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LLLI Center for Breastfeeding Information

Past Journal Abstracts of the Month

Journal Abstract of the Month for September 2007

“Hospital Practices that Increase Breastfeeding Duration: Results from a Population-Based Study”

Authors: Erin K. Murray, MSPH, RD, Sue Ricketts, MA, PhD, and Jennifer Dellaport, MPH, RD

Birth. 2007 Sept 34(3): 202-211

The United States based Healthy People 2010 breastfeeding goals include:

  • 75% of mothers breastfeeding their babies in the early postpartum period
  • 50% still breastfeeding at 6 months
  • 25% continuing to breastfeed for a full year after birth

In 2003, the US rates were 71% initiation, 36% still breastfeeding at 6 months, with only 14% exclusively breastfeeding. While we are well on our way to achieving the first goal of 75% initiation, clearly something happens between the newborn period and 6 months. This study takes a look at some of the hospital practices that might be affecting those duration rates—and it has implications for La Leche League Leaders wanting to increase the breastfeeding rates in their communities.


Using data from the 2002-2003 Pregnancy Risk Assessment Monitoring System (PRAMS) for the state of Colorado (whose initiation rates estimated at 83% are among the best in the country), researchers wanted to look at the effect of hospital practices on breastfeeding duration. The specific hospital practices are those defined by the Baby Friendly Hospital Initiative’s “Ten Steps to Successful Breastfeeding” (see box).

In an effort to isolate the impact of the various steps, births at hospitals designated as “Baby Friendly” were excluded from the study, as were non-breastfeeding infants and infants deemed “at risk” (low birthweight, preterm, neonatal intensive care unit admission at birth, or multiple births).

Using a surveys of approximately 3000 Colorado women within 2 to 4 months after birth in each of the two years, there were 2,172 mothers providing data for the study. Questions used in the study asked mothers about the hospital practices they experienced during delivery and the early postpartum period and correlated them with breastfeeding duration at 16 weeks. Researchers also looked at whether the impact of the studies varied by socioeconomic status.


Five of the hospital practices studied had the greatest impact on duration of breastfeeding at 16 weeks:

  • Baby breastfed in the first hour after birth
  • Baby fed only breast milk in hospital
  • Baby stayed in same room with mother
  • Baby did not use pacifier in hospital
  • Hospital gave mother phone number to call for breastfeeding help

Not only did these five practices have the greatest impact on breastfeeding rates individually, but two-thirds (68%) of the mothers who experienced all five of the practices were still breastfeeding at 16 weeks, as compared to one-half (53%) of the mothers who experienced anything less than all five. Only about one fifth (18%) of the mothers experienced all five practices.

The difference in duration rates was consistent across socioeconomic groups as well, although low-income mothers were less likely to breastfeed than higher-income mothers.

Researchers also looked at the reasons that mothers gave for stopping breastfeeding. The top reasons were related to a mother’s ability (or perception of her ability) to establish successful breastfeeding. The reasons given were compared across the two groups of mothers (those who experienced all 5 hospital practices, and those who experienced less than 5):

Top Reasons for
Stopping Breastfeeding

Mothers experiencing all 5 successful practices

(Total N = 141)

N  (%)

Mothers who did NOT experience all 5 successful practices 

(Total N = 1349)

N   (%)

Not producing enough milk 47 (31) 588 (44) < 0.001
Milk did not satisfy 48 (36) 501 (41) < 0.001
Difficulty nursing 25 (15) 440 (30) < 0.001
Stopped breastfeeding for any one of the top (12) reasons 83 (57) 949 (70) < 0.001

Once again, the mothers who experienced all 5 of the successful hospital practices were less likely to stop breastfeeding for those top reasons.

Researchers conclude:

To increase breastfeeding duration, physicians and hospital administrators must increase their efforts to establish and maintain a breastfeeding culture that promotes hospital practices supportive of breastfeeding within their institutions. (p. 210)

What Does This Study Mean to LLL Leaders?

These “successful hospital practices” should come as no surprise to La Leche League Leaders. We have been telling mothers these things for years. Mothers can have influence and say-so concerning most—if not all—of these 5 practices, provided they know ahead of time that it matters. Series Meeting 2: The Baby Arrives provides a perfect opportunity to discuss the importance of planning for not only the birth, but also those first hours and days after birth.

By establishing a relationship with the pregnant mothers she comes in contact with, the La Leche Leader is ensuring that the mother will at least have that phone number to call for help—regardless of whether the hospital provides it for her. Helping the mother understand WHY breastfeeding within the first hour after birth, exclusive breastfeeding on cue, not using a pacifier, and rooming-in all contribute to establishing a good milk supply, empowers the mother to create success. And her LLL Leader can be there for her to share in her successes and help if problems develop. That’s mother-to-mother support at its best!


World Health Organization (WHO). Protecting, promoting and supporting breastfeeding: the special role of maternity services. A joint WHO/UNICEF statement, Geneva: WHO, 1989.

This paper is categorized by the following keywords:

Breastfeeding duration
Baby-Friendly Hospital Initiative
Hospital practices

For more information about current breastfeeding rates in the United States, see: For more information about current breastfeeding rates in the United States, see:

For additional information about breastfeeding from the CDC, go to


abstract by Melissa Clark Vickers, Huntingdon, TN USA

Past Journal Abstracts of the Month

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