Many U.S. birth facilities are not providing maternity care that is fully supportive of breastfeeding, says a recent study reported by the Journal of the American Medical Association (JAMA) and the Centers for Disease Control and Prevention (CDC).
Research has shown that what happens in the hospital or birth center plays a crucial role in establishing breastfeeding and helping mothers to continue breastfeeding after leaving the birth facility, says study co-author, Ann DiGirolamo, PhD, assistant professor of global health, Rollins School of Public Health, Emory University.
The study, "Breastfeeding-Related Maternity Care Practices among Hospitals and Birth Centers - United States, 2007," used data from the CDC's 2007 Maternal Practices in Infant Nutrition and Care Survey. The authors analyzed responses from nearly 2,700 birth facilities in all 50 states, the District of Columbia and Puerto Rico. It asked birth facilities about their practices and policies in caring for women who choose to breastfeed their newborns. The practices were scored on a scale from 0 to 100 points.
The study found that hospitals and birth centers in many southern states scored lower in practices that are supportive of breastfeeding compared to other regions of the nation, with average total maternity practice scores ranging from 48 to 57. Seven southern states -- Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma and West Virginia -- also had the lowest percentages (less than 30 percent) of children who were breastfed for six months, according to the 2006 National Immunization Survey.
Birth facilities in western and New England states generally had higher scores compared to other parts of the country. Vermont and New Hampshire tied for the highest overall maternity practice scores (81), followed by Maine (77) and Oregon (74). In addition, Oregon, Maine and Vermont reported that more than 75 percent of children were breastfed.
The study reported scores related to seven aspects of maternity care. Nationally, the average facility score was 63 for key maternity practices in infant nutrition and care.
Out of a possible 100 points, the national scores were based on breastfeeding-related maternity care practices and policies associated with: labor and delivery, 60; breastfeeding assistance, 80; mother-newborn contact, 70; newborn feeding practices, 77; breastfeeding support after discharge, 40; nurse/birth attendant breastfeeding training and education, 51; and structural and organizational quality, 66. The study also found that mean total scores combining all seven categories of practice varied significantly among states -- ranging from a score of 48 in Arkansas to 81 in both New Hampshire and Vermont.
National Healthy People 2010 breastfeeding objectives established by the U.S. Department of Health and Human Services call for 75 percent of new mothers to initiate breastfeeding, 50 percent to continue for six months, and 25 percent to continue for one year. In addition, the national objectives have a goal for 40 percent of mothers to breastfeed exclusively for three months, and 17 percent of women to breastfeed exclusively for six months. ?
"These findings underscore the importance of improving the way hospitals and birth centers provide assistance, encouragement and support for breastfeeding," says lead study author and CDC epidemiologist Deborah Dee, PhD. "We have a great deal of work to do to accomplish our national objectives related to breastfeeding, and birth facilities can make a huge contribution to this effort."
In addition to DiGirolamo and Dee, study authors were: D.L. Manninen, PhD, and J.H. Cohen, PhD, of the Battelle Centers for Public Health Research and Evaluation, Seattle; K.R. Shealy, MPH, P.E. Murphy, MLIS, C.A. MacGowan, MPH, A.J. Sharma, PhD, K.S. Scanlon, PhD, and L.M. Grummer-Strawn, PhD, of the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC.
The study is based, in part, on contributions by: E. Adams, PhD, Oregon Health & Science University; K. Rosenberg, MD, Oregon Department of Human Services; A. Grinblat, MD, State University of New York at Buffalo; C.L. Quinn, MD, Albert Einstein College of Medicine; M. Applegate, MD, New York State Department of Health; K. Cadwell, PhD, and C. Turner-Maffei, MA, Baby-Friendly USA; A. Crivelli-Kovach, PhD, Arcadia University; E. Declercq, PhD, Boston University School of Public Health; A. Merewood, MPH, and B. Philipp, MD, Boston Medical Center; J. Dellaport, RD, and L. Tiffin, MS, California Department of Health Services; M.K. Dugan, MA, and E. Miles, MPH, Battelle Centers for Public Health Research and Evaluation; M. Pessl, Evergreen Perinatal Education; L. Feldman-Winter, MD, University of Medicine and Dentistry of New Jersey; and A. Spangler, MN, Amy's Babies.
References: JAMA. 2008;300(8):894-898; MMWR. 2008;57:621-625