In-hospital Formula Supplementation Research Articles

In-Hospital Formula Supplementation in Appalachian Women Intending to Exclusively Breastfeed.

In-hospital formula supplementation places infants at risk for early breastfeeding cessation. The study's aim was to identify predictive and protective factors for in-hospital formula supplementation in individuals documented as wanting to exclusively breastfeed and residing in a geographic region with adverse social determinants of health and low breastfeeding rates. Additionally, we wished to determine if lactation consultation served as a protective factor against supplementation. In this cross-sectional study, we retrospectively reviewed 500 randomly selected charts of newborns born in a 12month period at a regional tertiary care hospital. We included healthy, full-term neonates having a recorded maternal decision to exclusively breastfeed. Maternal-newborn dyad characteristics were compared between those exclusively breastfeeding and those with in-hospital formula supplementation. Of the 500 charts, 70% of individuals desired to exclusively breastfeed. Overall, 41% of breastfed newborns were supplemented with formula before discharge, and 32% of women met with lactation consultants prior to supplementation. No statistically significant association was present between exclusive breastfeeding at discharge and meeting with a hospital lactation consultant (p = 0.55). When controlling for the confounders of maternal demographics and lactation consultation, significant associations with formula supplementation included Cesarean delivery (odd ratio: 2.08, 95% confidence interval: 1.04-4.16), primiparity (2.48, 1.27-4.87), and high school level of education (2.78, 1.33-5.78). Maternal characteristics of high school level educational, primiparity, and Caesarean delivery place individuals at risk for in-hospital formula supplementation in individuals wishing to exclusively breastfeed. Addressing barriers to exclusive breastfeeding is essential to enhance maternal and newborn health equity.

O47 - What modifiable factors improve breastfeeding exclusivity and duration in Australian women?

Australian breastfeeding rates, particularly exclusive breastfeeding rates, are low and have been low for many years because strategies to increase them have been inadequate. New approaches for promoting and supporting breastfeeding are required. Data collected in 2008 suggested that Australian Breastfeeding Association (ABA) members had much higher exclusive breastfeeding rates (41.2% at 5 to 6 months) than the general Australian population. The Engaging Mothers: Breastfeeding Experiences Recounted (EMBER) project was undertaken 1) to determine whether ABA volunteer trainees had better breastfeeding outcomes and were, in fact, positive deviants regarding breastfeeding practices, 2) to explore attitudes, characteristics and behaviours underpinning beneficial breastfeeding practices and 3) to identify modifiable characteristics to inform breastfeeding promotion and support. Breastfeeding-related quantitative and qualitative data were obtained from lactation history questionnaires collected on application to train as volunteers with ABA and analysed using descriptive statistics. Participants in this project had much higher levels of exclusive breastfeeding to around 6 months (64%) and longer duration of breastfeeding (80% to one year) than the general Australian population, going beyond World Health Organization targets. Modifiable factors that positively influenced breastfeeding outcomes included knowledge of and motivation to breastfeed, birthing outcomes, immediate skin-to-skin contact, lack of in-hospital formula supplementation and partner and peer support. EMBER participants can be defined as positive deviants with positive attitudes, characteristics and behaviours towards breastfeeding that lead to much better breastfeeding outcomes compared to the general Australian population. Many of the modifiable factors that positively impacted their breastfeeding outcomes can be influenced by midwives supporting pregnant women, women giving birth and breastfeeding mothers. Midwives are uniquely positioned to provide breastfeeding education and information, and timely and well-informed breastfeeding support to mothers, to give them the best chance to breastfeed exclusively and breastfeed for longer.

The Effect of Circumcision on Exclusive Breastfeeding, Phototherapy, and Hospital Length of Stay in Term Breastfed Newborns.

Little is known about the effect of circumcision on breastfeeding in the hours and days after the procedure. Factors with the potential to negatively impact breastfeeding success in the newborn period may result in higher rates of jaundice requiring phototherapy and formula supplementation, both of which can potentially extend the length of initial hospitalization. Our objective was to determine the impact of circumcision on rates of exclusive breastfeeding, neonatal jaundice requiring phototherapy, and length of stay at hospital discharge immediately after birth. Term male newborn infants whose mothers intended to exclusively breastfeed were included in this retrospective cohort. Bivariate analysis and multivariate logistic regression modeling were used to evaluate target behaviors, comparing infant boys who were circumcised with those who were uncircumcised. Of the 1109 breastfed male newborns included, 846 (76.6%) were circumcised. There was no significant effect of circumcision status or circumcision timing on the rate of in-hospital formula supplementation. There were no differences in peak bilirubin levels, phototherapy requirement, or length of hospital stay for male newborns based on circumcision status. Circumcision did not affect the rate of exclusive breastfeeding, neonatal jaundice, phototherapy requirement, or length of hospital stay in this retrospective analysis of breastfed male newborns.

Validation of a Breastfeeding History Questionnaire for the Risk of In-Hospital Formula Supplementation Among Multiparous Women.

A woman's prior breastfeeding history may influence future decisions regarding infant feeding. Few quantitative tools utilizing this information have been demonstrated to predict breastfeeding success. To evaluate the efficacy of a prenatal breastfeeding history (BAP) questionnaire administered in prenatal care to predict in-hospital formula supplementation among multiparous women. This is a prospective observational study of multiparous women with singleton pregnancies who presented to a Baby-Friendly urban tertiary care center for 1st prenatal visit at < 20 weeks' gestation. The BAP tool generates a numerical score, with higher score (≥ 2) indicating prior successful breastfeeding experiences. The primary outcome was occurrence of non-medically indicated formula supplementation during the postpartum hospital stay. Student's t test and Pearson's chi-square test were used to compare continuous and categorical variables. A multivariable logistic regression was performed to assess the relationship of BAP score to formula supplementation. Of 587 women screened, 433 (73.8%) mother-infant dyads were analyzed. Rates of formula supplementation in women with BAP scores ≤ 1 were 67% (156/234) compared with 37% (73/199) in women with higher scores (p < 0.0001). After controlling for race/ethnicity, insurance, and obesity, women with BAP scores of ≤ 1 were 2.6 times more likely to supplement formula than women with higher scores (aOR 2.62, 95% CI [1.70, 4.04], p < .0001). In this prospective validation study, women with negative prior breastfeeding experiences, as evidenced by a lower BAP score, were more likely to supplement formula during the postpartum hospital stay.

In-hospital formula supplementation and breastfeeding initiation in infants born to women with pregestational diabetes mellitus.

To ascertain the rate of in-hospital supplementation as it relates to early breastfeeding (BF) and early formula feeding (FF) and its effects on BF (exclusive and partial) at the time of discharge for infants born to women with pregestational diabetes mellitus (PGDM). Retrospective cohort investigation of 282 women with PGDM who intended to BF and their asymptomatic infants admitted to the newborn nursery for blood glucose monitoring and routine care. Early feeding was defined by the initial feeding if given within four hours of birth. Of the 282 mother-infant dyads, for 134 (48%) early feeding was BF and for 148 (52%) early feeding was FF. Times from birth to BF and FF (median 1 hr, 0.3-6) were similar, while the time to first BF for those who FF and supplemented was longer (median 6 hr., 1-24). Ninety-seven infants (72%) who first BF also supplemented. Of these, 22 (23%) BF exclusively, 67 (69%) BF partially and 8 (8%) FF at discharge. One hundred seventeen (79%) who first FF also supplemented. Of these, 21 (18%) BF exclusively, 76 (65%) BF partially and 20 (17%) FF at discharge. Regardless of the type of first feeding, the majority of infants born to women with PGDM require supplementation. Even when medically indicated, in-hospital supplementation is an obstacle, albeit not absolute, to exclusive BF at discharge. Parents should be reminded that occasional supplementation should not deter resumption and continuation of BF.

Prevalence and predictors of exclusive breastfeeding among immigrant and Canadian-born Chinese women.

Breastfeeding is the optimal method for infant feeding, yet migrant women may be at risk for suboptimal exclusivity rates. In a cohort of immigrant and Canadian-born Chinese women, our objectives were to (a) describe patterns and prevalence of exclusive breastfeeding at 1, 3, and 6months postpartum; (b) identify risk and protective factors associated with exclusivity; and (c) examine potentially differential importance of these factors across this 6-month period. This was a prospective study of 565 immigrants and Canadian-born Chinese women (Toronto, Canada). Exclusive breastfeeding was measured at 1, 3, and 6months postpartum. Predictors comprised fixed (demographics, history of depression, immigrant status, prenatal breastfeeding classes, in-hospital formula supplementation, baseline social support, and baseline acculturative stress) and time-dependent (depression, anxiety, fatigue, and breastfeeding problems) variables. Descriptive statistics, logistic regression, and generalized linear mixed models, respectively, were undertaken to address the objectives. Patterns of breastfeeding practices included exclusive breastfeeding in all time points (26.8%) or none (32.9%) and moving from exclusive to nonexclusive (20.3%) or nonexclusive to exclusive breastfeeding (15.2%). Women less likely to breastfeed exclusively at 1, 3, or 6months were those whose infants received in-hospital formula supplementation. Exclusivity attrition was higher between 3 and 6months than 1-3months. Immigrant status and in-hospital formula supplementation had a significant impact on exclusivity earlier in the postpartum period while breastfeeding problems were associated with decreased exclusivity across time. Proactive preventive efforts are need to maintain breastfeeding exclusivity especially between 3 and 6months if women are to meet international breastfeeding recommendations.

200: Validation of a breastfeeding history questionnaire for the prediction of in-hospital formula supplementation in multiparous women

200: Validation of a breastfeeding history questionnaire for the prediction of in-hospital formula supplementation in multiparous women

Breastfeeding determinants in Cyprus: A cross-sectional study

AimTo identify the determinants of breastfeeding initiation, duration and exclusivity in Cyprus. MethodsA cross-sectional study was conducted that included 128 mothers of infants aged 6–18 months. Data was collected using a questionnaire. A chi-square test and multivariate logistic regression were performed for statistical analysis. ResultsThe only factor associated with breastfeeding initiation was care in the Neonatal Intensive Care Unit. In-hospital formula supplementation and use of a pacifier were negatively associated with breastfeeding duration, whereas previous breastfeeding experience for more than one month and father's tertiary educational level were positively associated. In-hospital formula supplementation and free formula samples were negatively associated, and father's tertiary educational level was positively associated with breastfeeding exclusivity. ConclusionsAlthough breastfeeding initiation rates were high, breastfeeding duration was far from the international recommendations. The role of the healthcare professionals and the father could be important for breastfeeding outcomes.

An Ecological Momentary Assessment of Primiparous Women's Breastfeeding Behavior and Problems From Birth to 8 Weeks.

Primiparous women are at risk for early, unintended breastfeeding reduction and cessation. Breastfeeding patterns that contribute to these outcomes require further exploration. Research aim: This study aimed to describe early, "real-time" breastfeeding behaviors and perceived problems of primiparous women. First-time mothers intending to exclusively breastfeed downloaded a commercial infant-feeding app during their postpartum hospitalization. Women logged feedings and their breastfeeding experiences, as they occurred, through 8 weeks postpartum. Additional feeding and background data were collected via electronic medical records and questionnaires administered at enrollment and 2 and 8 weeks postpartum. Summary statistics were compiled to examine weekly breastfeeding behaviors and problems. In this sample of 61 primarily highly educated, White women committed to breastfeeding, 38% ( n = 23) used formula during the postpartum hospitalization and 68% ( n = 34) used formula at least once by 2 weeks. Nine women stopped breastfeeding during the study. Women using any formula in the hospital and those with less positive baseline attitudes toward breastfeeding were less likely to be exclusively breastfeeding at 2 and 8 weeks, respectively ( p < .05). There was a trend toward declining at-breast feeds and high rates of milk expression during the study. Breastfeeding problems peaked at Week 2, with 81% of women ( n = 39) endorsing at least one problem at that time. The most prevalent problems included perception of inadequate milk, pain, latching, and inefficient feeds. Interventions to address suboptimal breastfeeding in primiparous women should consider the pervasiveness of early milk expression and in-hospital formula supplementation in this population, as well as the trajectory of common problems.

In-Hospital Formula Supplementation of Healthy Newborns: Practices, Reasons, and Their Medical Justification.

In-hospital formula supplementation is a common practice and has been shown to be a strong determinant of shorter exclusive and any breastfeeding. To investigate the reasons for and circumstances in which in-hospital formula supplementation occurs and whether the stated reasons are medically acceptable. This prospective cohort study was conducted among 342 mother-infant pairs from April to July 2011 at the Department of Obstetrics and Gynecology, University Hospital of Split, Croatia. Data were collected based on "every feed" charts and WHO/UNICEF "Questionnaire for Monitoring Baby-Friendly Hospitals". We used WHO/UNICEF Baby-Friendly Hospital Initiative and Academy of Breastfeeding Medicine documents on indications for supplemental feeding. During the first 48 hours and entire hospital stay, 49.5% and 62.8% of infants, respectively, received supplements, given on average 16.68 ± 18.6 hours after delivery. In 94.1% of supplemented infants, healthy newborns were given artificial milk, of which 5.9% of mothers had not been notified. The most common maternal reasons for supplementing were "lack of milk" (49.8%), a "crying baby" (35.5%), "cesarean section" (11.5%), newborn weight loss (10.6%), and sore nipples (10.1%). Of all the given reasons, 24.6% were categorized as being medically acceptable. Primiparas were 1.3 times more likely to supplement in hospital, whereas multiparas were 1.3 times more likely to exclusively breastfeed. In our study, most reasons for formula supplementation of healthy term newborns were not standard acceptable medical reasons, indicating a need for improved maternal support, revision of hospital policies, and training of hospital staff.

Predictors of Breastfeeding Confidence in the Early Postpartum Period

ObjectiveTo identify factors related to breastfeeding self-efficacy, an important psychological variable in sustained breastfeeding, in the postpartum period. DesignDescriptive correlational study. SettingData were collected on the mother–baby unit of an academic medical center in the Northeastern United States. ParticipantsThis convenience sample (N = 107) was composed of women in the first 4 days postpartum and included nearly equal numbers of primiparas (49.5%, n = 53) and multiparas (50.5%, n = 54). MethodsParticipants completed the Perceived Stress Scale–10, Birth Satisfaction Scale–Revised, Breastfeeding Self-Efficacy Scale–Short Form, and a demographic questionnaire. Descriptive and inferential statistics were used to analyze the data. ResultsBreastfeeding self-efficacy was positively correlated with birth satisfaction, number of children, partner support of breastfeeding, intention to breastfeed, intention to breastfeed exclusively for 6 months, and feeling prepared for birth. Breastfeeding self-efficacy was greater in women with previous breastfeeding experience and lower in mothers of newborns who received in-hospital formula supplementation. A standard multiple linear regression explained approximately 38.5% of the variance in self-efficacy scores. ConclusionNurses can apply our findings to inform strategies to increase breastfeeding confidence, such as promoting birth satisfaction, involving partners in breastfeeding education, and limiting the use of in-hospital formula supplementation.

Predictors of suboptimal breastfeeding: an opportunity for public health interventions

Sub-optimum breastfeeding significantly contributes to the global burden of disease. Our aim was to identify risk factors associated with suboptimal breastfeeding in Southern Croatia. Between February 2008 and August 2009, 773 mother-infant pairs were recruited from University Hospital of Split Maternity Unit. Mothers were interviewed at birth, 3, 6, 12 and 24 months. Ninety-nine percent of mothers initiated breastfeeding but only 2.2% of them exclusively breastfed whilst in hospital. At 24 months, 4.1% of mothers were breastfeeding. Exclusive and any breastfeeding at 3 months was negatively associated with maternal education of 12 years or less, smoking during pregnancy, intention to use a pacifier and in-hospital formula supplementation. In addition, exclusive breastfeeding at 3 months was negatively associated with primiparity, antenatal course non-attendance and not receiving assistance with breastfeeding from hospital staff. Antenatal course non-attendance and discussing infant feeding with a health professional during pregnancy lowered the odds for any breastfeeding at 6 months. At 12 and 24 months, a lower level of education, antenatal course non-attendance and not receiving advice in hospital on feeding frequency was significantly associated with lower odds of breastfeeding. Additionally, intention to use a pacifier was found to be a negative predictor of breastfeeding at 12 months. Important modifiable risk factors found to be significantly associated with suboptimal breastfeeding include smoking during pregnancy, intention to use a pacifier, in-hospital formula supplementation, not receiving advice from hospital staff on normal feeding patterns, not receiving assistance with breastfeeding in hospital and antenatal course non-attendance.

Effect of a hospital policy of not accepting free infant formula on in-hospital formula supplementation rates and breast-feeding duration.

To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration. Prospective cohort study. In-patient postnatal units of four public hospitals in Hong Kong. Two cohorts of breast-feeding mother-infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding. The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose-response pattern. After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.

Multiparous mothers: Breastfeeding support provided by nurses.

The study aimed to identify the informational, practical and emotional support that multiparous mothers had received from nurses in the early postpartum period.This is a descriptive and cross-sectional study on 278 multiparous mothers who took part in the research prior to their discharge from a maternity hospital in Ankara, Turkey. The instrument used was a 38-item questionnaire. Experiencing breastfeeding problems was the only statistically significant predictor of in-hospital supplementation (P < 0.01, OR 0.028, 95% CI 0.005-0.159). There were no statistically significant association between some predictor variables with regard to breastfeeding support and breastfeeding outcomes including in-hospital formula supplementation and breastfeeding problems. No significant associations are indicative for the need of more effective implementation of informational, practical and emotional breastfeeding support for multiparous mothers in easing their adjustment to breastfeeding. Nurses can encourage multiparous mothers to maintain breastfeeding through individual teaching, giving mothers a sense of security, providing understanding care and telling about what to do with regard to breastfeeding problems. Antenatal education and support could be more likely to make a difference.

In-Hospital Formula Use Increases Early Breastfeeding Cessation Among First-Time Mothers Intending to Exclusively Breastfeed

To evaluate in-hospital formula supplementation among first-time mothers who intended to exclusively breastfeed and determined if in-hospital formula supplementation shortens breastfeeding duration after adjusting for breastfeeding intention. We assessed strength of breastfeeding intentions prenatally in a diverse cohort of expectant primiparae and followed infant feeding practices through day 60. Among mothers planning to exclusively breastfeed their healthy term infants for ≥1 week, we determined predictors, reasons, and characteristics of in-hospital formula supplementation, and calculated the intention-adjusted relative risk (ARR) of not fully breastfeeding days 30-60 and breastfeeding cessation by day 60 with in-hospital formula supplementation (n = 393). Two hundred ten (53%) infants were exclusively breastfed during the maternity stay and 183 (47%) received in-hospital formula supplementation. The most prevalent reasons mothers cited for in-hospital formula supplementation were: perceived insufficient milk supply (18%), signs of inadequate intake (16%), and poor latch or breastfeeding (14%). Prevalence of not fully breastfeeding days 30-60 was 67.8% vs. 36.7%, ARR 1.8 (95% CI, 1.4-2.3), in-hospital formula supplementation vs exclusively breastfed groups, respectively, and breastfeeding cessation by day 60 was 32.8% vs. 10.5%, ARR 2.7 (95% CI, 1.7-4.5). Odds of both adverse outcomes increased with more in-hospital formula supplementation feeds (not fully breastfeeding days 30-60, P = .003 and breastfeeding cessation, P = .011). Among women intending to exclusively breastfeed, in-hospital formula supplementation was associated with a nearly 2-fold greater risk of not fully breastfeeding days 30-60 and a nearly 3-fold risk of breastfeeding cessation by day 60, even after adjusting for strength of breastfeeding intentions. Strategies should be sought to avoid unnecessary in-hospital formula supplementation and to support breastfeeding when in-hospital formula supplementation is unavoidable.

Predictors and Consequences of In-Hospital Formula Supplementation for Healthy Breastfeeding Newborns

Although exclusive breastfeeding is recommended for the first 6 months, the use of breast milk substitutes is widespread around the world. To describe the patterns of infant formula supplementation among healthy breastfeeding newborns, to identify factors contributing to in-hospital formula supplementation, and to assess the dose-response relationship between the amount of in-hospital formula supplementation and the duration of any breastfeeding. A sample of 1246 breastfeeding mother-infant pairs was recruited from 4 public hospitals in Hong Kong and followed prospectively for 12 months or until weaned. Multiple logistic regression analysis was used to examine factors associated with in-hospital supplementation. Cox regression analysis was used to explore the impact of in-hospital supplementation on breastfeeding duration. Of the total, 82.5% of newborns were supplemented in the hospital; one-half received formula within 5 hours of birth. Assisted vaginal delivery (odds ratio [OR] = 2.06, 95% confidence interval [CI] 1.03, 4.15), cesarean section (OR = 3.45, 95% CI 1.75, 6.80), and higher birth weight (OR = 1.56, 95% CI 1.12, 2.18) were positively associated with in-hospital formula supplementation, whereas initiating breastfeeding in the delivery room (OR = 0.55, 95% CI 0.33, 0.89) was associated with decreased likelihood of in-hospital supplementation. Any infant formula in the first 48 hours was associated with a shorter duration of breastfeeding (hazard ratio [HR] = 1.51, 95% CI 1.27, 1.80), but there was no dose-response effect. In-hospital formula supplementation is common in Hong Kong hospitals and appears to be detrimental to breastfeeding duration. Continued efforts should be made to avoid the provision of infant formula to breastfeeding babies while in the hospital unless medically indicated.

Breastfeeding support received by Turkish first‐time mothers

Research conducted to examine nurses' breastfeeding support to first-time mothers is sparse in Turkey. To identify informational, practical and emotional support that mothers had received from nurses in the early postpartum period. A descriptive and cross-sectional study of 192 mothers who took part in the research prior to discharge from a maternity hospital in Ankara, Turkey. Mean, standard deviation and percentages were used to analyze the maternal characteristics. Chi-square test was used to analyze informational, practical and emotional support received by the mothers in relation to socio-demographic characteristics. Multiple logistic regression analyses were performed to evaluate risk factors for in-hospital formula supplementation and experiencing breastfeeding problem. The mothers stated that the information provided should be adequate (41%), given individually (36.3%) and taught through practice (41%). Supplementary feeding was the only statistically significant predictor of in-hospital breastfeeding problems [P<0.01, odds ratio (OR) 0.109, 95% confidence interval (CI) 0.33-0.361]. Experiencing a breastfeeding problem, not receiving practical support, and the unavailability of nurses were statistically significant predictors of supplementation respectively (P<0.01, OR 0.084, 95% CI 0.023-0.309; P<0.05, OR 0.239, 95% CI 0.071-0.809; P<0.05, OR 3.442, 95% CI 1.059-11.183, respectively). Informational, practical and emotional support offered by nurses has the potential to make a difference in reducing breastfeeding problems and in-hospital supplementation. Practical support could be enhanced through effective implementation of early maternal/infant skin-to-skin contact in a busy hospital environment.

In-Hospital Formula Supplementation of Breastfed Babies: A Population-Based Survey

In-hospital formula supplementation of breastfed newborns is commonplace despite its negative association with breastfeeding duration. Although several studies have described the use of formula supplementation, few have explored the factors that may be associated with its use. The aim of this study was to explore factors associated with in-hospital formula supplementation using data from a large Australian population-based survey. All women who gave birth in September and October 2007 in two Australian states were mailed questionnaires 6 months after the birth. Women were asked how they fed their baby while in hospital after the birth. Multivariable logistic regression was used to explore specified a priori factors associated with in-hospital formula supplementation. Of 4,085 women who initiated breastfeeding, 23 percent reported their babies receiving formula supplementation. Breastfed babies had greater odds of receiving formula supplementation if their mother was primiparous (adj. OR=2.16; 95% CI: 1.76-2.66); born overseas and of non-English-speaking background (adj. OR=2.03; 95% CI: 1.56-2.64); had a body mass index more than 30 (adj. OR=2.27; 95% CI: 1.76-2.95); had an emergency cesarean section (adj. OR=1.72; 95% CI: 1.3-2.28); or the baby was admitted to a special care nursery (adj. OR=2.72; 95% CI: 2.19-3.4); had a birthweight less than 2,500 g (adj. OR=2.02; 95% CI: 1.3-3.15) or was born in a hospital not accredited with Baby-Friendly Hospital Initiative (BFHI) (adj. OR=1.53; 95% CI: 1.2-1.94). The number of factors associated with in-hospital formula supplementation suggests that this practice is complex. Some results, however, point to an opportunity for intervention, with the BFHI appearing to be an effective strategy for supporting exclusive breastfeeding.

Reasons for In-Hospital Formula Supplementation of Breastfed Infants From Low-Income Families

In-hospital formula supplementation of breastfed infants negatively impacts breastfeeding duration. Infants from low-income families have some of the lowest exclusive breastfeeding rates in the United States. The objectives of this study were to identify (1) reasons low-income breastfeeding mothers begin in-hospital formula supplementation and (2) risk factors for in-hospital formula supplementation. We surveyed 150 low-income mothers in a Washington, DC, clinic. Sixty percent had initiated breastfeeding, and 78% of these breastfed infants received formula supplementation in the hospital. There was no clear medical need for supplementation for 87% of the breastfed infants receiving supplementation. Infants of mothers who did not attend a prenatal breastfeeding class were almost 5 times more likely to receive in-hospital formula supplementation than those infants whose mothers had attended a class (OR, 4.7; 95% CI, 1.05-21.14). Improved knowledge about breastfeeding among nursing and medical providers is important to minimize unnecessary formula supplementation for breastfed infants.

Predictors of the duration of exclusive breastfeeding among first‐time mothers

Few women currently meet revised WHO recommendations to breastfeed exclusively for 6 months postpartum. In this prospective study we aimed to determine the influence of socio-demographic, psychosocial, and perinatal factors on the length of exclusive breastfeeding among 189 Canadian primiparous mothers. A majority of the participants did not meet their exclusive breastfeeding goals, and only 5% breastfed exclusively for a full 6 months. Breastfeeding self-efficacy, in-hospital formula supplementation, prenatal class attendance, and type of delivery independently predicted exclusive breastfeeding duration. Findings underscore the complex interplay of factors influencing breastfeeding, highlight the early postpartum weeks as a critical period for the establishment of exclusive breastfeeding, and suggest the need for a continuum of pre- and postnatal strategies for prolonging the exclusive breastfeeding period.