摘要：Objectives. We sought to assess whether breastfeeding-related hospital practices reported by mothers were associated with achievement of their intentions to exclusively breastfeed. Methods. We used data from Listening to Mothers II, a nationally representative survey of 1573 mothers who had given birth in a hospital to a singleton in 2005. Mothers were asked retrospectively about their breastfeeding intention, infant feeding at 1 week, and 7 hospital practices. Results. Primiparas reported a substantial difference between their intention to exclusively breastfeed (70%) and this practice at 1 week (50%). They also reported hospital practices that conflicted with the Baby-Friendly Ten Steps, including supplementation (49%) and pacifier use (45%). Primiparas who delivered in hospitals that practiced 6 or 7 of the steps were 6 times more likely to achieve their intention to exclusively breastfeed than were those in hospitals that practiced none or 1 of the steps. Mothers who reported supplemental feedings to their infant were less likely to achieve their intention to exclusively breastfeed: primiparas (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI] = 2.1, 9.3); multiparas (AOR = 8.8; 95% CI = 4.4, 17.6). Conclusions. Hospitals should implement policies that support breastfeeding with particular attention to eliminating supplementation of healthy newborns. Exclusive breastfeeding through at least the first 6 months is the physiologically appropriate approach to infant feeding. 1 Mixed or formula feeding carries with it increased risks of infection, developmental problems, mortality, and long-term ailments such as diabetes and cancers for mother and child. 2 – 5 In support of the evidence, the American Academy of Pediatrics, 6 American College of Obstetrics and Gynecology, 7 the American Public Health Association, 8 the World Health Organization, 9 and many other medical and health professional organizations 10 – 12 recommend that infants consume only mother's milk (exclusive breastfeeding) for at least the first 6 months of life, followed by continued breastfeeding with age-appropriate nutrient-rich complementary foods. The revised US Healthy People 2010 national objectives call for 17% of new mothers to be exclusively breastfeeding at 6 months. 13 Nonetheless, national statistics indicate that less than 12% of mother–baby pairs achieve this goal. 14 The “Ten Steps for the Protection, Promotion and Support of Breastfeeding” 15 are the central part of the Baby-Friendly Hospital Initiative, along with adherence to the International Code of Marketing of Breast-Milk Substitutes and subsequent World Health Organization resolutions. 16 These practices have been reported to support breastfeeding behaviors and influence outcomes, 17 , 18 though in some cases they have been subjects of political disputes. 19 However, with the exception of a recent Centers for Disease Control and Prevention study 20 and some data from hospitals that have achieved “Baby-Friendly” status, little is known about the prevalence of these practices in hospitals across the United States. Grizzard et al. 21 assessed Massachusetts hospitals and noted that hospitals with high or moderately high levels of implementation significantly differed from hospitals with partial implementation with respect to pacifier usage ( P = .002) and postpartum breastfeeding instruction ( P < .001). Acceptance of free formula was significantly associated ( P = .03) with overall Ten Steps implementation. Although several international studies have concluded that even some progress toward “Baby-Friendly Hospital” status is associated with increases in breastfeeding, available US data 20 on the achievement of exclusive breastfeeding in relation to the number of steps in place are limited. The goal of our study was to provide clinical and hospital administrative decision-makers with the information they need to institute policies and practices that enhance a woman's ability to achieve her intended duration of exclusive breastfeeding. We examined the results of a national survey that asked mothers about their feeding intentions “as [they] came to the end of [their] pregnancy” and their actual feeding patterns 1 week after the birth. We also asked mothers to report on their experiences with hospital practices known to influence breastfeeding success. Based on past research, we expected that hospital practices would be related to the fulfillment of a plan to exclusively breastfeed.
