 9 months declined to 4.5% at 24 months. Total duration of breastfeeding was positively associated with maternal education and marital status but not with maternal age, gender or birth order. Breastfeeding frequency at 9, 12 and 24 months was 4.8, 4 and 3.7, respectively. The complementary food feeding frequency increased significantly with age (4.5, 4.7 and 5.9 times per day, respectively). All children at any age point consumed fruits, cereal and milk products. The proportion of children consuming meat and vegetables had increased with age but between ages 9 and 24 months, at least 23-38% children did not consume vegetables daily and 28-40% did not consume foods from meat/fish/poultry/eggs group daily. The proportion of children consuming milk and foods associated with the early complementary feeding period had fallen with age while the consumption of cereal foods other than porridge had increased. Values of indicators of adequate complementary feeding practices tentatively suggested in the context of WHO expert consultation had closely reflected breastfeeding rates. CONCLUSIONS: Breastfeeding duration is shorter than WHO recommends. It is influenced by maternal education and marital status. Compliance with complementary feeding recommendations is relatively good. Continued promotion of healthy infant and young child feeding practices is needed. Indicators evaluating complementary feeding practices should assess breastfeeding separately from other aspects. SPONSORSHIP: Ministry of Health, 1st Faculty of Medicine, Charles' University of Prague.     

Ethnic Variation in Breastfeeding and Complimentary Feeding in the Republic of Ireland

Early nutrition plays a pivotal role in long-term health. The World Health Organization (WHO) recommends exclusive breastfeeding during the first six months of life, with the gradual introduction of solids after this period. However, studies in the Republic of Ireland (ROI) have shown poor compliance with guidelines. The ROI continues to have one of the lowest breastfeeding rates worldwide. Our objective was to analyse differences in breastfeeding and complimentary feeding behaviours between Irish and non-Irish mothers residing in the ROI, as well as the role of acculturation on these behaviours, using the national longitudinal study, Growing Up in Ireland (GUI). Mothers (n = 11,134) residing in the ROI were interviewed when their infants were nine months of age. The percentage of Irish mothers who initiated breastfeeding was 49.5%, as opposed to 88.1% among the non-Irish cohort (p < 0.001). Breastfeeding initiation reduced from 89.4% of non-Irish mothers who had arrived within the last year to five years ago to 67.5% for those who had arrived 11 to >20 years ago (p < 0.001). Our results indicate that cultural differences are an important factor in shaping patterns of infant feeding in the ROI. Reviewing existing support and education policies for parents is required to achieve the implementation of desirable infant feeding practices.     

Infants' first feeds in Hangzhou, PR China

Breastfeeding is the foundation of good nutrition and provides the basis for health throughout the life span. The WHO and the Chinese Ministry of Public Health recommend exclusive breastfeeding to six months of age. The practice of giving prelacteal feeds may interfere with the establishment of good breastfeeding practices and is contrary to the principles of Baby Friendly Hospital accreditation. The objective of this study was to investigate the prevalence of prelacteal feeds in a hospital in Hangzhou and the influence of this practice on breastfeeding at discharge. A longitudinal study of infant feeding was conducted in Hangzhou, China and a total of 638 mothers were recruited and interviewed while in hospital. The questionnaire included full details of infant feeding methods and factors likely to influence the initiation and duration of breastfeeding. Binary logistic regression was used to analyse factors influencing breastfeeding on discharge. In Hangzhou almost all babies are born in hospital, the median length of stay was 5.6 days and 77% of births were by caesarian section. In 26% of births the infants were given formula, water or milk as their first feed. At the time of discharge from hospital 91% of infants were receiving some breastmilk, but only 36% of mothers were exclusively breastfeeding. Breastfeeding on discharge from hospital was inversely related to giving prelacteal feeds (OR 0.115, 95% CI 0.055-0.238). While in hospital just over one quarter of infants received prelacteal feeds and these infants had a lower rate of breastfeeding on discharge.     

Breastfeeding rates and duration in Germany: a Bavarian cohort study

Breastfeeding is the recommended feeding for all healthy infants. The aim of our study was to assess the current state of breastfeeding prevalence, duration and behaviour in Bavaria, Germany as a basis for targeting breastfeeding promotion measures. The Bavarian Breastfeeding Study is a prospective cohort study of 3822 mothers who delivered in April 2005 in Bavaria, Germany. Breastfeeding duration and determinants such as socioeconomic status, attitudes towards breastfeeding, birth mode and breastfeeding problems were assessed by questionnaires 2-6 d after birth and 2, 4, 6, and 9 months after birth. The initial breastfeeding rate was 90 %. After 4 months 61 % still breastfed (any breastfeeding). In the multivariate analyses the main influencing factor reducing breastfeeding initiation was the partner's negative attitude towards breastfeeding (OR 21.79; 95 % CI 13.46, 35.27). No initial breastfeeding was also associated with lower education, maternal grandmother's negative attitude and pre-term birth. Protective factors were primary breastfeeding experience and information on breastfeeding before birth. Breastfeeding duration < 4 months was strongly associated with breastfeeding problems (OR 7.56; 95 % CI 6.21, 9.19), smoking, lower education, partner's negative attitude and Caesarean section. Since the attitude of family members is an important influencing factor on breastfeeding rates, breastfeeding promotion should also target the partners of pregnant women and the families of newborn infants. Public health interventions such as more effective support for the management of breastfeeding problems, especially in lower social status families, should be implemented and their effectiveness should be critically evaluated.     

The association of infant feeding with parent-reported infections and hospitalisations in the West Australian Aboriginal Child Health Survey

OBJECTIVE: To examine infant feeding associations with parent-reported infections and hospitalisations in Western Australian Aboriginal infants and children. METHOD: Families in Western Australia with children under 18 years of Aboriginal or Torres Strait Islander descent were included. A stratified multi-stage sample using an area-based sampling frame was compiled. Survey weights produced unbiased estimates for the population of families with Aboriginal children. Data were collected on demographic variables, maternal and infant characteristics and parent-reported recurring chest, ear and gastrointestinal infections. The data were linked to the Hospital Morbidity System to identify hospitalisations for infections for the same children. RESULTS: Twenty-seven per cent of Aboriginal children were breastfed for less than three months. Parent-reported recurring chest, ear and gastrointestinal infections were reported in 47% of the 0-3 age group. Hospitalisations due to upper respiratory and gastrointestinal infections were most common in the older children, but wheezing lower respiratory infections were most common in younger children. Breastfeeding for less than three months and birth weight less than 2,500 g were risk factors for parent-reported chest infections and hospitalisations for upper and wheezing lower respiratory infections (p<0.05). CONCLUSION: Rates of parent-reported chest infections and hospitalisations due to these infections continue to be high in Aboriginal infants and children. Because breastfeeding for less than three months and low birth weight are risk factors for these infections, interventions to reduce the prevalence of low birth weight and to increase breastfeeding rates should be primary health goals in Aboriginal communities for the benefits of Aboriginal infants and children.     

The factors facilitating and constraining the continuation of breastfeeding in women in Estrie (Quebec)

OBJECTIVE: To document breastfeeding rates from birth to six months as well as the factors facilitating and constraining the continuation of breastfeeding in women in the Eastern Townships of Quebec and to compare these to the results obtained in 1999. METHOD: Postal questionnaire sent to 374 mothers who had breastfed and analysis of archival data. RESULTS: Breastfeeding rates were 86.3% at birth and 75% at discharge from hospital in all mothers who gave birth to a child in 2004-2005. Breastfeeding rates in the 272 mothers who answered the questionnaire were reported to be 67.3% and 47.4% at three and six months respectively. Results indicate that 8.9% of infants were still receiving breast milk exclusively after the third month. However, 27.9% of the mothers had stopped breastfeeding during the infant's first week. Support from the nurses was the primary factor facilitating breastfeeding. The main reasons the mothers gave for stopping breastfeeding were problems with breastfeeding and fatigue. CONCLUSION: Breastfeeding rates in this area of Quebec have increased significantly in the past five years and are comparable with those in the rest of Canada. Breastfeeding exclusively up to six months is rare, and initiatives to support breastfeeding mothers in the hospital and in the community are having success.     

分娩方式与母乳喂养的相关性

目的:了解石河子市婴幼儿母乳喂养与分娩方式的相关性,分析原因并提出对策,提高母乳喂养率。方法:回顾性调查5所幼儿园321名3~5岁小儿的母亲有关母乳喂养情况。结果:母乳喂养率为91.3%,剖宫产的婴儿母乳喂养率低于自然分娩者。结论:剖宫产影响母乳喂养率。     

Breastfeeding Practices among Adolescent Mothers and Associated Factors in Bangladesh (2004–2014)

Optimal breastfeeding practices among mothers have been proven to have health and economic benefits, but evidence on breastfeeding practices among adolescent mothers in Bangladesh is limited. Hence, this study aims to estimate breastfeeding indicators and factors associated with selected feeding practices. The sample included 2554 children aged 0–23 months of adolescent mothers aged 12–19 years from four Bangladesh Demographic and Health Surveys collected between 2004 and 2014. Breastfeeding indicators were estimated using World Health Organization (WHO) indicators. Selected feeding indicators were examined against potential confounding factors using univariate and multivariate analyses. Only 42.2% of adolescent mothers initiated breastfeeding within the first hour of birth, 53% exclusively breastfed their infants, predominant breastfeeding was 17.3%, and 15.7% bottle-fed their children. Parity (2–3 children), older infants, and adolescent mothers who made postnatal check-up after two days were associated with increased exclusive breastfeeding (EBF) rates. Adolescent mothers aged 12–18 years and who watched television were less likely to delay breastfeeding initiation within the first hour of birth. Adolescent mothers who delivered at home (adjusted OR = 2.63, 95% CI:1.86, 3.74) and made postnatal check-up after two days (adjusted OR = 1.67, 95% CI: 1.21, 2.30) were significantly more likely to delay initiation breastfeeding within the first hour of birth. Adolescent mothers living in the Barisal region and who listened to the radio reported increased odds of predominant breastfeeding, and increased odds for bottle-feeding included male infants, infants aged 0–5 months, adolescent mothers who had eight or more antenatal clinic visits, and the highest wealth quintiles. In order for Bangladesh to meet the Sustainable Development Goals (SDGs) 2 and 3 by 2030, breastfeeding promotion programmes should discourage bottle-feeding among adolescent mothers from the richest households and promote early initiation of breastfeeding especially among adolescent mothers who delivered at home and had a late postnatal check-up after delivery.     

Impact of working status on breastfeeding in Singapore: evidence from the National Breastfeeding Survey 2001

BACKGROUND: This study uses data from the 2001 Singapore National Breastfeeding Survey to examine factors, including working status, associated with breastfeeding duration. METHODS: All women who delivered in the eight hospitals with obstetric services in Singapore from 1 April to 31 May 2001 were invited to participate in a survey on infant feeding and nutrition at 2 and 6 months postpartum. A total of 2149 respondents were interviewed for variables that were known or suspected to be associated with breastfeeding initiation and duration. Cox proportional hazards model was used to determine the associated effect of working status on breastfeeding duration. Kaplan-Meier estimate and survival curves were compared between working and non-working mothers. RESULTS: Working status had no effect on initiation of breastfeeding, but had an effect on breastfeeding duration. The median breastfeeding duration for non-working and working mothers was 9 weeks and 8 weeks, respectively. This difference was significant by log rank test [hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.14-1.41, P value <0.001]. About 31% of non-working mothers breastfed for up to 6 months as compared to 20% of working mothers. Working mothers were more likely to stop breastfeeding than non-working mothers (HR = 1.61, 95% CI 1.43-1.85, P value = 0.001) after adjusting for potential confounders. The most important reason for working mothers stopping breastfeeding between 2 and 6 months was attributable to work. CONCLUSION: More breastfeeding-friendly initiatives need to be put in place at workplaces to encourage working mothers to continue breastfeeding upon returning to work.     

Maternal control of child‐feeding during breast and formula feeding in the first 6 months post‐partum

Background: Mothers who breastfeed use lower levels of control over later child diet. The baby‐led nature of breastfeeding may encourage this low control to develop. Alternatively maternal desire for control may drive breastfeeding duration. The present study explored whether differences in maternal control are present during milk feeding and whether these stem from or drive breastfeeding duration. Methods: Five hundred and two mothers with an infant aged 6–12 months completed a modified retrospective version of the child‐feeding questionnaire adapted to reflect milk feeding during the first 6 months post‐partum. Participants were recruited from mother and baby groups and online parenting forums. Mothers recalled their use of encouraging intake and scheduling feeds in relation to their infant’s intake of milk. Attitudes towards breastfeeding were also measured, including views that breastfeeding is inconvenient, difficult and that formula‐fed infants were more content. Results: Compared to mothers who formula‐fed or ceased breastfeeding within 1 week, mothers who breastfed for at least 6 months recalled a lower use of scheduling and encouraging milk feeds. Mothers who initiated breastfeeding but ceased within 1 week reported lower control compared to exclusive formula feeders. A high level of scheduling feeds was associated with considering that breastfeeding was inconvenient and a greater perceived infant size, whereas encouraging feeds was associated with considering that breastfeeding was difficult, low maternal confidence and a smaller perceived infant size. Conclusions: Maternal desire for control may drive breastfeeding duration. A controlling maternal feeding style may therefore be dispositional and present much earlier than current studies suggest.     

Einflussfaktoren auf Verbreitung und Dauer des Stillens in Deutschland

Breastfeeding is the natural way of feeding infants in the first months of their lives and has been proven to have health benefits for both infants and mothers. Breastfeeding initiation and duration are affected by social, demographic and health factors. The aim of this study was to describe the current rates of breastfeeding initiation and duration in Germany, and to identify potential factors that underline these rates. Additionally, results are compared with the KiGGS basic (2003–2006; birth cohorts 1996–2002) study in order to reveal the development in the trends of breastfeeding initiation and duration in Germany. The KiGGS wave 1 (2009–2012) includes data on the breastfeeding behavior of mothers of 4410 children aged between 0 and 6 years (birth cohorts 2002–2012). Altogether, 82?% (95?% confidence interval 79.8–84.2 %) of children were ever breastfed, and the average breastfeeding duration was 7.5 months (7.2–7.8). There was a slight increase in the breastfeeding initiation in Germany over the last several years. Breastfeeding initiation among children aged 0-6 years increased by 4?% points compared to 0- to 6-year-olds (birth cohorts 1996–2002) from the KiGGS basic study. The breastfeeding duration stayed unchanged. The breastfeeding behavior was mainly related to the age of the mother at birth, the mother’s education level, smoking during pregnancy, and multiple or premature birth. Despite the overall increasing trend in breastfeeding initiation, there is still a growing need for breastfeeding promotion and support for young and less educated mothers, mothers who smoke during pregnancy, and also for mothers with premature babies or multiple births.     

The effect of employment status on breastfeeding in the United States.

BACKGROUND: In the United States, more new mothers are part of the work force than ever before. This trend has implications for many child-rearing practices, including breastfeeding. METHODS: Based on a national sample of new mothers (n = 228,000), this study considered the prevalence of the initiation and duration of breastfeeding to 6 months after delivery in 2003 among women who were employed full time, who worked part time, or who were not employed outside the home. Breastfeeding trends since 1984 were also considered. RESULTS: In 2003, at the national level, the prevalence of the initiation of breastfeeding and breastfeeding to 6 months after delivery were 66.0% and 32.8%, respectively. In the hospital, mothers who worked part time had a significantly (p <0.05) higher rate of breastfeeding (68.8%) than those who were employed full time (65.5%), or who were not employed (64.8%). Working full time had a (p <0.05) negative effect on breastfeeding duration. By 6 months after delivery, 26.1% of mothers employed full time, 36.6% of mothers working part time, and 35.0% of nonworking mothers breastfed their infant. Mothers who were not employed were more than twice as likely to breastfeed at 6 months than mothers who worked full time. Breastfeeding trends since 1984 indicated a large increase in the rate of breastfeeding at 6 months after delivery among full-time working mothers (204.5%). However, rates for these women have not yet reached those of mothers who worked part time or were not employed. CONCLUSIONS: To ensure that the Healthy People 2010 goals for breastfeeding are achieved (75% in the hospital and 50% at 6 months), programs designed to support working mothers who choose to breastfeed must be continued and strengthened.     

Availability of lactation counseling services influences breastfeeding among infants admitted to to neonatal intensive care units

PURPOSE: To assess the association between the presence of international board-certified lactation consultant (IBCLC) services at a delivery hospital and the breastfeeding practices of women whose infants required neonatal intensive care unit (NICU) admission. DESIGN: Cross-sectional study using population-level data. SETTING: Philadelphia, Pennsylvania. SUBJECTS: 2132 infants admitted to the NICU. MEASURES: Breastfeeding at hospital discharge was measured with the question, "Is the infant being breastfed?" Delivery hospitals were dichotomized as to the presence or absence of an IBCLC on staff ANALYSIS: Logistic regression was used to assess the relationship between breastfeeding at discharge and the presence of an IBCLC at the delivery facility while adjusting for maternal characteristics and birth outcomes. RESULTS: Among mothers of infants admitted to the NICU, breastfeeding rates among mothers who delivered at hospitals with an IBCLC were nearly 50% compared with 36.9% among mothers who delivered at hospitals without an IBCLC. The adjusted odds of breastfeeding initiation prior to hospital discharge were 1.34 (95% confidence interval = 1.03, 1.76) times higher for women who delivered at a facility with an IBCLC. CONCLUSIONS: To increase breastfeeding rates among the NICU population, these findings support the need for universal availability of IBCLCs at delivery facilities that have NICUs.