Hospitals' Influence on Breastfeeding

I mentioned that I would post on my senior seminar topic literally months ago and I'm just now getting around to it.  Infant and gestational nutrition just so happen to be the most fascinating topics to study, in my opinion.  I was originally going to just write about breastfeeding benefits in general but another girl in my class picked that topic.  I decided to go with a subtopic, and something that I firmly believe is a problem.  However, now that I am in nursing school (and already overwhelmed by it all), I hope I can successfully promote breastfeeding.  P.S. I wrote this paper in a pretty short amount of time due to nursing applications, entrance exams, and regular class exams.  I am aware that it is one of the worst papers I have ever written as far as wording.  That is all.

            The World Health Organization recommends that infants be exclusively breastfed for six months ¹.  Breastfeeding has endless benefits including sensory and cognitive development¹.  It is also important for immunity to many diseases and deficiencies.  Despite the number of benefits, many women choose not to breastfeed.  In an effort to discover why some women choose not to breastfeed exclusively, studies have been conducted and found that hospitals may play a role in the decision to not breastfeed.

            The reason for such a big push to breastfeed is all of the benefits to both the infant and the mother.  The skin-to-skin contact encourages bonding between the two as well as reduces infant crying ².  Breastfeeding also has numerous immunological effects.  It has been shown to reduce the risk of respiratory disease, asthma and wheeze, diarrhea, atopic disease, and gastrointestinal illness ².  While the infant is consuming breast milk, the mother’s immunities are passed on to the infant.  The infant will no longer have these immunities when it stops drinking the breast milk.  Recent findings have also shown that breastfeeding can guard against diabetes and obesity ².  Increased cognitive development and intelligence have been shown to increase due to breastfeeding as well ².  For the mother, breastfeeding can reduce the risk of pre-menopausal breast cancer and ovarian cancers ².  It also has emotional benefits for the mother.  Some of the benefits include attachment, relaxation, decreased perceived stress, and a decrease in

 negative moods ². 

Table 1.

All of these benefits have a direct link to exclusive breastfeeding and influence each mother individually.

            One factor that influences a woman’s decision in regards to breastfeeding is the receipt of a commercial hospital discharge pack.  These discharge packs typically include free formula or coupons for formula and are endorsed by the formula companies.  One study assessed the relationship between these discharge packs and exclusive breastfeeding ³.  A survey with 3,895 respondents was analyzed.  Of the respondents, 66.8% claimed to have received a commercial hospital discharge pack from the hospital they where they delivered ³.  Further investigation concluded that women who received a commercial hospital discharge pack were more likely to exclusively breastfeed for less amount of time than those who did not receive a commercial hospital discharge pack ³. 

Table 2.

It should be noted in Table 2 that almost 70% of all respondents were given commercial hospital discharge packs.  Among those who received the discharge packs, there was a negative correlation with elongated exclusive breastfeeding.  For those respondents that did not receive commercial hospital discharge packs, there was a positive correlation with elongated exclusive breastfeeding.  The conclusion is that mixed messages are being sent through the verbal instruction for breastfeeding and the physical example by means of commercial hospital discharge packs ³.

            While reports demonstrate the negative relationship between commercial hospital discharge packs and breastfeeding, hospitals still continue to distribute the discharge packs regularly.  Despite 88% of hospital facilities reporting that they initiated breastfeeding instruction to mothers, many actions contradict those teachings ⁴.  These unfavorable procedures include 65% of facilities directing mothers to regulate length of breastfeeding and 45% of facilities providing pacifiers to full-term, healthy infants ⁴.  Even more disturbing, 41% of breastfed infants in the hospital are given formula ⁴.  In regards to the commercial hospital discharge pack study mentioned, 70% of hospitals distribute these packs while 93% give them out to at least some mothers ⁴.  Table 3 gives some recommendations as to how to improve the quality of breastfeeding care in hospitals.

Table 3.

 

The study provides these recommendations based on the Baby-Friendly Hospital Initiative, which is the “gold standard” for breastfeeding care in hospitals ⁴.  The improvement of hospital breastfeeding practices could help with the elongation of breastfeeding.

            Hospitals have enough influence to inhibit a mother’s decision to elongate breastfeeding but they also have the ability to successfully promote breastfeeding through counseling.  Insufficient lactation is reported to be the most common reason why mothers have difficulties breastfeeding within the first few months after delivery ⁵.  Under normal, healthy conditions of the mother, breast milk is satisfactory, in both quality and quantity, for the needs of a growing infant ⁵.  Sakha reports that a mother’s inadequate knowledge of breastfeeding is the main reason for believing they have insufficient lactation.  In the study, proper training resulted in weight gain of 85.7% of the 63 infants.

Table 4.

A separate study showed that 94% of the mothers who participated in breastfeeding training decided to exclusively breastfeed till their infant was four months old ⁵.  The studies exemplify that proper breastfeeding training resulted in more breastfeeding success as well as a longer duration.

            The conclusion is that the majority of hospitals contribute to breastfeeding in a negative way.  Despite the numerous benefits of breastfeeding, such as immunological benefits, hospitals still widely use commercial hospital discharge packs that typically include formula or coupons for formula.  Studies have shown a negative correlation between elongation of breastfeeding and commercial hospital discharge packs.  Regardless of the current negative impact on breastfeeding, hospitals have the potential to promote breastfeeding and the elongation of its duration.  A survey of pediatricians showed that 55% of its respondents were in support of the elimination of hospital gifts bags ⁶.  The avocation for the removal of commercial hospital discharge packs and the establishment of correct breastfeeding training by health care professionals and patients may help expand the instance of elongated breastfeeding to six months.

References

1. World Health Organization. Exclusive breastfeeding. (2010). Retrieved from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/
2. Sloan, S., Sneddon, H., Stewart, M., & Iwaniec, D. (2006). Breast is best? Reasons why mothers decide to breastfeed or bottlefeed their babies and factors influencing the duration of breastfeeding. Child Care in Practice, 12(3), pg. 283-297.
3. Rosenberg, K., Eastham, C., Kasenhagen, L., & Sandoval, A. (2008). Marketing infant formula through hospitals: the impact of commercial hospital discharge packs on breastfeeding. Research and Practice, 98(2), pg. 290-296.
4. Bartick, M., Stuebe, A., Shealy, K., Walker, M., & Grummer-Strawn, L. (2009). Closing the quality gap: promoting evidence-based breastfeeding care in the hospital. Pediatrics, 124(4), pg. 793-801.
5. Sakha, K. (2009). The Role of the proper breastfeeding training in promoting lactation. Iranian Journal of Pediatrics, 19(4), pg. 354-358.
6. Revai, K., & Huston, R. (2009). Hospital distribution of formula discharge bags: opinions of Texas pediatricians. Breastfeeding Medicine, 4(3), pg. 157-160.