Mothers' Intentions to Breastfeed and Hospital Practices on Breastfeeding: A Longitudinal Study at 6 Months after Birth on Predictors of Breastfeeding in a Cohort of Mothers from a Large Northern New England Medical Center
Title: Mothers' Intentions to Breastfeed and Hospital Practices on Breastfeeding: A Longitudinal Study at 6 Months after Birth on Predictors of Breastfeeding in a Cohort of Mothers from a Large Northern New England Medical Center
- Summarize the literature and the available evidence for breastfeeding recommendations and hospital practices that influence breastfeeding initiation and duration.
- Describe this study’s findings on hospital practices, mothers’ experiences and other factors that may influence breastfeeding at 6 months.
- Review how these results may be used to inform providers and expectant parents on what hospital practices and personal decisions may influence breastfeeding duration.
To examine the effects of mothers’ intentions to breastfeed and hospital practices on 6-month breastfeeding
Design:
Predictive, longitudinal
Setting:
Hospital birth center in a large northeastern U.S city.
Sample:
A convenience sample of 1200 mothers who gave birth to full-term healthy babies and planned to breastfeed.
Methods:
Mothers completed a survey about infant feeding and hospital experiences before discharge between December 2010 and June 2012. Demographic and hospital practices data were collected through chart review. Follow-up calls were made at 6 months. Data were analyzed with logistic regression.
Results:
Seventy-seven percent (921/1200) completed the discharge survey and 60% (556/921) completed the follow-up. At 6 months, 25% (139/556) were exclusively breastfeeding, and 24% (133/556) were breastfeeding and/or pumping breastmilk. Also, 20% (111/556) were using a combination of breastfeeding and/or pumped milk and formula, while 31% (173/556) were feeding formula only. Low milk supply (78/181, 43%) and return to work (60/181, 33%) were cited as most common reasons for no longer exclusively breastfeeding. No effects on 6-month breastfeeding were found for type of delivery, gravidity and parity, or a five predictor model: health problems (e.g. gestational diabetes), birth interventions (e.g., induction), antibiotics, spinal, and epidural/intrathecal anesthesia. Older age, higher education, and being married or with a life partner (χ2 = 49.92, p < .001) and mothers’ intention to breastfeed predicted 6-month breastfeeding (χ2 = 6.23, p = .044). Hospital practices which favorably predicted breastfeeding were early skin-to-skin contact (χ2 = 11.24, p = .024), avoiding supplements (χ2 = 13.87, p = .001) and avoiding pacifier use (χ2 = 7.25, p = .027). The odds of not breastfeeding at 6 months were higher if supplements (OR = 2.01, CI = 1.34 - 3.02) or pacifiers (OR = 1.65, CI = 1.14 - 2.39) were used, and if physicians suggested supplements (OR = 7.2, CI = 2.47 - 21.09) while in the hospital, or if solid foods were started before 6 months (OR = 1.67, CI = 1.17 - 2.39). Rooming-in (χ2 = 5.52, p = .238) and putting-to-breast early (χ2 = 1.64, p= .440) did not affect 6-month breastfeeding.
Conclusion/Implications for nursing practice:
These findings demonstrate the need to further educate providers and encourage newborn care practices to sustain breastfeeding beyond the early postpartum period. The results may also be used to inform expectant parents (e.g. during childbirth classes) of what hospital practices and personal decisions may influence successful breastfeeding duration.
Keywords:
Breastfeeding, breastfeeding duration, hospital practices, intention to breastfeed