Is Baby Friendly Status Essential for Optimal Postpartum Breastfeeding Care?

Background: Among breastfeeding (BF) women, delivering in a Baby Friendly setting is known to increase BF duration. This prospective cohort study to ascertain BF duration among women delivering at two similarly sized hospitals (Baby Friendly (BFH) (n=429); community hospital (CH) (n=414) with a well established BF program).

Design/Methods: BF mothers with healthy term infants were interviewed postpartum, and surveyed at 2 weeks, 3 and 6 months assessing exclusivity and duration. Process evaluations assessed compliance with the Baby Friendly ten steps.

Results: Chi-square (bivariate) and Kaplan-Meier and Cox proportional hazards models (multivariate) demonstrated no significant differences between the hospitals' samples recruited. BFH evaluation showed strong implementation of nearly all baby friendly steps; CH had strong implementation of fewer steps. Survival analyses modeled duration of any BF at one and six months showing no significant differences between mothers recruited from the two hospitals. The model retained maternal education, confidence to BF, marital status, BF goal and post-discharge feeding plan as significant effects. Factors eliminated included maternal age, race, parity, lives with father of baby, previous BF and hospital BF experience (p>.05). The extent of censored data may have affected findings.

Conclusions: Compared to settings with minimal BF support, settings implementing Baby Friendly's ten steps increased BF duration among BF mothers. A setting with a well established BF support program that does not include all aspects of the ten steps may result in similar BF duration outcomes. Differences in exclusivity and cost between these two programs are under study.