Hospital Education in Lactation Practices (Project HELP): does clinician education affect breastfeeding initiation and exclusivity in the hospital?

BACKGROUND: A woman's decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates. METHODS: Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4-hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding-related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns. RESULTS: Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03-1.69). CONCLUSIONS: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates.

Factors associated with exclusive breastfeeding among Latina women giving birth at an inner-city baby-friendly hospital.

Latina women living in the United States initiate breastfeeding at high rates, but their exclusivity is low. We examined factors associated with exclusive breastfeeding prior to discharge among 349 healthy Latina women giving birth at a Baby-Friendlytrade mark hospital in Massachusetts in 2004 to 2005. Factors associated with exclusive breastfeeding included maternal age <25 years (P = .017), US-born mother (P = .023), and having a Birth Sister(sm) (doula) ( P = .030). In multivariate logistic regression analysis, maternal age <25 years (adjusted odds ratio [AOR] 2.29; 95% confidence interval [CI], 1.28-4.10), US-born mother (AOR 3.16; 95% CI, 1.20-8.29), and Birth Sister involvement (AOR 2.16; 95% CI, 1.18-3.97) remained positively associated with exclusive breastfeeding. Compared with women who gave 4 or more formula feeds, women who gave only 1 to 3 formula feeds were more likely to have a Birth Sister (AOR 1.95; 95% CI, 1.05-3.63), to deliver vaginally (AOR 3.05; 95% CI, 1.32-7.05), and to delay the first formula feed (AOR 1.04; 95% CI, 1.02-1.06).

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.