Have you heard the news? For the first time ever, the Centers for Disease Control and Prevention (CDC) has collected data about hospital and birth center maternity practices related to breastfeeding. This gives us a benchmark for assessing how such practices change over time—and, perhaps more importantly—it provides some direction for how maternity practices can be improved to provide crucial support for breastfeeding mothers.

About the survey
Nearly 2,700 U.S. hospitals and birth centers responded to the Maternity Practices in Infant Nutrition and Care Survey (mPINC) in 2007. The CDC requested that the person most
knowledgeable about the facility’s infant feeding and maternity practices complete it.

Questions were grouped into seven categories and addressed the following topics:

labor and delivery	mother-newborn skin-to-skin contact; early breastfeeding initiation
breastfeeding assistance	assessment, recording, and instruction provided on infant feeding; not giving pacifiers to breastfed newborns
mother-newborn contact	avoidance of separation during postpartum facility stay
newborn feeding practices	what and how breastfed infants are fed during facility stay
breastfeeding support after discharge	types of support provided after mothers and babies are discharged
nurse/birth attendant breastfeeding training and education	quantity of training and education that nurses and birth attendants receive

Researchers assigned scores ranging from 0 to 100 to facility responses, with “100” representing a practice most favorable toward breastfeeding.

Results
State-by-state, Arkansas had the lowest mean score (48), and New Hampshire and Vermont had the highest (81). In general, Southern states scored lower than any other region.

Scale-by-scale, breastfeeding assistance had the highest mean score (80). Nearly all facilities (99%) documented the feeding decisions of most maternity patients, and well over three-quarters (88%) said they taught most mothers breastfeeding techniques. However, well over half (65%) advised mothers to limit the duration of breastfeeding on each side (which is not supported by the medical literature). In addition, nearly half (45%) reported giving pacifiers to most healthy, full-term breastfed infants (even though current recommendations are to avoid pacifiers for at least the first couple of weeks following birth).

Additional findings include that many facilities (44%) do not make follow-up phone calls to breastfeeding mothers. Nearly one-quarter of facilities (24%) reported giving supplements to most healthy, full-term breastfed infants.

It may be no surprise that breastfeeding support after discharge scored the lowest of all the subscales (40). Nearly three-quarters of facilities (70%) give infant formula company packs to breastfeeding mothers at discharge.

It’s probably no surprise, either, that states’ mPINC scores seem to be correlated with state breastfeeding rates. The seven states that have reported having less than 30% of children breastfed for six months were also among those with the lowest mPINC scores. (Parents in Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, and West Virginia, what do you think? Did this survey get it right?)

What now?
Findings of the mPINC suggest that our hospitals and birth centers have a long way to go in providing truly breastfeeding-supportive care. Since some of their maternal and infant feeding practices are not evidence-based (feeding glucose water, not enabling skin-to-skin contact following birth, giving pacifiers, and more), parents who intend to breastfeed their babies need to know what standards of care they should expect from their birthing facilities.

Then, they need to ask. They need to ask as many questions as it takes to make sure that they—and their babies—receive breastfeeding-supportive practices (such as skin-to-skin care, rooming-in, no supplementation, no pacifiers, and more).