Although several key aspects of maternity care supportive of breastfeeding have improved in recent years, more work is needed to ensure all women receive the vital breastfeeding support. Why? Because breastfeeding has documented benefits to both mothers and children.
Babies who are breastfed are at a reduced risk for ear, respiratory, and gastrointestinal infections, asthma, sudden infant death syndrome, and necrotizing enterocolitis.
In addition, evidence suggests that breastfeeding is associated with a reduction in the risk for obesity and diabetes in children. Mothers who breastfeed have a reduced risk for breast and ovarian cancers, diabetes, and cardiovascular disease. The health effects for both mothers and infants from suboptimal breastfeeding rates contribute substantially to health care costs.
But there is a huge problem.
Mothers do not breastfeed for as long as they would like
Although the majority of mothers in the United States begin breastfeeding, many are not breastfeeding for as long as they would like.
The American Academy of Pediatrics recommends that infants be exclusively breastfed (i.e., breast milk with no solids or other liquids except vitamin/mineral supplements or medications) for about the first 6 months of life, and that they continue to be breastfed for at least 12 months, with introduction of nutrient-rich complementary foods at about age 6 months.
Eighty percent of infants in the United States begin breastfeeding; however, by age 6 months, just over half of all infants are receiving any breast milk, and only 22% exclusively breastfeed for the recommended first 6 months of life.
These low rates of exclusive and continued breastfeeding have implications for public health and better hospital policies and practices could increase rates of breastfeeding nationwide, contributing to improve it.
Do hospitals provide enough help?
Despite substantial improvement, as of 2013, implementation of several maternity care practices and policies was far from optimal. Just over one quarter of hospitals have a model breastfeeding policy, which is the foundation for many of the other steps.
In addition, fewer than half of hospitals reported routinely keeping healthy infants with their mothers throughout the hospital stay, a practice that allows mothers to become more familiar with their babies’ hunger cues, and increases opportunities for breastfeeding.
This report also describes two key indicators that were low at baseline and showed less progress: limiting the provision of fluids other than breast milk to healthy breastfed infants and the provision of optimal post-discharge support.
The provision of non–breast milk fluids to healthy breastfed infants has been associated with suboptimal breastfeeding behaviors, shorter breastfeeding duration, and mothers being less likely to meet their own breastfeeding intention.
Post-discharge support needs to improve
From 2007 to 2013, the percentage of hospitals providing adequate post-discharge support increased by only 20%. Problems with breastfeeding, such as trouble getting the baby to latch, pain, and a perception of insufficient milk, are common among new mothers and are associated with shorter duration of breastfeeding.
In a study of first-time mothers that assessed concerns with breastfeeding at several time points during the first 2 months of life, these problems were most pronounced at 3 and 7 days postpartum, which is after most women have left the hospital, but before they might be connected to other types of community support.
These early breastfeeding problems can often be overcome with early support and management. To receive this support, however, mothers need to have a continuum of care that extends from the hospital to other providers and programs in the first few weeks postpartum
Facilities providing maternity care need to adopt evidence-based practices to support breastfeeding. Experiences in the first hours and days after birth help determine later breastfeeding outcomes and improved hospital policies and practices could increase rates of breastfeeding nationwide, contributing to improved child health.
For Hospitals: 10 Steps to Successfully Support Breastfeeding
- Have a written breastfeeding policy that is routinely communicated to all health care staff
- Train all health care staff in skills necessary to implement this policy
- Inform all pregnant women about the benefits and management of breastfeeding
- Help mothers initiate breastfeeding within one hour of birth
- Show mothers how to breastfeed, and how to maintain lactation, even if they should be separated from their infants
- Give breastfeeding newborn infants no food or drink other than breastmilk, unless medically indicated
- Practice rooming-in—allow mothers and infants to remain together 24 hours per day
- Encourage breastfeeding on demand
- Give no artificial teats or pacifiers to breastfeeding infants
- Foster the establishment of breastfeeding support groups and refer mothers to these groups on discharge from the hospital or clinic
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