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A two phase project was designed to: 1) test an intervention [Best for Baby Card, (BBC)] designed to motivate women to breastfeed,

Available evidence strongly suggests that breastfeeding supports health and well-being for both mothers and infants. Given the health benefits of breastfeeding, this approach to infant feeding is also economically sound. For example, women who breastfeed are less likely to develop acute or chronic illnesses, thus diminishing costs for the healthcare system.1. and 2. It is estimated that if 90% of women in the United States breastfed their infants exclusively for six months following birth, a savings of thirteen billion dollars would result.3

In 2012, the American Academy of Pediatrics reaffirmed their recommendation that exclusive breastfeeding begin at birth and continue for at least six months.3 Continuing breastfeeding as other foods are introduced is also recommended.3 The Healthy People 2020 report strongly supports raising the percentage of women who breastfeed during their hospital stay from 76.9% to 81.9% nationally.4 This recommendation has implications for hospitals in relation to nursing practice on labor and delivery units. In 2010 the Ten Steps to Successful Breastfeeding were developed by the World Health Organization (WHO) and United Nations Children Fund (UNICEF) describing how facilities can encourage women to breastfeed. 5 These steps however may be too late if women have decided not to breastfeed before coming to the hospital to deliver their infants. How and when women make their decision may be important factors in their decision-making.

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Research suggests that several factors are associated with women’s decisions to breastfeed. Scott, Landers, Hughes, and Binns6 found that age, employment, partner support, and timing of the decision to breastfeed influenced women’s decision making. Women who were older, had supportive partner(s), and made the decision to breastfeed prior to pregnancy were more likely to do so. Employed women were less likely to breastfeed than non-employed women. Another factor, women’s knowledge about breastfeeding, has also been positively associated with both an intent and decision to breastfeed.7. and 8. Swanson and Power9 found that nurses were second in importance to partners in terms of influencing women’s decision-making regarding breastfeeding. In addition, during hospitalization, five practices have been shown to positively influence mothers’ decisions to breastfeed. These practices include: placing babies skin-to-skin on mothers, breastfeeding in the first hour of life, ensuring infants receive breast milk only while in the hospital, keeping babies in the same room as mother, and not giving a pacifier in the hospital.9 The presence of a lactation consultant on the unit is also thought to positively influence mothers to breastfeed.10 While these hospital-based interventions may assist some women to make the decision to breastfeed, if women have clearly made their decision not to breastfeed prior to hospitalization or even pregnancy, they may not be open to changing their decision at the time of delivery.

A quasi-experimental design was used to evaluate the effectiveness of a pocket sized laminated card (BBC)

Women from two out of five obstetrical practices associated with the hospital received the BBC laminated cards. Women from the other three practices constituted the control group.

A questionnaire, the Baptist Health Lexington Breastfeeding Questionnaire (BHLBQ) was administered that identified whether or not participants had received the BBC.

The BHLBQ also asks respondents to answer questions related to their infant feeding choice as well as their attitudes and behaviors towards breastfeeding

A Comparison of Women Who Breastfed to Those Who Did Not Breastfeed.
Items From The Baptist Health Breastfeeding Questionnaire        Breastfed for length of stay        Did not breastfeed for length of stay
Stated that they intended to breastfeed before pregnancy⁎        95.1% (78)
n = 82        21.1% (8)
n = 38
Stated that their partner was supportive of breastfeeding⁎        100% (80)
n = 80        75% (24)
n = 32
Stated that their baby used a pacifier in the hospital        73.2% (60)
n = 82        84.2% (32)
n = 38