The hospital policy on breastfeeding project to promote breastfeeding in Italy: not so ambitious, still effective.

Abstract

Background: According to the available data, the breastfeeding rate at hospital discharge is suboptimal in Italy. The present study aims to evaluate the effectiveness of the Hospital Policy on Breastfeeding (HPB) Project launched by the Italian scientific societies specialising in perinatal care to promote breastfeeding in maternity hospitals (MHs).

Methods: The HPB project was designed as an open before-after study to increase the rate of exclusive breastfeeding at hospital discharge in a population of healthy term infants with a normal birth weight following a bundle intervention. The primary outcome was the breastfeeding rate at hospital discharge. The secondary outcomes were data on the elements of the bundle intervention: 1) establishment of a local hospital breastfeeding working group, 2) adoption of a breastfeeding policy, 3) breastfeeding training for perinatal care professionals, 4) enhanced implementation of skin-to-skin contact practice at childbirth and mother-baby rooming-in, and 5) development and/or improvement of breastfeeding-related protocols.

Results: Of the 104 hospitals that were initially enrolled in a two-years study between February 2023 and January 2025, 97 completed it. The exclusive breastfeeding rate and the fully breastfeeding rate of healthy term newborns with a normal birth weight at hospital discharge increased from 67.3% to 71.0% (p < 0.001), and from 69.3% to 71.3% (p < 0.001), respectively over a four-month period. Moreover, all secondary outcomes improved. Specifically: 1) more MHs set up a multidisciplinary breastfeeding working group, developed breastfeeding policy and prepared the breastfeeding-related protocols, 2) the proportion of perinatal healthcare workers trained in breastfeeding increased from 55.9% up to 71.7% (p < 0.001), and 3) the proportion of newborns who experienced skin-to-skin contact in the delivery room after vaginal delivery increased from 76.9% to 89.4% (p < 0.001), as did the proportion of newborns who experienced rooming-in, from 83.9% to 85.4% (p < 0.05), as measured over a one-month period.

Conclusion: The HPB Project successfully promoted exclusive breastfeeding at hospital discharge, as well as skin-to-skin contact and rooming-in practices, among healthy term infants with a normal birth weight, in a large sample of Italian MHs.