Breastfeeding-Friendly Hospital Practices and Missed Care Among Immigrant and U.S.-Born Black Mothers: “In the Hospital, Hell, There Was No Help There”

BACKGROUND: Implementation of the Ten Steps of the Baby-Friendly Hospital Initiative (BFHI) has been shown to reduce disparities in breastfeeding exclusivity and duration. The Pregnancy Risk Assessment Monitoring System (PRAMS) includes questions on care during the delivery hospital stay that are correlated with the Ten Steps, but immigrants are under-represented in that data. RESEARCH AIMS: Researchers assessed whether Somali and U.S.-born Black women received best-practice care in lactation during their delivery hospital stay, and how their experiences compared to U.S.-born Black women as reported by Minnesota PRAMS. METHODS: A total of 28 Somali immigrant and eight U.S.-born Black women completed a survey and participated in one of six focus groups. Researchers completed a thematic analysis of the focus group discussions and analyzed survey data which included an 11-question item from the PRAMS Phase 8 questionnaire. RESULTS: Mothers felt they needed more prenatal education but were not comfortable raising the topic. Those comfortable with asking questions reported breastfeeding significantly longer. Despite high rates of breastfeeding initiation, participants reported missing essential care. Participants were significantly less likely than PRAMS respondents to receive information on or assistance with breastfeeding, to exclusively breastfeed, or to receive a telephone number for post-discharge support. Three out of five participants reported being offered formula when they had not requested it, and almost half reported they were given formula at discharge. CONCLUSION: Among this cohort, experiences differed markedly from the care reported by U.S.-born Black PRAMS respondents. Hospitals need to improve lactation support and cease promotion of formula in this population.