Determinants of Breastfeeding Practices Pre- and During the COVID-19 Pandemic: A Retrospective Cohort Study

<b>Background/Objectives:</b> Exclusive breastfeeding (EBF) during hospitalization is essential for infant health but remains suboptimal in many Gulf Cooperation Council (GCC) countries. Maternal factors and the COVID-19 pandemic may have influenced breastfeeding practices. Understanding these determinants is crucial for improving postnatal care. This study aimed to identify determinants of breastfeeding practices during hospitalization before and during the COVID-19 pandemic in Bahrain. <b>Methods:</b> This retrospective cohort study reviewed electronic records of 321 mothers and their newborns discharged between March 2019 and March 2021 from a larger pool of 4500 cases. A structured data collection form was used to capture maternal age, parity, nationality, mode of delivery, COVID-19 period of delivery (pre-pandemic vs. pandemic), breastfeeding method, and reasons for mixed feeding. Descriptive and inferential statistical analyses were conducted to identify associations between variables. <b>Results:</b> Multiparous mothers had significantly higher exclusive breastfeeding rates than primiparous mothers (<i>p</i> = 0.016). The mode of delivery showed a strong association with breastfeeding outcomes, with vaginal births linked to higher EBF rates (<i>p</i> < 0.01). A notable decline in EBF was observed during the COVID-19 pandemic period, from 40% pre-pandemic to 14% during the pandemic. <b>Conclusions:</b> Exclusive breastfeeding during hospitalization is significantly influenced by delivery method and maternal parity. Although the COVID-19 pandemic may have contributed to reduced EBF rates, further research is required to validate these trends. These findings emphasize the importance of supportive hospital policies, particularly for first-time and cesarean mothers, and stress the need to strengthen breastfeeding practices during public health emergencies.