Improving Breastfeeding Duration the Easy Way: Five Simple Hospital Practices

BACKGROUND: Breastfeeding has many short- and long-term health benefits for mother and infant. The prevalences of ever breastfed, breastfeeding duration, and exclusive breastfeeding are higher in Colorado compared to the United States. An analysis of 2002-2003 Colorado Pregnancy Risk Assessment Monitoring System data identified five successful hospital practices (e.g., breastfed within the first hour after birth and breast milk only in the hospital) that significantly increased breastfeeding duration among mothers of healthy infants. An initiative titled Colorado Can Do 5! was begun in 2008 to encourage birthing hospitals to adopt these five hospital practices. The purpose of this study was to compare breastfeeding duration among various groups of mothers including those who received the five successful hospital practices.

METHODS: Colorado Pregnancy Risk Assessment Monitoring System data from 2012 and 2013 representing 2,895 mothers who recently gave birth were used for this analysis. The Kaplan-Meier method was used to construct breastfeeding duration curves, and differences between the curves were tested using a log-rank test. Data were examined using SAS-callable SUDAAN.

RESULTS: The data show that 26.4% (95% CI: 24.1-28.7) of mothers who gave birth in 2012 and 2013 breastfed for less than two months and 73.6% (95% CI: 71.3-75.9) breastfed for two months or more. Among mothers who gave birth to healthy infants, 29.9% (95% CI: 27.2-32.7) experienced all five successful hospital practices. Among mothers of healthy infants who experienced all five successful hospital practices, 71.2% (95% CI: 61.4-78.8) were breastfeeding at four months duration. Among mothers of healthy infants who did not experience all five successful hospital practices, 56.0% (95% CI: 50.5-61.1) were breastfeeding at four months duration.   

CONCLUSIONS: Five successful hospital practices resulted in higher breastfeeding rates at various time points after birth. Experiencing these five hospital practices resulted in an eight week extension of the duration of breastfeeding. The prevalence of mothers who experienced all five hospital practices increased by 60 percent over a 10 year period. Length of breastfeeding duration was restricted based on age of infant when the survey was completed. Maternal self-report of the hospital practices may differ from the practices that are actually being implemented in birthing hospitals. Implementation of these five successful hospital practices at birthing hospitals should lead to higher rates of breastfeeding duration resulting in healthier mothers and infants.