247: Should the gold standard breastfeeding measure in socioeconomically disadvantaged (SED) women be breastfeeding continuation, not initiation?

Abstract

Public-health interventions like the Baby Friendly Hospital Initiative aim to improve breastfeeding (BF) rates among SED women by increasing BF initiation. However, BF initiation may not correlate with BF continuation. We investigated the breastfeeding attrition rate among SED women within 48 hours of delivery at a Baby Friendly hospital and reasons for formula supplementation. This cross-sectional study occurred in 2016 at a university-based Baby Friendly Hospital. SED women without a BF contraindication who delivered non-anomalous singletons were recruited at scheduled visits within 6 months of delivery. Consenting women completed a validated BF survey. The primary outcome was exclusive BF at postpartum day #2 (PPD2). Secondary outcomes were BF initiation and reasons for initiating formula. We compared outcomes in women who exclusively breastfed to those who supplemented with formula. Of the 149 women included, 129 (86.6%) initiated BF. By PPD2, only 51 (34.3%) were exclusively BF, while 47 (31.5%) supplemented with formula and 51 (34.3%) exclusively formula fed. There were no differences in age, race, education level, or annual household income between women who exclusively BF and those who supplemented with formula. However, those who supplemented with formula were more likely to have enrolled in the Women and Infant Care Program (97.9% versus 84.3%; p=0.02). They were also more likely to believe their babies were not interested in nursing (17.0% vs. 4.0%; p=0.045) or their milk letdown took too long (27.7% vs. 10.0%; p=0.03). The rates of reported latch difficulty and concern for neonatal weight loss or low milk supply were similar. While women in both groups were similarly likely to ask for help from hospital staff for breastfeeding issues, those who chose to supplement with formula were less likely to believe they received help (53.3% vs 73.3%; p=0.049). Though most SED women at a Baby Friendly Hospital initiated BF, the majority added formula by PPD2, suggesting BF initiation rates do not correlate with BF continuation rates in this population. To increase exclusive BF rates among SED women, educational measures should focus on improving understanding of normal neonatal behavior and train hospital staff to effectively respond to patient inquiries about BF challenges.