Baby-friendly hospitals and cesarean section rate: a survey of Italian hospitals.

BACKGROUND The Baby-Friendly Hospital Initiative aims at protecting, promoting, and supporting breastfeeding. Cesarean section is known to represent an obstacle to breastfeeding. In this observational study we compared Baby-Friendly and non-Baby-Friendly hospitals (BFHs and non-BFHs, respectively) in terms of cesarean section rate. MATERIALS AND METHODS Italian BFHs were compared with non-BFHs located in the same regions. Data used for analysis were type of hospital, annual deliveries, annual cesarean section deliveries, region of location, and BFH status. The primary outcome was a cesarean section rate below a threshold specific for the identified regions; because of skewed distribution, the median rate was chosen. Descriptive and comparative univariate and multivariate analyses were carried out. RESULTS In 2009, in Italy, there were 20 BFHs located in eight regions. Compared with the 207 non-BFHs with more than 200 annual deliveries located in the same regions, BFHs had a cesarean section rate below the median of the eight regions (30.4%; interquartile range 14.6%), even after adjustment for confounders (adjusted odds ratio, 12.71; 95% confidence interval, 1.84, 87.72). In addition, being a public hospital, performing a higher number of deliveries, and being located in specific regions also predicted a cesarean section rate below the median. Overall, the regions with at least one BFH showed a lower cesarean section rate, compared with regions without BFHs. DISCUSSION In Italy there are few BFHs, but regions with at least one BFH show a cesarean section rate below the national median. Several factors impact on the cesarean section rate, causing huge variation among regions. Nevertheless, within the same region, BFHs have a lower cesarean section rate compared with non-BFHs.