Breastfeeding duration rates and factors affecting continued breastfeeding among infants born at an inner-city US Baby-Friendly hospital.

The effects of Baby-Friendly status on breastfeeding duration in the United States have not been published. The objectives of this study were to obtain breastfeeding rates at 6 months among babies born in a US Baby-Friendly hospital and to assess factors associated with continued breastfeeding at 6 months. The authors randomly selected 350 medical records of infants born in 2003 at Baby-Friendly Boston Medical Center. Of 336 eligible infants, 248 (74%) attended the 6-month well-child visit and 37.1% (92/248) were breastfeeding at 6 months. In multivariate logistic regression, the likelihood of breastfeeding at 6 months was decreased by presence of a feeding problem in the hospital (AOR 0.27; 95% CI 0.07-0.99), whereas the likelihood of breastfeeding at 6 months increased with maternal age (AOR 1.05; 95% CI 1.00-1.10) and for mothers born in Africa (AOR 4.29; 95% CI 1.36-13.5) or of unrecorded birthplace (AOR 3.29; 95% CI 1.38-7.85). Breastfeeding duration is traditionally poor in low-income, black populations in the United States. Among a predominantly low-income and black population giving birth at a US Baby-Friendly hospital, breastfeeding rates at 6 months were comparable to the overall US population.

The effect of peer counselors on breastfeeding rates in the neonatal intensive care unit: results of a randomized controlled trial.

OBJECTIVE: To determine whether peer counselors impacted breastfeeding duration among premature infants in an urban population. DESIGN: This was a randomized controlled clinical trial. SETTING: The trial was conducted in the Newborn Intensive Care Unit at Boston Medical Center, an inner-city teaching hospital with approximately 2000 births per year. PARTICIPANTS: One hundred eight mother-infant pairs were enrolled between 2001 and 2004. Pairs were eligible if the mother intended and was eligible to breastfeed per the 1997 guidelines from the American Academy of Pediatrics and if the infant was 26 to 37 weeks' gestational age and otherwise healthy. INTERVENTION: Subjects were randomized to either a peer counselor who saw the mother weekly for 6 weeks or to standard of care. MAIN OUTCOME MEASURE: The main outcome measure was any breast-milk feeding at 12 weeks postpartum. RESULTS: Intervention and control groups were similar on all measured sociodemographic factors. The average gestational age of infants was 32 weeks (range, 26.3-37 weeks) with a mean birth weight of 1875 g (range, 682-3005 g). At 12 weeks postpartum, women with a peer counselor had odds of providing any amount of breast milk 181% greater than women without a peer counselor (odds ratio, 2.81 [95% confidence interval, 1.11-7.14]; P = .01). CONCLUSIONS: Peer counselors increased breastfeeding duration among premature infants born in an inner-city hospital and admitted to the neonatal intensive care unit. Peer counseling programs can help to increase breastfeeding in this vulnerable population.

Breast pump access in the inner city: a hospital-based initiative to provide breast pumps for low-income women.

An effective electric breast pump is an important tool for the management of breastfeeding challenges such as provision of human milk to sick or premature infants. A breast pump is also, in Western culture, critical for breastfeeding mothers who return to work. Obtaining an effective electric breast pump can be particularly difficult for uninsured or impoverished women because of the expense, complicated insurance reimbursements, and scarcity of providers that supply breast pumps to the inner-city community. To address this problem at Boston Medical Center (BMC), an inner-city hospital that serves a poor and minority urban population, members of the Breastfeeding Center worked with a local charity and local insurance companies to increase access to pumps for all women at BMC and to guarantee that every breastfeeding mother with an infant in the neonatal intensive care unit receive a double-setup electric breast pump, regardless of her insurance status or ability to pay.

Calls to an inner-city hospital breastfeeding telephone support line.

Support for breastfeeding mothers after they leave the hospital is often inadequate in low-income, inner-city areas where few resources are available. In becoming a Baby-Friendly Hospital, inner-city Boston Medical Center established a breastfeeding telephone support line to overcome this discrepancy. Records of support line calls for the first 5 years of operation were reviewed to record the level of need and determine reasons for use. A total of 1959 calls for 2482 reasons were received between January 1999 and December 2003. The most common reason for calling was "need help obtaining a breast pump" or "need information about breast pumps" (44%; 1096/2482), followed by "breast issue" (7%; 181/2482) and "milk supply question" (7%; 167/2482). The results indicate that inner-city women seek breastfeeding support and demonstrate a substantial need for breast pumps. These findings suggest that the lack of breast pumps may be a barrier to continued breastfeeding for inner-city breastfeeding women.

Breastfeeding rates in US Baby-Friendly hospitals: results of a national survey.

OBJECTIVES: The objectives of this study were to analyze all available breastfeeding data from US Baby-Friendly hospitals in 2001 to determine whether breastfeeding rates at Baby-Friendly designated hospitals differed from average US national, regional, and state rates in the same year and to determine prime barriers to implementation of the Baby-Friendly Hospital Initiative. METHODS: In 2001, 32 US hospitals had Baby-Friendly designation. Using a cross-sectional design with focused interviews, this study surveyed all 29 hospitals that retained that designation in 2003. Demographic data, breastfeeding rates, and information on barriers to becoming Baby-Friendly were also collected. Simple linear regression was used to assess factors associated with breastfeeding initiation. RESULTS: Twenty-eight of 29 hospitals provided breastfeeding initiation rates: 2 from birth certificate data and 26 from the medical record. Sixteen provided in-hospital, exclusive breastfeeding rates. The mean breastfeeding initiation rate for the 28 Baby-Friendly hospitals in 2001 was 83.8%, compared with a US breastfeeding initiation rate of 69.5% in 2001. The mean rate of exclusive breastfeeding during the hospital stay (16 of 29 hospitals) was 78.4%, compared with a national mean of 46.3%. In simple linear regression analysis, breastfeeding rates were not associated with number of births per institution or with the proportion of black or low-income patients. Of the Ten Steps to Successful Breastfeeding the 3 described as most difficult to meet were Steps 6, 2, and 7. The reason cited for the problem with meeting Step 6 was the requirement that the hospital pay for infant formula. CONCLUSION: Baby-Friendly designated hospitals in the United States have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates.