Hospital Accreditation Doesn't Ensure Breastfeeding

March 13, 2013

By Andrew M. Seaman

NEW YORK (Reuters Health) Mar 13 - For efforts to promote breastfeeding, making sure that a hospital follows so-called baby-friendly practices is more important than whether it is formally accredited by a breastfeeding initiative, according to a new study.

Australian researchers found that new mothers were more likely to be breastfeeding their newborns a few months after delivery if their hospitals followed the Baby-Friendly Hospital Initiative (BFHI) guidelines, than if they gave birth in a hospital accredited by the Initiative.

"The paper shows that components of the BFHI steps are important for breastfeeding continuation and are more important than whether a hospital has BFHI accreditation or not," wrote Dr. Wendy Brodribb, the study's lead author from The University of Queensland, in an email to Reuters Health.

Created in 1991 by the World Health Organization and the United Nations Children's Fund, the Initiative was built around 10 steps designed to improve the odds of women breastfeeding their children.

Those steps include informing women about the benefits of breastfeeding, helping them breastfeed within the hour after delivery, and allowing new mothers to stay in the same room as their child - also known as rooming in.

The Initiative also accredits hospitals that follow those 10 steps. There are 154 accredited hospitals in 37 U.S. states and the District of Columbia, according to Baby-Friendly USA, which oversees the U.S. accreditation program.

According to the researchers, accrediting hospitals under the Initiative has resulted in increased breastfeeding rates.

But some questioned whether the Initiative helps in countries where mothers already regularly breastfeed their children. In Australia, for example, 94% of mothers breastfeed at birth and 64% still breastfeed four months later.

In the U.S., according to the Centers for Disease Control and Prevention, 77% of new mothers start out breastfeeding and 47% are still doing it, though not necessarily exclusively, six months later.

For the new study, Dr. Brodribb and her colleagues surveyed about 7,000 mothers four months after they gave birth in Queensland from February 1 to May 31, 2010.

Overall, about 96% of the women were breastfeeding right after delivery, and giving birth at a BFHI-accredited hospital did not seem to increase the number of women breastfeeding over the next few months.

In fact, women who gave birth in accredited hospitals were slightly less likely to be breastfeeding one month after birth, compared to women who gave birth in non-accredited hospitals.

The researchers wrote March 11 online in Pediatrics that they can't tell from their data what could have caused that decrease.

They did find, however, that women were more likely to be breastfeeding in the four months after birth if they delivered in a hospital that followed four of the ten steps outlined by the Initiative.

Those specific steps were breastfeeding within the hour after delivery, rooming in, giving the newborn no other food or drink, and immediately putting the baby against its mother's skin.

In the study, mothers were two to three times more likely to still be breastfeeding one and four months after birth if all of those steps were taken, compared to women who were exposed to less than those four steps.

"It's really the practices that the mothers experience that's really important for increasing the number of mothers who breastfeed," said Trish MacEnroe, executive director of Baby-Friendly USA in Albany, New York.

MacEnroe, who was not involved with the study, said she can't speak for Australia, but it's crucial to make sure hospitals continue to practice BFHI steps once accreditation is achieved.

"We don't want people to just get our prize and say 'we're done.' We want these practices to be sustained," she said.

Dr. Brodribb also said that their findings should not be interpreted to mean that the Initiative does not work. Instead, it shows that both accredited and non-accredited hospitals in Australia have adopted the 10 steps, she said.

"The BFHI initiative has led the change in maternity care. Without it many of these practices would not have been implemented in either the accredited or non-accredited hospitals and many women would not have breastfed successfully," Dr. Brodribb said.


Pediatrics 2013.