Infant Feeding Practices and Perceived Optimal Breastfeeding Interventions among Low-Income Women Delivering at a Baby-Friendly Hospital

Abstract

Objective To determine infant feeding practices of low-income women at a Baby-Friendly Hospital and to ascertain breastfeeding interventions they believe would increase exclusive breastfeeding.

Study Design This cross-sectional study occurred at a tertiary care Baby-Friendly Hospital. Low-income women without breastfeeding contraindications were recruited at scheduled obstetrician/gynecologist appointments within 6 to 9 months of delivering a term, nonanomalous infant. Participants completed a survey. Outcomes included infant feeding patterns and perceived usefulness of proposed breastfeeding interventions.

Results Of 149 participants, 129 (86.6%) initiated breastfeeding; by postpartum day 2 (PPD2), 47 (31.5%) exclusively breastfed, 51 (34.2%) breastfed with formula, and 51 (34.2%) exclusively formula fed. On a scale of 1 (“strongly agree”) to 5 (“strongly disagree”), women who supplemented with formula on PPD2 were significantly more likely than those who exclusively formula fed to agree education on neonatal behavior, 1 (interquartile range [IQR] 1, 2) versus 2 (IQR 1, 3); p = 0.026 and on-demand access to breastfeeding videos on latch or positioning, 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.043; 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.021, respectively, would have helped them exclusively breastfeed.

Conclusion Though low-income women at a Baby-Friendly Hospital had high breastfeeding initiation rates, the majority used formula by PPD2. To increase breastfeeding rates among low-income women, future interventions should provide appropriate and effective breastfeeding interventions.

Keywords

Baby-Friendly Hospital initiative - breastfeeding - breastfeeding educational interventions - health disparity - low-income women

Note

This article was presented in poster form as abstracts 247, 889, and 890 at the 38th Annual SMFM Pregnancy Meeting in Dallas, TX, from January 29 to February 3, 2018.

• References

• 1 Patnode CD, Henninger ML, Senger CA, Perdue LA, Whitlock EP. Primary care interventions to support breastfeeding: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016; 316 (16) 1694-1705
• 2 World Health Organization and UNICEF. Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care. Geneva, Switzerland: World Health Organization and UNICEF; 2009
• 3 National Implementation of the Baby-Friendly Hospital Initiative, 2017. Licence CC. Geneva: World Health Organization; 2017
• 4 Merten S, Dratva J, Ackermann-Liebrich U. Do Baby-Friendly Hospitals influence breastfeeding duration on a national level?. Pediatrics 2005; 116 (05) e702-e708
• 5 Hofvander Y. Breastfeeding and the Baby Friendly Hospitals Initiative (BFHI): organization, response and outcome in Sweden and other countries. Acta Paediatr 2005; 94 (08) 1012-1016
• 6 Venancio SI, Saldiva SR, Escuder MM, Giugliani ER. The Baby-Friendly Hospital Initiative shows positive effects on breastfeeding indicators in Brazil. J Epidemiol Community Health 2012; 66 (10) 914-918
• 7 Brodribb W, Kruske S, Miller YD. Baby-Friendly Hospital accreditation, in-hospital care practices, and breastfeeding. Pediatrics 2013; 131 (04) 685-692
• 8 Nobari TZ, Jiang L, Wang MC, Whaley SE. Baby-Friendly Hospital Initiative and breastfeeding among WIC-participating infants in Los Angeles county. J Hum Lact 2017; 33 (04) 677-683
• 9 Merewood A, Mehta SD, Chamberlain LB, Philipp BL, Bauchner H. Breastfeeding rates in US Baby-Friendly Hospitals: results of a national survey. Pediatrics 2005; 116 (03) 628-634
• 10 Whalen BL, Kelly J, Holmes AV. The New Hampshire Ten Steps to Successful Breastfeeding Collaborative: a statewide QI initiative. Hosp Pediatr 2015; 5 (06) 315-323
• 11 Kramer MS, Chalmers B, Hodnett ED. , et al; PROBIT Study Group (Promotion of Breastfeeding Intervention Trial). Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001; 285 (04) 413-420
• 12 Yotebieng M, Labbok M, Soeters HM. , et al. Ten Steps to successful breastfeeding programme to promote early initiation and exclusive breastfeeding in DR Congo: a cluster-randomised controlled trial. Lancet Glob Health 2015; 3 (09) e546-e555
• 13 Taylor EC, Nickel NC, Labbok MH. Implementing the Ten Steps for successful breastfeeding in hospitals serving low-wealth patients. Am J Public Health 2012; 102 (12) 2262-2268
• 14 Munn AC, Newman SD, Mueller M, Phillips SM, Taylor SN. The impact in the United States of the Baby-Friendly Hospital Initiative on early infant health and breastfeeding outcomes. Breastfeed Med 2016; 11: 222-230
• 15 Patnode CD, Henninger ML, Senger CA, Perdue LA, Whitlock EP. Primary care interventions to support breastfeeding: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016; 316 (16) 1694-1705
• 16 Centers for Disease Control and Prevention (CDC). Racial and socioeconomic disparities in breastfeeding--United States, 2004. Morb Mortal Wkly Rep 2006; 55 (12) 335-339
• 17 American College of Obstetricians and Gynecologists Women's Health Care Physicians; Committee on Health Care for Underserved Women. Committee Opinion No. 570: breastfeeding in underserved women: increasing initiation and continuation of breastfeeding. Obstet Gynecol 2013; 122 (2 Pt 1): 423-428
• 18 Anstey EH, Chen J, Elam-Evans LD, Perrine CG. Racial and geographic differences in breastfeeding - United States, 2011-2015. MMWR Morb Mortal Wkly Rep 2017; 66 (27) 723-727
• 19 Thompson AL, Mendez MA, Borja JB, Adair LS, Zimmer CR, Bentley ME. Development and validation of the Infant Feeding Style Questionnaire. Appetite 2009; 53 (02) 210-221
• 20 Feltner C, Weber RP, Stuebe A, Grodensky CA, Orr C, Viswanathan M. Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries. Comparative Effectiveness Review No. 210. (Prepared by the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center). Rockville, MD: Agency for Healthcare Research and Quality; 2018
• 21 Patterson JA, Keuler NS, Olson BH. The effect of Baby-Friendly status on exclusive breastfeeding in U.S. hospitals. Matern Child Nutr 2018; 14 (03) e12589
• 22 Furman L, Combs BC, Alexander AD, O'Riordan MA. Breast-feeding rates at an inner-city pediatric practice. Clin Pediatr (Phila) 2008; 47 (09) 873-882
• 23 Hundalani SG, Irigoyen M, Braitman LE, Matam R, Mandakovic-Falconi S. Breastfeeding among inner-city women: from intention before delivery to breastfeeding at hospital discharge. Breastfeed Med 2013; 8 (01) 68-72
• 24 Healthy People 2020. Washington, DC: US Department of Health and Human Services, Offices of Disease prevention and Health Promotion. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives . Accessed December 9, 2018
• 25 Specifications Manual for Joint Commission National Quality Measures. Measure Information Form. Measure Set: Perinatal Care. Available at: https://manual.jointcommission.org/releases/TJC2018A/MIF0170.html . Published 2018. Accessed June 6, 2018
• 26 Schreck PK, Solem K, Wright T, Schulte C, Ronnisch KJ, Szpunar S. Both prenatal and postnatal interventions are needed to improve breastfeeding outcomes in a low-income population. Breastfeed Med 2017; 12: 142-148
• 27 Whitehead L, Seaton P. The effectiveness of self-management mobile phone and tablet apps in long-term condition management: a systematic review. J Med Internet Res 2016; 18 (05) e97
• 28 Martinez-Brockman JL, Harari N, Pérez-Escamilla R. Lactation advice through texting can help: an analysis of intensity of engagement via two-way text messaging. J Health Commun 2018; 23 (01) 40-51
• 29 Kellams AL, Gurka KK, Hornsby PP. , et al. The impact of a prenatal education video on rates of breastfeeding initiation and exclusivity during the newborn hospital stay in a low-income population. J Hum Lact 2016; 32 (01) 152-159
• 30 Miremberg H, Ben-Ari T, Betzer T. , et al. The impact of a daily smartphone-based feedback system among women with gestational diabetes on compliance, glycemic control, satisfaction, and pregnancy outcome: a randomized controlled trial. Am J Obstet Gynecol 2018; 218 (04) 453.e1-453.e7
• 31 Gilliam ML, Martins SL, Bartlett E, Mistretta SQ, Holl JL. Development and testing of an iOS waiting room “app” for contraceptive counseling in a Title X family planning clinic. Am J Obstet Gynecol 2014; 211 (05) 481.e1-481.e8
• 32 Lowe JB, Barnes M, Teo C, Sutherns S. Investigating the use of social media to help women from going back to smoking post-partum. Aust N Z J Public Health 2012; 36 (01) 30-32
• 33 Fein SB, Labiner-Wolfe J, Shealy KR, Li R, Chen J, Grummer-Strawn LM. Infant feeding practices study II: study methods. Pediatrics 2008; 122 (Suppl 2): S28-S35
• 34 Center for Disease Control and Prevention. Breastfeeding Report Card 2013. Atlanta, Georgia: Center for Disease Control and Prevention; 2016:8
• 35 Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr 2012; 95 (05) 1113-1135