Maternal Request for In-Hospital Supplementation of Healthy Breastfed Infants Among Low-income Women

Background: While hospital policies and medical issues are important factors in determining exclusive breastfeeding rates, medically unnecessary supplementation of infants is likely to be due, in part, to maternal request for formula.

Objectives: The goal of this project was to gain an understanding of the facilitating factors and decision-making processes surrounding maternal request for formula in the early postpartum period.

Methods: A series of 12 focus groups were conducted among 97 English- and Spanish-speaking low-income participants in California’s Supplementary Nutrition Program for Women, Infants, and Children (WIC). Mothers were asked to share their in-hospital infant-feeding experiences.

Results: The overarching theme that emerged was “lack of preparation” for what the early postpartum period would be like. Specifically, the decisions to formula feed fell into the following categories: inadequate preparation for newborn care (the need for rest and unrealistic expectations about infant behavior), lack of preparation for the process of breastfeeding, and formula as a solution to breastfeeding problems. Cultural factors were not mentioned as reasons for supplementation.

Conclusion: Interventions to promote in-hospital exclusive breastfeeding must address mothers’ real and perceived barriers, specifically mothers’ expectations related to breastfeeding and infant behavior.