by Heidi Green
April 16, 2009

It seems common sense that hospitals can influence breastfeeding behavior. There you are: the new mother with the baby in your arms. During your time at the hospital, nurses, doctors and others are likely popping in and out of your room up to 54 times a day. They’re just full of advice and interventions. So, it may be no surprise at all that a recent study of national data finds a link between women’s hospital experiences and their actual breastfeeding experience.

Research
A team of researchers led by Eugene Declercq, PhD looked at data from a national survey of 1,573 women between the ages of 18 and 45 who had given birth in 2005 to a single, still-living child. For this study, the researchers aimed to develop an understanding of typical hospital birth experiences and their impact on breastfeeding initiation. Therefore, they removed data for mothers of babies who were placed in neonatal intensive care units.

The breastfeeding portion of this survey asked each mother about her feeding intentions “as [she] came to the end of [her] pregnancy” as well as her actual feeding practices one week after her child’s birth. Feedings were described as exclusive breastfeeding, exclusive formula feeding, or mixed feeding.

Each mother also responded to questions about her experiences with hospital staff related to seven specific practices previously identified as influencing breastfeeding success. Specifically, they looked at mothers’ reports of hospital staff:

1. helping the mother get started breastfeeding
2. showing her how to position her baby
3. encouraging feeding on demand
4. informing mothers about community breastfeeding resources
5. supplementing breastfeeding with formula or water
6. giving the baby a pacifier
7. providing free formula samples

Readers should keep in mind that the questions related to breastfeeding were just a brief part of a 30-minute survey that also included questions on prenatal, intrapartum and postpartum experiences, as well as maternal attitudes related to birth and demographic characteristics.

Results
Here’s what the researchers found:

• The more breastfeeding-supportive practices reported, the more mothers achieved their goals of exclusive breastfeeding. This was found to be true both for first-time mothers and those who had given birth before.

• Even though approximately 70 percent of mothers said they planned to exclusively breastfeed their babies, just 50 percent were doing so one week after birth. The difference between intended and actual exclusive breastfeeding was much smaller among mothers who had given birth previously than first-time mothers.

• Among first-time mothers, four hospital factors were identified as significantly associated with likelihood of achieving breastfeeding intention. Specifically, helping mother get started, hospital staff not supplementing with water or formula, telling mothers about community breastfeeding-support resources, and staff not giving the baby a pacifier.

• Among mothers who had given birth previously, hospital staff not supplementing and hospital staff encouraging feeding on demand were most important.

• The mothers’ accounts here support previous research. Readers are encouraged to check out the World Health Organization’s Evidence for the Ten Steps to Successful Breastfeeding and the Baby-Friendly Hospital Initiative.

Recommendations
Declercq and his colleagues call on clinical and hospital administrative decision-makers to consider this information when developing policies and practices that will enhance a mother’s ability to achieve her breastfeeding goals.

In the meantime, expectant parents should note how common health care practices might influence their breastfeeding experience, so that they can make informed decisions and respond to situations that might arise during the postpartum hospital stay. (Supplementation jumps right to mind: 40 percent of white first-time mothers reported that their child received formula or water in the hospital, as did 71 percent of black and 74 percent of Hispanic mothers. This despite evidence that supplementation disrupts the supply-and-demand establishment of breastfeeding.)

Most of all, don’t hesitate to discuss any concerns you have with your health care provider before you give birth—and with hospital staff during your postpartum stay.