Evaluation of current hospital breastfeeding practices in the Southeastern Pennsylvania Delaware Valley

Background: The purpose of this study was to describe breastfeeding policies and practices among hospitals in the five-county Philadelphia metropolitan area and the degree to which the hospitals are implementing the Ten Steps to Successful Breastfeeding. Methods: In-depth group interviews were used to collect data. Twenty-four hospitals were invited to participate in the study. Information on current policies and practices was obtained from personnel representing different areas of maternity services. One questionnaire per hospital was completed to create a composite picture of breastfeeding practices. Hospitals were classified according to the degree to which they were implementing the Ten Steps. Results: Breastfeeding rates significantly differed when compared by location, 48% for urban hospitals versus 73% for suburban hospitals (p=0.015). Most hospitals were classified as high or moderately high implementers on seven of the Ten Steps including hospital policies (76%), staff training (65%), printed information distributed to breastfeeding mothers (100%), breastfeeding initiation (59%), oral breastfeeding instruction given to mothers (94%), infant feeding schedules (88%), and hospital postpartum support (100%). Most hospitals reported partial or low implementation on two key practices, formula supplementation (59%) and rooming-in (70%).

Conclusions: Areas identified as needing the greatest attention are the overuse of formula supplementation of breastfeeding infants and limited contact time between the mother and newborn during the postpartum hospital stay. Changes reported in implementation of the Ten Steps compared to data collected in 1994 and 1999 indicate an increased awareness regarding breastfeeding and enhanced promotion and support of health care professionals in the hospital setting.