Impact of delivery type and maternity care practices on initiation of breastfeeding in an inner city population

Background: Type of delivery and maternity care practices have been shown to significantly affect intention to breastfeed and duration breastfeeds. Objective: To examine the relative contribution of delivery type and maternity care practices on initiation of breastfeeding in an inner city population. Design/Methods: We conducted an observational retrospective study of mothers of infants born 7/10-9/10 and discharged from the term nursery at a community hospital in Philadelphia, PA. We assessed the associations of delivery type (vaginal vs C section) and maternity care practices (initial breastfeeding in delivery room and term nursery) on exclusive breastfeeding and breast and formula feeding at discharge. Results: The study population included 680 mothers: 18% were <19 ys, 25% >30 yrs; 60% African American, 18% Latinas; 85% Medicaid; 33% C section. Half (56%) intended to breastfeed; 44% exclusively, 12% breast and formula. At discharge 21% of infants were exclusively breastfed, 29% breast and formula fed. Mothers who had a C section were less likely to exclusively breastfeed at discharge (16.7% C section vs 22.7% vaginal) but this was not statistically significant. Infants who initially breastfed in the delivery room or the term nursery were 6.7 and 3.6 times more likely, respectively (both p<0.001), to exclusively breastfed at discharge. Conclusions: In an inner city population with a low maternal intent to breastfeed, C section deliveries posed a challenge to initiation of successful breastfeeding. However, maternity care practices were the most critical factors to support successful breastfeeding through discharge.