Association of Hospital Practices and Early Postnatal Support with Breastfeeding Outcomes in Premature and Term...

Exclusive breastfeeding offers optimal benefits for infant nutrition and health and increases maternal involvement, bonding and interactions. This study aimed to explore breastfeeding practices among mothers in Romania and identify risk factors associated with low exclusive breastfeeding rates.

A cross-sectional online survey was conducted between September and December 2025, targeting mothers in Romania via social media platforms. The questionnaire, developed specifically for this study, collected data on sociodemographic characteristics, birth and neonatology variables, hospital practices, feeding intentions, community influences, and breastfeeding outcomes. Responses were analyzed using Fisher's exact tests and multivariable logistic regression.

A total of 357 complete questionnaires were analyzed. Cesarean section was the most frequent mode of delivery (54.6%), while immediate mother-infant contact after birth was reported by only 35.6% of mothers, and breastfeeding initiation within the first hour occurred in 10.6% of cases. Overall, 49.3% of mothers reported exclusive breastfeeding, 35.3% mixed feeding, and 15.4% exclusive formula feeding. Women who delivered in private hospitals reported earlier mother-infant contact, more frequent encouragement to initiate breastfeeding, and earlier breastfeeding initiation compared with those delivering in public hospitals. Preterm birth was associated with delayed breastfeeding initiation, reduced rooming-in, and lower rates of exclusive breastfeeding up to six months. In multivariable logistic regression, rooming-in was independently associated with higher odds of exclusive breastfeeding (aOR = 2.798, 95% CI: 1.779-4.401), while lack of lactation support was associated with lower odds (aOR = 0.546, 95% CI: 0.302-0.987). No significant associations were observed for timing of initial maternal-infant contact (aOR = 1.084, 95% CI: 0.679-1.733) or encouragement from medical staff to initiate breastfeeding (aOR = 1.207, 95% CI: 0.721-2.020).

Our study highlights current breastfeeding practices and associated hospital factors in Romania. However, significant challenges remain in supporting and encouraging mothers to optimally feed their infants. Additional investment and bold policy action are needed to promote and support breastfeeding from the first hour of life, for both term and preterm infants, in all maternity hospitals in Romania.