Examining the Baby Café Model and Mothers' Breastfeeding Duration, Meeting of Goals, and Exclusivity

Baby Café USA, Inc., (BCUSA), 501(c)(3), was established in 2011 to promote the development of licensed, drop-in, free-of-charge, and standardized breastfeeding support sites offering peer support coupled with professional lactation care. Licensing requires approval by BCUSA, and includes program operation materials, web presence, and training for all staff. Specific standards include regular weekly sessions offering comfortable informal seating, breastfeeding-positive messaging, snacks, a digital scale, and the presence of an International Board-Certified Lactation Consultant (IBCLC), or oversight by an IBCLC when the café is staffed with alternative approved breastfeeding counselors. Many cafes also offer guest speakers on various helpful subjects, and Facebook^® forums where mothers connect socially, sharing breastfeeding knowledge and experiences.

In efforts to increase awareness and accessibility to all mothers, Baby Cafés are required to establish connections with appropriate surrounding community programs such as Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Visiting Nurse Association (VNA), and Healthy Start, and have referral points for necessary medical or psychosocial intervention. Statistical data are collected by all cafes and submitted to BCUSA for analysis.

There are currently 154 licensed Cafés in 31 states, providing support to thousands of mothers, and increasing lactation access to underserved areas with low breastfeeding rates. The average annual operation expense is $11,000. Cafés are individually funded by sponsoring organizations using a range of national, community, and private grants, such as block and obesity grants. Baby Cafés are World Health Organization (WHO) Code compliant ¹ and fulfill Step 10 of the Baby-Friendly Hospital Initiative (BFHI) requirements.²

Currently, 83.2% of U.S. mothers initiate breastfeeding, but contrary to Centers for Disease Control and Prevention (CDC) recommendations, only 24.9% exclusively breastfeed for the recommended 6 months, with 35.9% continuing to 1 year.³ Healthy People 2020 (HP2020), the Surgeon General's Call to Action, and BFHI all identify a need for increased efforts by both health care providers and the community to help mothers reach breastfeeding goals by establishing accessible support systems.^2,4,5 Current literature confirms that breastfeeding support from family, friends, and health care workers significantly impacts a woman's decision to breastfeed. The literature further identifies postpartum community support as crucial for a successful breastfeeding experience.⁶ Although multiple studies have determined the need for breastfeeding support groups, there is a lack of consistency in the development and evaluation of community models. There is limited research that has defined the combination IBCLC and peer support as one of the successful components of support groups.^7,8 This report describes the Baby Café program, with its required standards and practices, that may provide a model for nationwide network of professional community support activities.

Breastfeeding mothers from two separate Baby Cafés, one in Massachusetts and the other in Texas, were chosen for this study. The Massachusetts Baby Café (Melrose-Wakefield Hospital [MWH]) is 30 minutes outside Boston: attending mothers birthed in Boston and surrounding area hospitals. The Texas Baby Café (San Antonio [SA]) is sited in five SA urban WIC offices and is open to both WIC and non-WIC mothers. The MWH Café population is 83% Caucasian with 3% using WIC, whereas the SA population is 82% Hispanic with 99% using WIC (Table 1). All surveyed mothers desired to breastfeed and self-selected to attend the Baby Cafés.

Baby Cafés collected three types of data: initial registration and demographics, weekly attendance and exclusivity, and outcome survey data. Institutional Review Board (IRB) approval was received from MWH. This report used initial registration, exclusivity, and outcome survey data for analysis.

At first attendance, individual mothers register with their first name, contact information, their baby's first initial and age, start date of any formula use, and personal breastfeeding duration goal. Each mother is assigned an ID number, protecting her privacy. Of the 563 mothers surveyed, 4 had “no goal” and were excluded from analysis, leaving a total of 559 mothers: 150 from MWH Café and 409 from SA Café.

A point-in-time survey was given to the mother at her baby's age of just over 6 months, and again over 12 months.⁹ Surveys were administered through phone call, e-mail, or in person at Baby Café. Mothers reported their current breastfeeding status, beginning and ending dates of formula use, the Café's usefulness, and whether they attended five times or more. The attendance parameter “five times or more” was based on the average number of American Academy of Pediatrics (AAP) recommended pediatric well visits in the first 6 months, when feeding difficulties are often discovered.¹⁰ If weaned at the time of the survey, the month of wean age was recorded.

Mothers rated the helpfulness of the Café on a scale of 1–5 (1 being not helpful, and 5 extremely helpful), and offered comments on the program. Wean age was compared with the mother's intended breastfeeding duration. The mother's success meeting her initial duration goal was compared with her Café attendance category of “five times or more” or “less than five times.” Outcomes were defined as falling short of, meeting/and or exceeding own goal, and meeting AAP-recommended 12-month goal.

Formula usage was divided into age brackets closely aligned to the AAP standard visit time frames, specifically, birth–3 weeks; 3–6 weeks; 6 weeks–3 months; 3–6 months; 6–12 months, and 1–3 years. Formula supplementation rates were calculated and resulting breastfeeding exclusivity rates were determined for each age group. Exclusivity is defined as baby receiving only breast milk within each time frame (up to 6 months) and receiving only breast milk and solids from 6 to 12 months. Exclusivity rates were compared with those published by the CDC.³ Chi-square analysis was used to compare Baby Café attendance with mothers' success meeting the AAP and personal breastfeeding duration goals. A publicly available chi-square calculator from Social Science Statistics website was used to determine whether the results were statistically significant.

AAP goal: 326 (58%) of the surveyed mothers met the AAP goal of breastfeeding for 12 months, significantly higher than the national CDC national rate of 35.9%. Of the 559 total mothers, 127 (23%) attended Baby Café “five times or more.” Of the high attendance mothers, 89 (70%) met the AAP breastfeeding goal. The chi-square analysis of mothers meeting the 12-month goal resulted in a statistically significant difference (p < 0.05) between those who attended “less than five times” and those who attended “five times or more,” χ² = 9.35 (1), p = 0.0023 (Table 2).

Personal goal: 77% (MWH) and 79% (SA) of surveyed mothers met and/or exceeded their personal breastfeeding duration goals and were more likely to have attended the Cafés “five times or more.” There was no statistically significant difference between meeting personal goals and number of attendances (Table 3).

Exclusivity: The CDC reports national breastfeeding exclusivity rates of 47% at 3 months and 25% at 6 months. The MWH mothers reported exclusivity rates of 77% at 3 months and 71% at 6 months. These rates are 1.64 and 2.84 times higher at 3 and 6 months, respectively, than the rates of the total breastfeeding population published by CDC. Mothers in SA reported similar rates (Table 4).

Mothers' ratings of both Café's helpfulness were high, with the percentages as follows: extremely helpful 75.37%; very helpful 16.30%; helpful 6.30%; slightly helpful 2.04%; and not helpful 0.00%. The comments were very positive for the combination of professional/peer support, with frequent mentions of “I learned so much”; “Café solved my issue when I was going to quit and I'm still breastfeeding”; “Great breastfeeding experts with the answers,” and “I wouldn't be breastfeeding without Baby Café.”

This report demonstrates that the Baby Café model offers community breastfeeding support that may assist mothers meeting AAP 3- and 6-month exclusivity and 12-month duration breastfeeding goals.

This report is the first, to our knowledge, to examine the outcomes of the Baby Café model. Follow-up surveys allow for evaluation of possible long-term implications for communities. A significant majority of the mothers (70%) meeting the AAP breastfeeding duration goal attended the Baby Café five or more times, suggesting that a motivated and frequently attending breastfeeding mother may find guidance and solutions for issues that otherwise might result in breastfeeding cessation. Typical comments from mothers were “I wouldn't be breastfeeding without Baby Café”; “I was about to quit when I went, but they fixed it and I am still breastfeeding”; and “They found a tongue-tie that fixed the problem and I am still breastfeeding.”

Baby Cafés facilitate discussions with open sharing of concerns and issues: offering experienced mothers' opportunities to assist first-time mothers and fostering community connections and friendships. Mothers offered comments reflecting their enjoyment of the social connection such as “I made so many friends,” “It was very friendly and welcoming,” “I learned something new every time,” and “My best friends are now Café moms.”

The demographics of the mothers in the two Baby Cafés used in this report differed widely from each other. Melrose mothers were 61% college educated, 83% Caucasian, 95% aged >25 years, 2% WIC recipients, and resided in a suburban area. The SA mothers were 79% high school educated, 79% Latino, 53% aged >25 years, 79% WIC recipients, and resided in a predominantly urban area. Despite these demographic differences, the Baby Café model was flexible enough to meet the needs of these different breastfeeding populations.

The Baby Café model is suitable for a range of communities and, by offering available opportunities for free professional community-based assistance and support, may help mothers reach their stated breastfeeding goals.