Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed

Objectives. We sought to assess whether breastfeeding-related hospital practices reported by mothers were associated with achievement of their intentions to exclusively breastfeed. Methods. We used data from Listening to Mothers II, a nationally representative survey of 1573 mothers who had given birth in a hospital to a singleton in 2005. Mothers were asked retrospectively about their breastfeeding intention, infant feeding at 1 week, and 7 hospital practices. Results. Primiparas reported a substantial difference between their intention to exclusively breastfeed (70%) and this practice at 1 week (50%). They also reported hospital practices that conflicted with the Baby-Friendly Ten Steps, including supplementation (49%) and pacifier use (45%). Primiparas who delivered in hospitals that practiced 6 or 7 of the steps were 6 times more likely for achieve their intention to exclusively breastfeed than were those in hospitals that practiced none or 1 of the steps.Mothers who reported supplemental feedings for their infant were less likely to achieve their intention to exclusively breastfeed: primiparas (adjusted odds ratio [AOR]=4.4; 95% confidence interval [CI]=2.1, 9.3); multiparas (AOR=8.8; 95% CI=4.4, 17.6). Conclusions. Hospitals should implement policies that support breastfeeding with particular attention to eliminating supplementation of healthy newborns.