Electronic health records (EHR) provide high-volume data about postpartum breastfeeding care. Despite the importance of exclusive breastfeeding as a quality indicator, there is no standardized method for analyzing this data. Following a systematic approach, we applied an EHR preparation framework to flowsheet documentation to evaluate data quality and create indicators of breastfeeding support (number of documented support interactions/expected number of interactions = support ratio) and breastfeeding intensity (number of breastmilk feedings/total feedings). A stepwise framework of (1) data extraction, (2) cohort development, (3) variable compilation, and (4) analysis was applied to data from a single hospital system in Minnesota available through a clinical data repository. In all, 33,285 dyads were included in the analysis. The overall mean support ratio was 2.33; 1.0 indicates the minimum support goal was met. Mean breastfeeding intensity by hospital ranged from 0.62 to 0.90 (0.84 overall). Over 50% of dyads were missing documentation for lactation care indicators, and none had complete data for all indicators. The selected indicators may be used in future research as a standardized method of evaluating breastfeeding support and outcomes during the postpartum hospital stay, and may be adapted for other research where repeated flowsheet measures are used.
Gallagher et al. (2026) studied this question.