Breastfeeding Support on Upswing in Many US Hospitals

Troy Brown, RN

October 06, 2015

Hospitals have made great strides in facilitating breastfeeding in recent years, but more still needs to be done, according to a Vital Signs report from the Centers for Disease Control and Prevention (CDC).

Cria G. Perrine, PhD, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC, and colleagues published their findings October 6 in Morbidity and Mortality Weekly Report.

The Baby-Friendly Hospital Initiative is a worldwide program begun by the World Health Organization and the United Nations Children's Fund. At its foundation are the Ten Steps to Successful Breastfeeding, which outline evidence-based hospital policies and practices proven to improve breastfeeding outcomes.

In 2007, the CDC began conducting the biennial Maternity Practices in Infant Nutrition and Care (mPINC) survey among all birth facilities in the United States and its territories. The CDC evaluated data in 2007 (baseline), 2009, 2011, and 2013 to identify trends in the prevalence of birth facilities complying with the Ten Steps to Successful Breastfeeding.

Benefits for Health of Mothers and Babies

Breastfeeding has important benefits for the health of mothers and babies, Tom Frieden, MD, MPH, Director of the CDC, explained in a news teleconference.

"Breast-fed infants have lower risks [for] infections — ear infections, respiratory infections, intestinal infections, and others. They also have a lower risk [for] asthma, sudden infant death syndrome, and appear to have a somewhat lower risk [for] obesity," Dr Frieden said. "Mothers also benefit; mothers who breast-feed are less likely to get breast cancer, ovarian cancer, diabetes, and heart disease."

"Breast-feeding saves money," Dr Frieden noted. "It is estimated that more than $2 billion a year in annual medical costs for children could be saved if breast-feeding recommendations were met."

The Ten Steps to Successful Breastfeeding

"Of the 4 million babies born in the US each year, only 14% are born in hospitals designated as baby friendly. However, if we look at the number of hospitals that are adopting some aspects of baby friendly hospitals…the proportion implementing most of those steps doubled, from 29% in 2007 to almost 54% in 2013. That's a nearly two-fold increase in 6 years," Dr Frieden explained.

From 2007 to 2013 the number of states with ≥ 60% of hospitals implementing more than half of the steps described below increased from 4 to 21.

  • Have a written breastfeeding policy that is routinely communicated to all healthcare staff. Hospitals made considerable improvement in hospital implementation of a model breastfeeding policy from 2007 to 2013 (11.7% to 26.3%).

  • Train all healthcare staff in skills necessary to implement this policy. Staff competency improved from 44.6% in 2007 to 60.2% in 2013.

  • Inform all pregnant women about the benefits and management of breastfeeding. From baseline in 2007 and across survey years to 2013, most US hospitals provided prenatal breastfeeding education (range = 91.1% - 92.8%).

  • Help mothers initiate breastfeeding within 1 hour of birth. From 2007 to 2013, initiation of breastfeeding during the first hour of birth increased from 43.5% to 64.8%.

  • Show mothers how to breastfeed, and how to maintain lactation, even if they should be separated from their infants. From 2007 to 2013, the teaching of breastfeeding techniques to women increased from 87.8% to 92.2%.

  • Give breastfeeding newborn infants no food or drink other than breast milk, unless medically indicated. Progress was less than optimal regarding the feeding of nonbreast milk to breastfed infants. This metric increased from 20.6% in 2007 to only 26.4% in 2013.

  • Practice rooming-in — allow mothers and infants to remain together 24 hours per day. Rooming-in increased from 30.8% in 2007 to 44.8% in 2013.

  • Encourage breastfeeding on demand. Teaching of feeding cues increased from 77.0% in 2007 to 87.5% in 2013.

  • Give no artificial teats or pacifiers to breastfeeding infants. Limiting of pacifier use increased from 25.3% in 2007 to 45.0% in 2013.

  • Foster the establishment of breastfeeding support groups and refer mothers to these groups on discharge from the hospital or clinic. The availability of optimal postdischarge breastfeeding support also could use improvement, as this increased from 26.8% in 2007 to only 32.2% in 2013.

Impressive Progress

"What happens in the hospital can determine whether a mom starts and continues to [breastfeed], and we know that many moms — 60 percent — stop [breastfeeding] earlier than they'd like," Dr Perrine, said in a news release. "These improvements in hospital support for [breastfeeding] are promising, but we also want to see more hospitals fully supporting mothers who want to [breastfeed]. The Ten Steps help ensure that mothers get the best start with [breastfeeding]."

"With this effort, we worked with 89 hospitals in 29 different states to work towards baby-friendly designation. As of August, 50 of these hospitals have achieved baby-friendly designation, and the other 39 were in the final phase," Dr Perrine said at the teleconference. "This effort specifically targeted hospitals with a large number of births that were serving populations that were predominantly African-American and low income. As a result of this effort, an additional 155, 000 babies per year are now born in hospitals offering ideal [breastfeeding] with support."

[The Indian Health Service] began their baby friendly updates in 2011, and as of now, all 13 Indian Health Service hospitals are designated baby friendly.

What Healthcare Providers Can Do

"Every hospital that supports the delivery of babies can participate in CDC's mPINC survey and get an individualized report of how they compare to other hospitals. Hospitals can work with doctors, lactation consultants, and organizations to create networks that support breastfeeding mothers and their infants," Dr Frieden explained.

"Doctors and other healthcare providers can help write hospital policies that encourage mothers to breastfeed. They can counsel mothers on breastfeed during prenatal visits and include lactation care providers on patient care teams. They can support breastfeeding at hospital and at well-baby visits," Dr Frieden added.

"Next year the Joint Commission will be looking at exclusive breastfeeding during and at discharge unless medically contraindicated as a key indicator for hospitals," Dr Frieden concluded.

For more information about the CDC's work to improve hospital practices to support breastfeeding, visit For more information about breastfeeding rates, state programs, and other activities to support breastfeeding, please visit


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