Which of the Ten Steps to Successful Breastfeeding has the greatest impact in the US?

Background/Purpose: Breastfeeding support in hospitals is a major determinant of breastfeeding success. The Ten Steps for Breastfeeding in the Maternity Setting are the standard of practice in this regard. Recent studies have shown that there is general dose response, in that the number of steps in place is positively associated with breastfeeding outcomes. However, there is little in the literature exploring the impact of individual Steps, which would allow for prioritization by health system planners and facilities seeking to implement those most efficacious. In the US, the Maternity Practices in Infant Nutrition and Care (mPINC) survey gathered data on these practices across the nation. The purpose of this study is to explore the relationship between each of the Steps measured in this survey and state-level breastfeeding rates in order to establish if any of the steps are significantly associated with higher rates of breastfeeding and breastfeeding duration. Methods: mPINC subscales were included in forward stepwise regression analysis using Statistical Analysis Software (SAS). Findings: Rooming-in is significantly associated with the 3 outcome variables studied: initiation, exclusive breastfeeding (3 months) and exclusive breastfeeding (6 months). Postpartum skin-to-skin and post-discharge support planning contributed to the model at 3 and 6 months, but did not independently achieve significant association. Discussion/Conclusions: At the state level there is a clear association between the hospital practice of rooming in and the breastfeeding outcomes measured. Immediate Skin to skin and post-discharge support contribute to exclusive breastfeeding continuation. Therefore the recommendation is to prioritize Steps 4, 7 and 10.