title: A cohort study of exclusive breastfeeding from birth to hospital discharge and associated risk factors among infants born in hospital in three communities in Newfoundland and Labrador
Creators: name: Stanoev, Rosemary 
Publisher: name: Memorial University of Newfoundland
Year: 2023

description: Objective: To identify maternal (e.g. age, education level, partnership status), infant (e.g. gestational age, Apgar scores, ventilation), and hospital-level characteristics (e.g. type of delivery, facility, pain management) associated with exclusive breastfeeding in hospital in three communities in Newfoundland and Labrador. Methods: A retrospective cohort study of 1,556 infants born in Clarenville, Corner Brook, and Gander from 2015 to 2016. The primary outcome variable was exclusive breastfeeding from birth to hospital discharge, defined as the infant ingesting only mother’s own milk during hospital stay. For descriptive statistics, mean/standard deviation and frequency/proportion were provided for continuous and categorical variables, respectively. Logistic regression was used to identify significant risk factors associated with exclusive breastfeeding in hospital in the univariate and multivariate analysis. Results: 50.3% of the study population exclusively breastfed from birth to hospital discharge. There were significant differences (p < 0.05) in exclusive breastfeeding between hospital sites, with Gander having the highest rate at 59.5%, followed by Clarenville (49.7%), and Corner Brook (48.0%). There were differences across hospital sites in maternal education levels, gestational age, cesarian section rates, epidural use, episiotomies, induction rates, length of stay, forceps, and vacuum use (p < 0.05). Intervention rates were greatest in Clarenville, with a higher proportion of individuals undergoing induction, epidural, cesarian section, and operative vaginal delivery (p < 0.05). In the multivariate model, compared to Gander, infants from Clarenville (OR = 0.61, 95% CI: 0.41 – 0.92) and Corner Brook (OR = 0.55, 95% CI: 0.39 – 0.78) had significantly lower exclusive breastfeeding rates in hospital. Other significant factors associated with increased likelihood of exclusive breastfeeding from birth to discharge from hospital included no pre-existing diabetes (OR = 4.262, 95% CI: 1.201 – 15.118), not smoking (OR = 2.473, 95% CI: 1.814 – 3.371), post-secondary education (OR = 2.178, 95% CI: 1.624 – 2.922), infants not requiring bag-mask ventilation (OR = 1.928, 95% CI: 1.163 – 3.194), non-cesarian delivery (OR = 1.660, 95% CI: 1.297 – 2.126), and no narcotics and epidural during labour (OR = 1.475, 95% CI: 1.022 – 2.129). Vacuum use during delivery was associated with decreased likelihood of exclusive breastfeeding in hospital (OR = 0.472, 95% CI: 0.318 – 0.701). Conclusions: Hospital site of birth is significantly associated with exclusive breastfeeding from birth to discharge in Newfoundland and Labrador, adding to the literature that maternity practices and health policies contribute to infant feeding in hospital. Several other maternal and infant characteristics and interventions also contribute to exclusive breastfeeding from birth to discharge.