Providing Equitable Postpartum Breastfeeding Support at an Urban Academic Hospital

Area of Science:

• Public Health
• Maternal and Child Health
• Quality Improvement

Background:

• Exclusive breastfeeding rates at hospital discharge were significantly lower for obstetrician/gynecologist resident service clients (7%) compared to the hospital average (34%).
• A baseline survey revealed that 75% of resident clients believed it was best to supplement human milk with formula.
• Racial disparities were noted, with lower exclusive breastfeeding initiation rates among Hispanic and non-Hispanic Black participants compared to non-Hispanic White participants.

Purpose of the Study:

• To equitably increase exclusive breastfeeding rates at hospital discharge by 20% within 8 weeks among obstetrician/gynecologist resident service clients.
• To address and reduce racial disparities in exclusive breastfeeding practices within the study population.

Main Methods:

• A quality improvement project utilized a plan-do-study-act (PDSA) format, implementing interventions based on the Baby-Friendly Hospital Initiative (BFHI).
• Interventions included a prenatal infant feeding plan, a postpartum educational video with teach-back, cue-based feeding logs, and enhanced staff education.
• Run charts were used to monitor intervention effectiveness over time, with outcome data informing subsequent PDSA cycles.

Main Results:

• Exclusive breastfeeding rates at hospital discharge increased from 7% at baseline to 13% post-implementation.
• Significant improvements were observed among racial groups, with exclusive breastfeeding rates for Black clients rising from 0% to 16%.
• While clients demonstrated high knowledge of Baby-Friendly practices (89% teach-back average), 65% continued to supplement with formula, primarily due to supply concerns.

Conclusions:

• Equitable implementation of BFHI steps can effectively reduce racial disparities in early postpartum breastfeeding.
• Initiating breastfeeding preparation and education prenatally is crucial for supporting families in achieving exclusive breastfeeding goals.
• Addressing maternal concerns about milk supply is essential to further enhance exclusive breastfeeding rates.