Study of mothers' perceptions of breastfeeding support in Lithuania: is Baby-Friendly Hospital status associated with better breastfeeding support?

Résumé

BACKGROUND: Breastfeeding support provided by healthcare professionals plays an important role in successful breastfeeding initiation and continuation. Previous studies have shown that breastfeeding-supportive maternity care and implementation of the Baby-Friendly Hospital Initiative (BFHI) are associated with improved breastfeeding outcomes and more positive maternal experiences [1, 2]. However, evidence regarding mothers' perceptions of breastfeeding support in Lithuania remains limited, and little is known about potential differences between Baby-Friendly and non-Baby-Friendly hospitals. The aim of this study was to evaluate maternal perceptions of breastfeeding support provided in Lithuanian maternity hospitals and to compare breastfeeding support between Baby-Friendly and non-Baby-Friendly hospitals. In addition, a secondary aim was to explore the internal structure of the newly developed questionnaire using exploratory factor analysis to facilitate interpretation of breastfeeding support domains.METHODS: This cross-sectional comparative observational study was conducted in June 2022. Women (2-6 months postpartum) who had given birth to a healthy full-term infant in Lithuania completed an anonymous online questionnaire distributed via national social media parenting groups. Differences in breastfeeding support between Baby-Friendly and non-Baby-Friendly hospitals were analysed using descriptive statistics and appropriate statistical tests (Mann-Whitney U and χ² tests). Exploratory factor analysis was performed to examine the internal structure of the breastfeeding support questionnaire.RESULTS: A total of 572 women aged 18-45 years participated in the study; 65.7% delivered in a Baby-Friendly Hospital (BFH), and 76.2% were still breastfeeding at the time of the survey. Overall, breastfeeding support was evaluated as moderate, with a median total score of 65.0 out of 110 points (IQR 49-81). The highest-rated services were those provided by healthcare professionals (HCPs) during the first hours after childbirth (mean score 3.76 (SD 1.1) out of 5), while the lowest-rated were services related to HCPs' support for continued breastfeeding after discharge (mean score 2.40 (SD 1.0) out of 5). Most women reported that they had been given the opportunity for early breastfeeding and skin-to-skin contact; however, upon discharge, they received insufficient information from HCPs regarding peer support groups for breastfeeding mothers, the risks associated with the use of feeding bottles, pacifiers, and nipple shields, and the involvement of other family members in supporting breastfeeding. The evaluation of breastfeeding support and breastfeeding success were associated with hospital status - women who delivered in BFH rated the services more positively and were more likely to report continued breastfeeding compared to those who delivered in non-BFH (p