Factors affecting exclusivity among Latina women giving birth in an inner-city, US Baby Friendly hospital

Background: Latina women in the US have high breastfeeding initiation rates, but also high rates of formula supplementation, beginning in the hospital postpartum. The American Academy of Pediatrics recommends 6 months of exclusive breastfeeding. Objective: To examine factors affecting exclusive breastfeeding among Latinas at an urban, US Baby-Friendly Hospital. Methods: We obtained demographic and feeding data from hospital records on 231 healthy, breastfeeding-eligible Latina women and their newborns at Boston Medical Center in 2004-5. Pairs were excluded for contraindications to breastfeeding, NICU admission, and maternal complications that might compromise breastfeeding (such as psychiatric disorders with complex medication), to obtain a sample optimally capable of exclusive breastfeeding. We compared exclusively breastfeeding versus mixed feeding pairs across these variables using univariate and multivariate logistic regression. Results: The mean age of mothers was 26.8; 84% of women received public subsidized insurance such as Medicaid; 13.4% were US born; 65.4% were non-US born; for 21.2% birthplace was unknown or undocumented. 73.2% had a vaginal birth, 56.7% were assisted by midwives, and 43.4% by physicians. 39.4% of mothers also had a doula (a lay childbirth assistant). 24.7% of women exclusively breastfed, 68.0% mixed fed, and 7.4% formula fed. Comparing exclusive breastfeeders with mixed feeders in univariate analysis, younger age (OR 0.83; 95% CI 0.87-0.98), US birthplace (OR 2.85; 95% CI 1.14-7.12), and vaginal birth (OR 2.28; 95% CI 1.04-5.02) were predictors of exclusive breastfeeding. Additionally, the presence of a doula increased the likelihood of exclusive breastfeeding at a level approaching statistical significance (p=0.06). In multivariate logistic regression analysis including maternal age, insurance, birthplace, and type of delivery, younger maternal age (AOR 0.88; 95% CI 0.81-0.96) and vaginal delivery (AOR 2.81; 95% CI 1.01-7.81) remained significant predictors of exclusive breastfeeding. Conclusion: The strongest predictor of exclusive breastfeeding among a healthy Latina population was vaginal delivery; women with vaginal delivery had almost 3 times the odds of exclusively breastfeeding than women with cesarean birth. Further investigation is needed to determine why cesarean birth in a Baby-Friendly hospital would be associated with formula supplementation.