Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112353

Michelle R. Adler, MD, Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code FM, Portland, OR 97239-3098, (503) 494-8311, adlermi@ohsu.edu, Kenneth D. Rosenberg, MD, MPH, Office of Family Health, Oregon Department of Human Services, 800 NE Oregon Street, Suite 850, Portland, OR 97232, John Stull, MD, MPH, Department of Public Health & Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code CB-669, Campus Services Building, Portland, OR 97239-3098, and Andrea Crivelli-Kovach, PhD, CHES, Department of Medical Science and Community Health, Arcadia University, 450 South Easton Rd, Glenside, PA 19038.

Introduction: The Ten Steps of the World Health Organization Baby Friendly Hospital Initiative (BFHI) have been proposed as a hospital intervention that increases breastfeeding. Using an institutional level survey tool, this study of breastfeeding support in Oregon's hospitals explores the association between compliance with the Ten Steps and breastfeeding of infants born in those hospitals.

Methods: In 1998, representatives from each of Oregon's 57 birthing hospitals answered 65-question surveys that were used to calculate hospital breastfeeding support scores. Breastfeeding outcomes were obtained from newborn metabolic screening forms. Linear regression analysis was used to determine whether hospital breastfeeding support scores were predictive of breastfeeding prevalence.

Results: Oregon hospitals excelled at assisting mothers with breastfeeding initiation, encouraging demand feeding, and providing breastfeeding information. They struggled with having a comprehensive breastfeeding policy, providing staff with breastfeeding training, avoiding supplementation, and offering post-discharge breastfeeding support. After controlling for hospital size, number of deliveries, and location, linear regression analysis demonstrated that comprehensive hospital breastfeeding support was predictive of the proportion of mothers who initiated breastfeeding (p<0.05) and who were breastfeeding at two-weeks postpartum (p<0.05).

Discussion: Consistent with other studies, this evaluation of Oregon hospitals demonstrates that comprehensively implementing the BFHI Ten Steps promotes breastfeeding. Although evaluating breastfeeding support and outcomes at a hospital level limits the ability to control for confounders, this study suggests that a 65-question, institutional level survey can provide an adequate measure of breastfeeding support. Evaluation instruments such as this survey should be considered for hospital-based quality improvement initiatives addressing breastfeeding support.

Learning Objectives:

• Describe a method for measuring hospital breastfeeding support,
• Examine the relationship between hospital breastfeeding support and breastfeeding outcomes,
• Discuss the benefits and limitations of using a simple scoring system to measure hospital breastfeeding support

Keywords: Breastfeeding, Hospitals

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation