Saturday, October 25, 2008

New study claims to show that hospital practices affect breastfeeding

A new study in a supplement to the October issue of Pediatrics claims to show that hospital practice affect breastfeeding. According to Effect of Maternity-Care Practices on Breastfeeding by DiGirolamo et al:
Increased "Baby-Friendly" hospital practices, along with several other maternity-care practices, improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to implement these practices continues to exist, as illustrated by the small proportion of mothers who reported experiencing all 6 of the "Baby-Friendly" hospital practices measured in this study.
However, reading the study and looking at the data indicates that the study shows only a very weak correlation between 3 of 6 breastfeeding initiatives and rate of breastfeeding. These weak correlations are far eclipse by the characteristics of the mothers themselves.

The study itself is well done.
This analysis of the Infant Feeding Practices Study II focused on mothers who initiated breastfeeding and intended prenatally to breastfeed for >2 months, with complete data on all variables (n = 1907). Predictor variables included indicators of 6 "Baby-Friendly" practices (breastfeeding initiation within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) along with several other maternity-care practices. The main outcome measure was breastfeeding termination before 6 weeks.
What did the authors find?

The first finding was that most women who intended to breastfeed for at least 2 months were still breastfeeding at 6 weeks. Over 85% of women who were still breastfeeding.

Second, the small proportion of women who had stopped breastfeeding by 6 weeks differed substantially from the women who had continued. They were much less likely to be married, have any college education, make more than $20,000/year, and this was much more likely to be their first child. These are very strong associations.

Third, all hospital practices designed to promote breastfeeding showed only weak associations with breastfeeding duration or no association at all. For example, after correcting for demographic differences, rooming in, breastfeeding on demand and information about breastfeeding did NOT have a statistically significant impact on breastfeeding duration. The hospital practices that did have statistically significant associations, breastfeeding initiation within 1 hours [OR= 0.71 (0.53–0.95)], no formula given [OR=0.47 (0.34–0.64)] and no pacifiers offered [OR=0.73 (0.54–0.99)], had only weak associations.

Frankly, I think the real message of this study is that for women who intend to breastfeed, hospital practices have no impact at all on breastfeeding duration. The claims of the authors are questionable at best. It makes no sense that breastfeeding on demand would have no impact on breastfeeding duration, but withholding a pacifier would have an impact on breastfeeding duration. All and all, it is interesting study, but it does not tell us much of anything about the value of hospital breastfeeding iniatitives on women who have already decided they will breastfeed. A much more interesting study would be to examine the impact of hospital practices on breastfeeding among women who have no strong feelings about feeding options.

0 Old Comments: