Hospital practices to promote breastfeeding: Does maternal age matter?

Background: Rates of exclusive breastfeeding are disproportionately low among young mothers in the United States (US). Although the importance of hospital practices to promote breastfeeding is increasingly recognized, it remains unclear to what extent practices explain disparities in breastfeeding by maternal age. Accordingly, we aimed to determine how maternal age affects 1) use of hospital practices and 2) associations between hospital practices and exclusive breastfeeding at one week.

Methods: Data were derived from Listening to Mothers III, a nationally representative survey administered to mothers of singleton births in US hospitals between July 2011 and June 2012. We included participants (N=1506) intending to breastfeed and who delivered at 37 weeks gestation or later.  We used weighted multivariate logistic regression models to adjust for potential confounders.

Results: Compared to older mothers (age≥30), teenage mothers (ages 18-19) were more likely to have hospital staff give their babies a pacifier (OR=1.92; 95%CI=1.14-3.23) and were less likely to room-in with their babies (OR=0.32; 95% CI=0.19-0.55). Among older mothers, neither receiving a pacifier nor rooming-in was associated with exclusive breastfeeding at one week; however, among teenage mothers, both pacifier use and rooming in were associated with a greater odds of exclusive breastfeeding at one week (OR=4.09; 95% CI=1.47-11.35 and OR=5.14; 95%CI=1.76-15.01; respectively). 

Implications: Hospital practices to promote breastfeeding may be differentially implemented based on maternal age. Increasing the proportion of young mothers who room-in with their babies may be particularly important for reducing breastfeeding disparities. Pacifier use among babies of young mothers requires further exploration.