To describe mothers’ exclusive breastfeeding intentions and whether Baby-Friendly hospital practices are associated with achieving these intentions.
In the 2005–2007 Infant Feeding Practices Study II, women completed a prenatal questionnaire and approximately monthly questionnaires through 12 months. Mothers met their prenatal exclusive breastfeeding intention if their duration after the hospital stay (excluding hospital supplementation) equaled or exceeded their intention. Primary predictor variables included 6 Baby-Friendly hospital practices: breastfeeding within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, and information on breastfeeding support.
Among women who prenatally intended to exclusively breastfeed (n = 1457), more than 85% intended to do so for 3 months or more; however, only 32.4% of mothers achieved their intended exclusive breastfeeding duration. Mothers who were married and multiparous were more likely to achieve their exclusive breastfeeding intention, whereas mothers who were obese, smoked, or had longer intended exclusive breastfeeding duration were less likely to meet their intention. Beginning breastfeeding within 1 hour of birth and not being given supplemental feedings or pacifiers were associated with achieving exclusive breastfeeding intention. After adjustment for all other hospital practices, only not receiving supplemental feedings remained significant (adjusted odds ratio = 2.3, 95% confidence interval = 1.8, 3.1).
Two-thirds of mothers who intend to exclusively breastfeed are not meeting their intended duration. Increased Baby-Friendly hospital practices, particularly giving only breast milk in the hospital, may help more mothers achieve their exclusive breastfeeding intentions.
Breastfeeding should not hurt. If there is a proper latch, there is no pain so the education provided under the initiative helps with that. The point is that the excuses women give for not breastfeeding can be reduced and replaced with women breastfeeding comfortably and happy. Why does that matter? Provided with the proper resources, practices and education, more women breastfeed, which was their intention. No reason to be upset at these highly predictable findings.
Conflict of Interest:
None declared
I'm deeply puzzled that the authors didn't ask mothers why they stopped breastfeeding. They might have drawn entirely different conclusions if they had.
The authors did not consider a very important explanation for the disparity between mothers' intentions regarding length of breastfeeding and the actual length of exclusive breastfeeding:
Starting breastfeeding is difficult, painful, frustrating and inconvenient. And continuing breastfeeding is difficult, sometimes painful, and inconvenient, especially for women who work, which in 2012 is most women.
Unfortunately, because the authors did not ask women why they stopped breastfeeding, they elided this reality.
The discrepancy is not a surprise. Discrepancies between intention and outcome are a common result of resolutions that turn out to be more difficult than anticipated, including diet and exercise among other intentions.
Women stop breastfeeding for deeply personal reasons, including the fact that for many it is painful, difficult and inconvenient. If we refuse to address that reality and keep searching for solutions in hospital policies, we will not succeed in increasing breastfeeding rates.
Conflict of Interest:
None declared