Hospitals' Use of Breastfeeding Standard Jumps Dramatically

AAFP Offers Additional Breastfeeding Resources for Family Physicians

October 26, 2015 01:39 pm Chris Crawford
[Young mother breastfeeding newborn]

Since 2007, the percentage of hospitals in the United States using the majority of the Ten Steps to Successful Breastfeeding( has increased dramatically, according to a recently posted issue of CDC's Vital Signs,( rising from about 29 percent in 2007 to 54 percent in 2013. This jump in breastfeeding support could help increase the prevalence of mothers breastfeeding their infants and subsequently lead to healthier children.

"Breastfeeding has immense health benefits for babies and their mothers," said CDC Director Tom Frieden, M.D., M.P.H., in a related news release.( "More hospitals are better supporting new moms to breastfeed -- every newborn should have the best possible start in life."

The AAFP has endorsed the Ten Steps to Successful Breastfeeding, which were developed by the World Health Organization and UNICEF in 1989 to boost breastfeeding initiation and duration. The steps form the core of the collaboration's Baby-Friendly Hospital Initiative,( a global program launched in 1991 "to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding."

Story Highlights
  • Since 2007, the percentage of hospitals in the United States using the majority of the Ten Steps to Successful Breastfeeding has nearly doubled, according to the CDC.
  • A Vital Signs report from the agency examined data from the CDC's Maternity Practices in Infant Nutrition and Care survey, which measures the percentage of U.S. hospitals with practices that are consistent with the 10 steps.
  • Family physicians can help support breastfeeding mothers by using the AAFP's extensive resources.

Of the nearly 4 million infants born each year in the United States, 14 percent are born in "Baby-friendly" hospitals -- a number that has almost tripled in recent years, but still remains relatively low.

"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," said Cria Perrine, Ph.D., an epidemiologist in CDC's Division of Nutrition, Physical Activity and Obesity, in the 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."

Findings from CDC Survey

According to the complete Vital Signs report( published in Morbidity and Mortality Weekly Report, the findings are based on data from the CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) survey,( which measures the percentage of U.S. hospitals with practices that are consistent with the 10 steps.

The steps include:

  • educating all pregnant women about the benefits and management of breastfeeding,
  • helping mothers initiate breastfeeding within one hour of birth,
  • keeping mothers and babies together throughout the entire hospital stay, and
  • fostering the establishment of breastfeeding support groups and referring mothers to these groups after hospital discharge.

Some encouraging findings from the Vital Signs report include the fact that across all survey years, hospital staff provided high levels of prenatal breastfeeding education (91 percent in 2007 and 93 percent in 2013) and instruction in specific breastfeeding techniques for new mothers (88 percent in 2007 and 92 percent in 2013). Also, early initiation of breastfeeding increased from about 44 percent in 2007 to nearly 65 percent in 2013.

But other data from the survey pointed to areas for potential improvement. For example, in 2013

  • just 26 percent of hospitals ensured that only breast milk was given to healthy, breastfeeding infants who didn't need infant formula for a medical reason;
  • only 45 percent of hospitals kept mothers and babies together throughout the entire hospital stay, which provides opportunities to breastfeed and helps mothers learn feeding cues; and
  • only 32 percent of hospitals provided adequate support for breastfeeding mothers when they left the hospital, including a followup visit and phone call and referrals for additional support.

To better support breastfeeding mothers, the report suggested hospitals

  • implement the Ten Steps to Successful Breastfeeding and work toward achieving Baby-Friendly status;
  • use the CDC's mPINC survey's customized reports to improve maternity care practices that support breastfeeding; and
  • work with doctors, nurses, lactation specialists and organizations to create networks that provide clinic-based, at-home or community breastfeeding support for mothers.

Resources for Family Physicians

AAFP member Anne Montgomery, M.D., M.B.A., of La Quinta, Calif., who chaired the working group that developed the Academy's breastfeeding position paper, told AAFP News there is good evidence that the more of the 10 steps health care professionals follow, the better the outcomes for breastfeeding mothers. "So it is excellent news that hospitals are making progress," she said.

Montgomery said family physicians can supplement that progress by supporting breastfeeding mothers in their practices, and she recommended Academy members use the extensive resources the AAFP has developed to support their efforts.

And although hospitals are doing a better job of improving breastfeeding initiation rates, the biggest challenge for the country remains boosting continuation rates, she said.

"Mothers face lots of barriers in meeting their breastfeeding goals," Montgomery said. "Even family physicians who don't do maternity care can make a big difference by advocating for adequate paid maternity leave, helping protect public breastfeeding and ensuring adequate workplace support for breastfeeding."

Related AAFP News Coverage
New Breastfeeding Toolkit Offers Comprehensive Resource
Academy Provides Tools for Clinical Use, Coding and Patient Education


AAFP Resources Encourage FPs to Promote, Support Breastfeeding
Updated Position Paper Offers Comprehensive Information, Key Recommendations


Additional Resources
Pediatrics: Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention(

Pediatrics: Effect of Maternity-Care Practices on Breastfeeding(