Assessment of Breastfeeding Promotion in Maternity Hospitals Based on Specified International Recommendations-Experiences From Germany.

Background: The staff of maternity hospitals play an essential role in the start of breastfeeding. This study assessed specific aspects of breastfeeding promotion in German hospitals using the recommendations of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

Research aim: To identify specific hospital practices and structures that are in compliance with the recommendations and those that still need to be improved.

Method: A cross-sectional survey and descriptive analysis was conducted in 109 German hospitals. This web-based questionnaire examined the structural conditions and usual handling of breastfeeding support. Recommendations were reported using sub-criteria.

Results: The implementation of the sub-criteria ranged from less than 25% to more than 90%. Hospitals were more likely to have a breastfeeding policy (85.3%, n = 93) than a breastfeeding coordinator (73.4%, n = 80). Immediate skin-to-skin contact after birth and early breastfeeding initiation were implemented more frequently after a vaginal (89.9%, n = 98 and 71.6%, n = 78) than after Cesarean delivery (45.9%, n = 50 and 54.1%, n = 59). Additional feeding of fluids was usually restricted to a medical indication (70.6%, n = 77), however, the decision to feed formula was rarely made by hospital staff alone (27.5%, n = 30). Large hospitals (> 1000 births/year) had a written breastfeeding policy and a breastfeeding coordinator more frequently than smaller hospitals (p < 0.01, Fisher's exact test).

Conclusion: The use of sub-criteria of WHO recommendations helped identify critical parts of breastfeeding promotion in hospitals, providing concrete starting points for targeted interventions. This differentiated approach could be promising for future analyses of breastfeeding promotion.