Few Hospitals Take Steps Needed to Encourage Breast-Feeding

From Medscape Medical News

Nancy A. Melville

August 3, 2011 — Only a small percentage of hospitals in the United States practice the full range of key strategies that the World Health Organization (WHO) advocates to support and encourage breast-feeding among new mothers, according to a new report from the Centers for Disease Control and Prevention published online August 2.
Breast-feeding is well known to provide a plethora of important health benefits to children, including protecting against childhood obesity and preventing infectious illnesses. However, the report indicates, only 14% of hospitals have a written, model breast-feeding policy.
In addition, healthy infants are regularly given formula even when it is not necessary at nearly 80% of hospitals, a practice that significantly hinders a mother's efforts to learn breast-feeding and to feed her infant solely on breast milk at home.
Only a third of hospitals practice "rooming in," in which the baby stays in the room with the mother, allowing for frequent opportunities to learn breast-feeding. And nearly 75% of hospitals fail to provide follow-up support, such as a home visit, a phone call from staff, or referral to lactation consultants after leaving the hospital.
"Hospitals play a vital role in supporting a mother to be able to breastfeed," said CDC Director Thomas R. Frieden, MD, MPH, in a press statement.
"Those first few hours and days that a mom and her baby spend learning to breastfeed are critical. Hospitals need to better support breastfeeding, as this is one of the most important things a mother can do for her newborn."
The findings represent data from the CDC's national survey of Maternity Practices in Infant Nutrition and Care, part of the WHO and UNICEF's Baby-Friendly Hospital Initiative. The initiative's core mission is to advocate "Ten Steps to Successful Breastfeeding" that hospitals should follow to improve breast-feeding initiation, duration, and exclusivity.
The evidence-based steps, endorsed by the American Academy of Pediatrics, include the specification that hospitals refrain from giving formula or food other than breast milk to healthy infants unless there is a medical need for it.
Hospitals should also encourage mothers to room in and stay in the company of their infant 24 hours a day, and they should provide new mothers with the follow-up communication and resources to continue to receive breast-feeding support after leaving the hospital.
The report, which looked at data from 2007 and 2009, showed that only a tiny percentage of hospitals — 2.4% — recommended practices covering at least 9 of the 10 steps in 2007, and the figure improved only slightly to 3.5% by 2009.
Most hospitals did provide some breast-feeding support by 2009: 93% had staff members offer prenatal breast-feeding education, 89% taught mothers breast-feeding techniques, and 82% taught mothers how to recognize breast-feeding cues from their newborns.
But the low rate of hospitals that practice the WHO/UNICEF Ten Steps of Successful Breastfeeding suggests most still fall short in providing new mothers adequate breast-feeding support, the authors wrote.
"These data illustrate the persistent use of practices that are inconsistent with best-practice standards and do not support breastfeeding," they said.
One important reason why hospitals fail to adopt the full range of recommended breast-feeding strategies is a perception of higher costs; however, following the steps appropriately should not cost significantly more, explained study coauthor Cria G. Perrine, PhD, in a CDC press briefing on Tuesday.
"We do have data that suggests that a baby-friendly hospital is no more than the cost of the birth in a non baby-friendly hospital, so while there may be costs associated with becoming baby-friendly, those depend on where they are and what improvements they need to make," said Dr. Perrine, an epidemiologist with the CDC's Division of Nutrition, Physical Activity and Obesity.
The breast-feeding efforts could in fact lead to reduced expenses in the long-term, Dr. Frieden added at the press briefing.
"Some hospitals have found that going baby-friendly has not significantly increased their expenses, and of course, it will substantially reduce health care expenditures overall, as children are less likely to need to come back with respiratory infections and diarrhea and ear infections, and mothers are less likely to get ovarian and breast cancer, " stated Dr. Frieden.
Suboptimal breast-feeding in the United States results in an estimated $2.2 billion in additional direct medical costs annually, according to the report.
Dr. Frieden also added that hospitals often have relationships with formula providers that result in new mothers receiving formula for free.
"The formula companies will often provide free formula for the infants who are premature or otherwise need special formulas, and they do that in exchange for the hospital promoting formula, basically, by giving formula to every mother who leaves the hospital, and that deal saves the hospital some cash in the purchase of the specialty formulas."
Evidence, meanwhile, indicates that children are much better off with breast milk alone. One recent meta-analysis showed that children who were breast-fed for 9 months or more had a more than 30% reduced odds of becoming overweight, compared with those who were never breast-fed. Also, the risk for infections and illnesses in children is increased when breast-feeding is discontinued early, according to the report.
Considering the benefits, hospitals should give breast-feeding support a higher priority, Dr. Frieden said at the press briefing.
"We're a very long way from where we need to be," he said. "Currently, only about 1 in 6 mothers, [that is] 15% of mothers, breastfeed exclusively for 6 months, and less than half of mothers, 44%, breastfeed at all for 6 months. Seventy-five percent of women start breastfeeding in the hospital, but many barriers are presented that make it less likely that women who want to breastfeed will do so," he added.
"In fact, less than 1 out of 20 babies born in the US in this year is born in a hospital that meets the baby-friendly guidelines of the World Health Organization and UNICEF."
MMWR Morb Mortal Wkly Rep. Published online August 2, 2011.