The Influence of Type of Maternity Care Provider on Early Breastfeeding Rates. A Retrospective Cohort Study of All Women Who Gave Birth in Victoria, Australia 2010 to 2020

BACKGROUND: Breastfeeding plays a vital role in infant health and development. Maternity care providers are well-positioned to support breastfeeding during the postnatal period. In Australia, there are multiple options for public and private maternity care. To date, there is limited information on how caregiver and hospital type influence early breastfeeding. AIM: To examine associations between type of care provider during antenatal and intrapartum care, hospital type and early breastfeeding rates in Victoria, Australia. METHODS: Retrospective cohort study of all live, singleton, term births in Victoria, Australia 2010-2020 (N = 638,809). We investigated associations between variables using bivariate and multivariable logistic regression models. RESULTS: Most women (95.7%) initiated breastfeeding, and 77.1% provided the last feed before hospital discharge exclusively from the breast. About a quarter of infants (27.0%) received commercial milk formula while in hospital. Women who received antenatal or intrapartum care from a midwife or general practitioner were more likely to initiate breastfeeding, and their infants to have their last feed before discharge from the breast, and less likely to receive formula in hospital compared to those cared for by an obstetrician. Dyads who received care in public hospitals had better breastfeeding outcomes than those in private hospitals. The small proportion (0.2%) who received private midwifery care showed the most favourable breastfeeding outcomes. CONCLUSIONS: Early breastfeeding outcomes in Victoria differ in relation to antenatal and intrapartum care provider and hospital type, and indicate disparities in supportive breastfeeding practices. Implementation of Baby Friendly Health procedures may help standardise care across these settings.