Combined pro-breastfeeding practices are advantageous in facilities providing maternity and newborn services

This study aimed to evaluate the association between a set of pro-breastfeeding practices in facilities providing maternity and newborn services and the prevalence of exclusive breastfeeding at 30 days postpartum, considering the contribution of each practice. A cross-sectional study nested within a cohort study was conducted with 287 women who delivered healthy term infants in two hospitals in southern Brazil. They were interviewed at home at 30 days postpartum. The following practices were evaluated: skin-to-skin contact soon after birth, breastfeeding in the first hour, uninterrupted rooming-in, professional support with breastfeeding, breastfeeding guidance, encouragement to breastfeed on demand, no supplementation with infant formula, and no pacifier use. A score of pro-breastfeeding practices was calculated using a logistic model, which allowed each practice to have its discriminatory capacity and difficulty estimated individually. Poisson regression was used to estimate the association between exclusive breastfeeding at 30 days and the pro-breastfeeding practice score. The prevalence of exclusive breastfeeding at 30 days was 61.7%. The practices with greatest discriminatory capacity, that is, those that contributed most to the score estimates, were professional support with breastfeeding, breastfeeding guidance, and encouragement to breastfeed on demand. The most difficult ones were breastfeeding in the first hour, encouragement to breastfeed on demand, and non-utilization of infant formula. For each unit (standard deviation) of increase in the score, there was an increase of 20% in the prevalence of exclusive breastfeeding at 30 days. We conclude that the set of pro-breastfeeding practices assessed here increased the effect of these practices on exclusive breastfeeding rates at 30 days.