August 2011 

Hospital Support

for Breastfeeding 

Preventing obesity begins 

in hospitals 

 www http://www.cdc.gov/vitalsigns

Childhood obesity is an epidemic. In the US, 

1 preschooler in 5 is at least overweight, and half 

of these are obese. Breastfeeding helps protect 

against childhood obesity. A baby’s risk of becoming an overweight child goes down with each 

month of breastfeeding. In the US, most babies 

start breastfeeding, but within the first week, 

half have already been given formula, and by 9 

months, only 31% of babies are breastfeeding at 

all. Hospitals can either help or hinder mothers 

and babies as they begin to breastfeed. The BabyFriendly Hospital Initiative describes Ten Steps to 

Successful Breastfeeding that have been shown to 

increase breastfeeding rates by providing support 

to mothers. Unfortunately, most US hospitals 

do not fully support breastfeeding; they should 

do more to make sure mothers can start and 

continue breastfeeding.

 See page 4 

Want to learn more? Visit 

30% 

Breastfeeding for 9 months 

reduces a baby’s odds of 

becoming overweight by 

more than 30%. 

1 in 3 

Even mothers who 

want to breastfeed have 

a hard time without 

hospital support; about 

1 mother in 3 stops 

early without it. 

5%

About 5% of US babies are 

born in hospitals that are 

designated Baby-Friendly. 

National Center for Chronic Disease Prevention and Health Promotion 

Division of Nutrition, Physical Activity, and Obesity 

1
Most hospitals do not fully


support breastfeeding
 Problem 

1. Breastfeeding helps protect against 

childhood obesity and other illnesses, 

and lowers medical costs. 

◊ The American Academy of Pediatrics 

recommends babies be fed nothing but breast 

milk for about the first 6 months and continue 

breastfeeding for at least 1 year. 

◊ Babies who are fed formula and stop 

breastfeeding early have higher risks of obesity, 

diabetes, respiratory and ear infections, and 

sudden infant death syndrome (SIDS), and tend 

to require more doctor visits, hospitalizations, 

and prescriptions. 

◊ Low rates of breastfeeding add $2.2 billion a 

year to medical costs. 

◊ Mothers who breastfeed have lower risks of 

breast and ovarian cancers. 

2. Hospitals should do more to 

help mothers start and continue 

breastfeeding. 

◊ Hospitals that wait to start the first 

breastfeed, or separate babies from mothers, 

or routinely give formula to breastfeeding 

babies make it harder for mothers and babies 

to be able to breastfeed. 

◊ When hospitals support mothers to feed their 

babies only breast milk, it helps mothers to 

continue feeding only breast milk at home. 

3. Baby-Friendly hospitals make 

special efforts to support mothers to 

breastfeed. 

◊ The World Health Organization/UNICEF 

Baby-Friendly Hospital Initiative, endorsed 

by the American Academy of Pediatrics, 

recognizes hospitals that follow the Ten 

Steps to Successful Breastfeeding. 

◊ When hospitals have more of the Ten Steps 

to Successful Breastfeeding in place, mothers 

breastfeed longer. 

The Baby-Friendly Ten Steps to Successful Breastfeeding 

1. Have a written breastfeeding policy that is routinely communicated to all health care staff. 

2. Train all health care staff in skills necessary to implement this policy. 

3. Inform all pregnant women about the benefits and management of breastfeeding. 

4. Help mothers initiate breastfeeding within 1 hour of birth. 

5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. 

6. Give newborn infants no food or drink other than breast milk, unless medically indicated. 

7. Practice “rooming in”— allow mothers and infants to remain together 24 hours a day. 

8. Encourage breastfeeding on demand. 

9. Give no pacifiers or artificial nipples to breastfeeding infants. 

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the 

hospital or clinic. 

2 SOURCE: www.babyfriendlyusa.org/eng/10steps.html 
Percentage of any and exclusive breastfeeding 

by month since birth among US infants born in 2008 

75 

† Estimated at 7 days after birth 

† 

0 1 2 3 4 5 6 

52 

15 

75 

46 

69 

40 

64 

35 

59 

27 

52 

19 

47 44 

Any Breastfeeding 

Exclusive Breastfeeding* 

50 

*Exclusive breastfeeding = infant receives only 

breast milk and vitamins or medications, but no 

other solids or liquids. 

SOURCE: CDC National Immunization Survey 25 

0 

Percentage of US Infants 

Months 

Percentage of US hospitals with recommended policies and 

practices to support breastfeeding, 2007 and 2009 

Model breastfeeding policy 

Staff competency assessment 

Prenatal breastfeeding education 

Early initiation of breastfeeding 

Teach breastfeeding techniques 

Limited use of supplements 

Rooming-in 

Teach feeding cues 

Limited use of pacifiers 

Post-discharge support 

0 25 50 75 100 

Percentage of US Hospitals 

2007
 

2009
 

SOURCE: CDC National Survey of Maternity 

Practices in Infant Nutrition and Care (mPINC) 

Percentage of hospitals by number of 

recommended policies and practices 

to support breastfeeding in 2009 

9–10 practices 0–2 practices 

6–8 practices 

33% 

3–5 practices 

54% 

9%4% 

US State Info 

Percentage of births at Baby-Friendly facilities in 2011, by state 

AL

AZ

AR

CA CO

CT

FL

GA

IL IN

IA

KS

KY

LA

ME

MI

MN

MS

MO

NE

NH

NY

NC

ND

OH

OK

OR

PA

SC

SD

TN

TX

UT

VT

VA

D.C.

WA

WV

WI ID

MT

NV

NM

WY HI

AK

RI

MA

NJ

DE

MD

0%
 

>0–9%
 

10–19%
 

20% or more
 

SOURCE: Baby-Friendly facilities in 2011 

(www.babyfriendlyusa.org) and CDC National Center 

for Health Statistics 2009 Live Births 

3 
What Can Be Done 

We must help hospitals support mothers to breastfeed. 

 

 

Federal government can 

◊ Promote maternity care policies and practices 

that increase breastfeeding rates. 

◊ Track hospital policies and practices that 

support mothers to be able to breastfeed. 

◊ Help all federal hospitals implement the Ten 

Steps to Successful Breastfeeding. 

State and local government can 

◊ Set statewide maternity care quality standards 

for hospitals to support breastfeeding. 

◊ Help hospitals use the Ten Steps to Successful 

Breastfeeding, starting with the largest hospitals 

in the state. 

Hospitals can 

◊ Partner with Baby-Friendly hospitals to learn 

how to improve maternity care. 

◊ Use CDC’s Maternity Practices in Infant 

Nutrition and Care (mPINC) survey data to 

prioritize changes to improve maternity care 

practices. 

◊ Stop distributing formula samples and 

give-aways to breastfeeding mothers. 

◊ Work with community organizations, doctors, 

and nurses to create networks that provide 

at-home or clinic-based breastfeeding support 

for every newborn. 

◊ Become Baby-Friendly. 

Doctors and nurses can 

◊ Help write hospital policies that help every 

mother be able to breastfeed. 

◊ Learn how to counsel mothers on breastfeeding during prenatal visits, and support 

breastfeeding in the hospital and at each 

pediatric doctor’s visit until breastfeeding 

stops. 

◊ Include lactation consultants and other 

breastfeeding experts on patient care teams. 

◊ Coordinate lactation care between the 

hospital and outpatient clinic. 

Mothers and their families can 

◊ Talk to doctors and nurses about breastfeeding plans, and ask how to get help with 

breastfeeding. 

◊ Ask about breastfeeding support practices 

when choosing a hospital. 

◊ Join with other community members to 

encourage local hospitals to become 

Baby-Friendly. 

www http://www.cdc.gov/vitalsigns

 www http://www.cdc.gov/mmwr

CS225478B 

For more information, please contact 

Telephone: 1-800-CDC-INFO (232-4636) 

TTY: 1-888-232-6348 

E-mail: cdcinfo@cdc.gov 

Web: www.cdc.gov 

Centers for Disease Control and Prevention 

1600 Clifton Road NE, Atlanta, GA 30333 

4 Publication date: 08/02/2011