ArticleBirth (Berkeley, Calif.)2023
A dose-response relationship found between the Ten Steps to Successful Breastfeeding indicators and in-hospital exclusive breastfeeding in US hospitals.
Article in Birth (Berkeley, Calif.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Monitoring childbirth and immediate postpartum care quality: A scoping review of indicators in high-income countries.PloS one · 2026Article
- Longitudinal Association of Maternity Care Practices with Exclusive Breastfeeding in U.S. Hospitals, 2018-2022.Children (Basel, Switzerland) · 2025Article
- Changes in maternity care policies and practices that support breastfeeding as measured by the Ten Steps to Successful Breastfeeding - United States, 2018-2022.BMC pregnancy and childbirth · 2024Article
- Association Between Prepregnancy Body Mass Index and Newborn Breastfeeding Initiation.Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine · 2024Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundIn-hospital exclusive breastfeeding (EBF) is associated with longer breastfeeding durations, yet only 64% of US newborns are EBF for 7 days. The Ten Steps to Successful Breastfeeding (Ten Steps) are a set of evidenced-based maternity practices shown to improve breastfeeding outcomes; these were updated in 2018.
methodsUsing hospital-level data from the 2018 Maternity Practices in Infant Nutrition and Care Survey (n = 2045 hospitals), we examined the prevalence of implementation of Ten Steps indicators (each step and total number of steps implemented). Using linear regression, we also examined the association between the steps and EBF prevalence adjusted for hospital characteristics and all other steps. Discharge support was not included in the models since it primarily occurs after hospital discharge.
resultsThe most frequently implemented step was the provision of prenatal breastfeeding education (95.6%). Steps with low implementation included rooming-in (18.9%), facility policies supportive of breastfeeding (23.4%), and limited formula supplementation (28.2%). After adjusting for hospital characteristics and all other steps, limited formula supplementation (difference = 14.4: 95% confidence interval [CI]: 12.6, 16.1), prenatal breastfeeding education (difference = 7.0; 95% CI: 3.3, 10.8), responsive feeding (difference = 6.3; 95% CI: 3.7, 9.0), care right after birth (skin-to-skin; difference = 5.8; 95% CI: 4.2, 7.4), and rooming-in (difference = 2.4; 95% CI: 0.4, 4.6) were associated with higher in-hospital EBF prevalence. We found a dose-response relationship between the number of steps implemented and in-hospital EBF prevalence.
conclusionIncreased implementation of the updated Ten Steps may improve EBF and infant and maternal health outcomes.
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