Mothers' Intentions to Breastfeed and Hospital Practices on Breastfeeding: A Longitudinal Study at 6 Months After Birth on Predictors of Breastfeeding in a Cohort of Mothers From a Large Northern New England Medical Center

Objective: To examine the effects of mothers’ intentions to breastfeed and hospital practices on breastfeeding rates at 6 months. Design: Predictive, longitudinal. Setting: Hospital birth center in a large northeastern U.S. city. Sample: A convenience sample of 1,200 mothers who gave birth to full-term healthy infants and planned to breastfeed. Methods: Mothers completed a survey about infant feeding and hospital experiences before discharge between December 2010 and June 2012. Demographic and hospital practices data were collected through chart review. Follow-up calls were made at 6 months. Data were analyzed with logistic regression. Results: Seventy-seven percent (921/1200) completed the discharge survey and 60% (556/921) completed the follow-up. At 6 months, 25% (139/556) were exclusively breastfeeding, and 24% (133/556) were breastfeeding and/or pumping breast milk. Also, 20% (111/556) were using a combination of breastfeeding and/or pumped milk and formula, whereas 31% (173/556) were feeding formula only. Low milk supply (78/181, 43%) and return to work (60/181, 33%) were cited as most common reasons for no longer exclusively breastfeeding. No effects on 6-month breastfeeding rates were found for type of delivery, gravidity and parity, or a five predictor model: health problems (e.g., gestational diabetes), birth interventions (e.g., induction), antibiotics, spinal, and epidural/intrathecal anesthesia. Older age, greater education, being married or with a life partner (χ2 = 49.92, p < .001), and mothers’ intention to breastfeed predicted 6-month breastfeeding (χ2 = 6.23, p = .044). Hospital practices that favorably predicted breastfeeding were early skin-to-skin contact (χ2 = 11.24, p = .024), avoiding supplements (χ2 = 13.87, p = .001), and avoiding pacifier use (χ2 = 7.25, p = .027). The odds of not breastfeeding at 6 months were higher if supplements (odds ratio [OR] = 2.01, CI 1.34-3.02) or pacifiers (OR = 1.65, CI 1.14-2.39) were used and if physicians suggested supplements (OR = 7.2, CI 2.47-21.09) while in the hospital, or if solid foods were started before 6 months (OR = 1.67, CI 1.17-2.39). Rooming-in (χ2 = 5.52, p = .238) and putting-to-breast early (χ2 = 1.64, p = .440) did not affect 6-month breastfeeding rates. Conclusion/Implications for Nursing Practice: These findings demonstrate the need to further educate providers and encourage newborn care practices to sustain breastfeeding beyond the early postpartum period. The results may also be used to inform expectant parents (e.g., during childbirth classes) of hospital practices and personal decisions that may influence successful breastfeeding duration. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses