ELECTRONIC ARTICLE |



* Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
Breastfeeding Center, Boston Medical Center, Boston, Massachusetts
Department of Pediatrics, Division of Neonatology, Boston Medical Center, Boston, Massachusetts
|| Department of Pediatrics, Boston University School of Medicine, and Breastfeeding Center, Boston Medical Center, Boston, Massachusetts
| ABSTRACT |
|---|
|
|
|---|
Methods. A total of 200 medical records of full-term, healthy infants who were born at BMC in 2000 and 2001 were reviewed using the same criteria as the study conducted for 1999. Records were selected randomly by a computer-generated list. All infant feedings during the hospital postpartum stay were tallied, and each infant was categorized into 1 of 4 groups: 1) exclusive breast milk, 2) mostly breast milk, 3) mostly formula, and 4) exclusive formula.
Results. Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rates, defined as an infants receiving any amount of breast milk, remained at high levels: 87% (1999), 82% (2000), and 87% (2001). Infants who received more breast milk than formula also was sustained: 73% (1999), 67% (2000), and 67% (2001). Infants who were breastfed exclusively across the 4 years did not differ significantly: 34% (1999), 26% (2000), and 25% (2001).
Conclusions. Full implementation and continued application of the "Ten Steps to Successful Breastfeeding," the framework of the Baby-Friendly Hospital Initiative, has an extended positive impact on breastfeeding rates in a US hospital setting.
Key Words: breastfeeding breastfeeding rates Baby-Friendly Hospital Initiative
Abbreviations: BFHI, Baby-Friendly Hospital Initiative BMC, Boston Medical Center
Prominent national and international physician organizations strongly recommend breastfeeding.14 The American Academy of Pediatrics, describing breastfeeding as "the optimal form of nutrition for infants," recommends exclusive breastfeeding for approximately the first 6 months of life, continuing to at least 1 year or beyond with the addition of complementary foods at approximately 6 months of age.1
The Baby-Friendly Hospital Initiative (BFHI), created in 1991 by UNICEF and the World Health Organization, strives to increase breastfeeding rates worldwide.59 Previously, we reported breastfeeding rates at Boston Medical Center (BMC) before (1995) and with (1999) Baby-Friendly policies in place. Breastfeeding initiation rates increased from 58% to 86.5%, rates among women offering more breast milk than formula rose from 30% to 73%, and exclusive breastfeeding rates improved from 5.5% to 33.5%.10,11 The purpose of this study was to establish whether Baby-Friendly (in the United States, the terminology Baby-Friendly is a trademark of the US Fund for UNICEF) status would sustain elevated breastfeeding rates at this US hospital beyond the year of designation. Breastfeeding rates in 1999 were compared with rates in 2000 and 2001.
| METHODS |
|---|
|
|
|---|
Infant feeding information was obtained from the 24-hour flow sheet completed for every newborn by maternity nursing staff. The same flow sheet was used for all study periods. Information found in the flow sheet included documentation of each infant feeding and type of feeding given. The research assistant totaled infant feedings during the postpartum stay, and each infant was categorized into 1 of 4 feeding groups: exclusive breast milk (infant received no formula), mostly breast milk (
50% of feedings were breast milk), mostly formula (>50% of feedings were formula), and exclusive formula. For example, if a vaginally born infant had a total of 19 feedings during the 2-day hospital stay after birth and 13 feedings were breast milk and 6 feedings were formula, then the infant was placed in the "mostly breast milk" category.
For the 3 years investigated during this study, births at BMC fluctuated between 1800 and 2000 per year. This study received institutional review board approval. SAS v8.2 software (Carey, NC) was used to analyze all data. Analysis of variance was used to test the equality of mean birth weights. Calculating
2 statistics and using Fisher exact test when appropriate evaluated all other comparisons. Significance level of
0.05 was used throughout.
| RESULTS |
|---|
|
|
|---|
|
|
|
| DISCUSSION |
|---|
|
|
|---|
Although the decline in exclusive breastfeeding rates did not reach statistical significance, the decrease of approximately 30% bears close observation. As noted, breastfeeding exclusivity varied according to method of birth: 30% of infants who were born vaginally and breastfed exclusively in both 2000 and 2001 compared with 10% of infants in 2000 and 7% in 2001 born by cesarean birth. This highlights the importance of monitoring initiation rates at Baby-Friendly sites to detect areas that need improvement. Indeed, the BMC hospital-wide Baby-Friendly Task Force is currently reviewing hospital policies and systems for infants who are born by cesarean birth
With breastfeeding initiation rates sustained and meeting Healthy People 2010 goals of a 75% initiation rate, an important focus at BMC will be to monitor duration rates to determine whether they meet Healthy People 2010 goals of 50% of women breastfeeding at 6 months and 25% breastfeeding at 1 year. We also suggest that the BFHI is 1 strategy to answer the Surgeon Generals call to address low breastfeeding rates among black women.13 Only 34% of US-born black mothers at BMC initiated breastfeeding in 1995. As noted in this study, with Baby-Friendly policies in place, these rates increased to 74% in 1999 and were sustained in 2000 (77%) and 2001 (69%).
These data add to the international evidence on the effectiveness of the BFHI. Kramer et al14,15 evaluated 16 sites in Belarus that were randomly assigned to receive "an experimental intervention modeled on the Baby-Friendly Hospital Initiative" and compared outcome data with 15 control sites that continued with "traditional" maternity practices. He showed that Baby-Friendly practices increased the likelihood of and amount of breastfeeding at 12 months, increased breastfeeding rates and exclusive breastfeeding rates at 3 and 6 months of life, and significantly reduced the incidence of gastrointestinal tract infections and atopic eczema during the first year of life. In another study to determine whether early mother-infant contact reduced rates of infant abandonment, a Russian hospital that "implemented portions of the" BFHI found that infant abandonment decreased from approximately 50 per 10 000 births to approximately 28 per 10 000 births during a 6-year period after implementation of early infant contact and rooming in.16 In China, after 2 years of BFHI implementation, breastfeeding rates doubled in rural areas and increased from 10% to 47% in urban areas. Exclusive breastfeeding in Cuba rose from 25% to 72% during a 6-year period after the introduction of the BFHI.17
Limitations of the study deserve mention. First, the research assistant who conducted the medical record review was not blind to the study hypothesis, but the research team met numerous times and clearly delineated medical record review guidelines and study parameters. Second, there is no measure of the accuracy of nurse recordings of feedings.
| CONCLUSIONS |
|---|
|
|
|---|
| ACKNOWLEDGMENTS |
|---|
| FOOTNOTES |
|---|
Reprint requests to (B.L.P.) Division of General Pediatrics, Boston Medical Center, Maternity Building, 4th Floor, 91 E Concord St, Boston, MA 02118. E-mail: bobbi.philipp{at}bmc.org
| REFERENCES |
|---|
|
|
|---|
This article has been cited by other articles:
![]() |
A. Merewood, B. Patel, K. N. Newton, L. P. MacAuley, L. B. Chamberlain, P. Francisco, and S. D. Mehta Breastfeeding Duration Rates and Factors Affecting Continued Breastfeeding Among Infants Born at an Inner-City US Baby-Friendly Hospital J Hum Lact, May 1, 2007; 23(2): 157 - 164. [Abstract] [PDF] |
||||
![]() |
B L Philipp and A Radford Baby-Friendly: snappy slogan or standard of care? Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2006; 91(2): F145 - F149. [Abstract] [Full Text] [PDF] |
||||
![]() |
U. Shaikh and C. Chantry Reflections on the American Academy of Pediatrics' 2005 Policy Statement on "Breastfeeding and the Use of Human Milk" J Hum Lact, February 1, 2006; 22(1): 108 - 110. [PDF] |
||||
![]() |
A. C. Celi, J. W. Rich-Edwards, M. K. Richardson, K. P. Kleinman, and M. W. Gillman Immigration, Race/Ethnicity, and Social and Economic Factors as Predictors of Breastfeeding Initiation Arch Pediatr Adolesc Med, March 1, 2005; 159(3): 255 - 260. [Abstract] [Full Text] [PDF] |
||||
![]() |
Recent References J Hum Lact, February 1, 2004; 20(1): 106 - 112. [PDF] |
||||
![]() |
Minerva BMJ, September 20, 2003; 327(7416): 690 - 690. [Full Text] [PDF] |
||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||