Home versus Hospital Breastfeeding Support for Newborns: A Randomized Controlled Trial

ABSTRACT: Background: The advantages of breastfeeding have been well established for both mothers and their infants. Existing research reports equivocal effects of early discharge and postpartum home care on breastfeeding success. The purpose of this study was to compare the effects of breastfeeding support offered in hospital and home settings on breastfeeding outcomes and maternal satisfaction for mothers of term and near‐term newborns who experienced standard or early discharge. Methods: In a randomized controlled trial with prognostic stratification for gestational age, 101 term and 37 near‐term (35–37 weeks’ gestational age) mother‐newborn pairs were randomized to either a standard care group (standard care and standard length of hospitalization) or an experimental group (standard hospital care with early discharge and home support from nurses who were certified lactation consultants). Data collection occurred before randomization, at discharge from hospital, and from 5 to12 days postpartum. Primary outcomes included breastfeeding rates and maternal satisfaction. Results: More mothers of term newborns in the experimental group were breastfeeding exclusively at follow‐up (p=0.02) compared with the control group. No significant breastfeeding differences occurred among mothers with near‐term newborns in the experimental and standard care groups. Conclusions: In‐home lactation support appears to facilitate positive breastfeeding outcomes for mothers of term newborns. This may also be a beneficial model of postpartum care for mothers of near‐term newborns; however, further research is required. The findings suggest implications for health caregivers and policy makers with respect to postpartum lactation and health care services. (BIRTH 29:4 December 2002)     

An Evaluation of a Telephone‐Based Postnatal Support Intervention for Infant Feeding in a Regional Australian Citya

ABSTRACT: Background: Postnatal breastfeeding support in the form of home visits is difficult to accommodate in regional Australia, where hospitals often deal with harsh economic constraints in a context where they are required to provide services to geographically dispersed consumers. This study evaluated a predominately telephone‐based support service called the Infant Feeding Support Service. Methods: A prospective cohort design was used to compare data for 696 women giving birth in two regional hospitals (one public, one private) and participating in the support service between January and July 2003 with data from a cohort of 625 women who gave birth in those hospitals before the introduction of the support service. Each mother participating in the support service was assigned a lactation consultant. First contact occurred 48 hours after discharge, and approximately weekly thereafter for 4 weeks. Breastfeeding duration was measured at 3 months postpartum. Results: For women from the private hospital, the support service improved exclusive breastfeeding duration to 4.5 weeks postpartum, but these improvements were not evident at 3 months postpartum. No effects were observed for mothers from the public hospital. Quantitative and qualitative data demonstrated high levels of client satisfaction with the support service. Conclusions: This small‐scale, predominately telephone‐based intervention provided significant, although apparently context‐sensitive, improvements to exclusive breastfeeding duration. (BIRTH 32:4 December 2005)     

An Evaluation of Rooming-in Among Substance-exposed Newborns in British Columbia

ObjectiveRooming-in, the practice of caring for mother and newborn together in the same room immediately from birth, is preferred for the general postpartum population but is not yet standard practice of care for newborns of substance-using women. Such newborns are usually separated from their mothers and admitted to a neonatal intensive care unit and treated for substance withdrawal if necessary. We compared clinical and psychosocial outcomes associated with traditional standard care models versus an interdisciplinary rooming-in model of care for substance-exposed newborns.MethodsWe conducted a retrospective comparative review of a cohort of substance-exposed newborns. Data were extracted from the British Columbia Perinatal Health Program database to populate the standard care and rooming-in groups. The main study outcomes were neonatal admission to NICU, breastfeeding, presence of neonatal withdrawal, length of stay, and custody status at discharge.ResultsRooming-in was associated with a significant decrease in admissions to NICU and a shorter NICU length of stay for term infants, increased likelihood of breastfeeding (either exclusively or in combination with formula) during the hospital stay, and increased odds of the baby being discharged home with the mother. There were no significant differences between groups with respect to the presence of neonatal substance withdrawal or breastfeeding status at discharge.ConclusionRooming-in may facilitate a smooth transition to extrauterine life for substance-exposed newborns by decreasing NICU admissions and NICU length of stay for term infants, encouraging breastfeeding, and increasing maternal custody of infants at discharge. This review supports the finding that rooming-in is both safe and beneficial for substance-exposed babies.     

Hospital Practice Versus Evidence‐Based Obstetrics: Categorizing Practices for Normal Birth in an Egyptian Teaching Hospitala

ABSTRACT: Background: Little is known of common normal labor hospital practices in Egypt or of their relationship to evidence‐based obstetrics. This study documented facility‐based practices for normal labor and delivery in Egypt for the first time by categorizing 44 practices observed in a busy obstetric teaching hospital according to the World Health Organization (WHO) Technical Working Group on Normal Birth classification of normal birth practices. Methods: A multidisciplinary approach combined directly observing practices that were applied to individual laboring women and their newborns, observing ward activities, interviews, and focus groups. One hundred seventy‐five normal births were observed in their entirety, over 28 days and nights, by medically trained observers using an observation checklist that documented 537 variables for each woman. Mothers were interviewed postpartum, and findings were shared with practitioners for their feedback. Observed practices were categorized according the 1999 WHO classification of 59 practices for normal birth, depending on their usefulness, effectiveness, or harmfulness. Results: There was infrequent use of beneficial practices that should be encouraged and an unexpectedly high level of harmful practices that should be eliminated. Some beneficial practices were applied inappropriately, and practices of unproved benefit were also documented, some of which are potentially harmful to childbearing mothers and their babies. Conclusions: Hospital practices for normal labor were largely not in accordance with the WHO evidence‐based classification of practices for normal birth. The findings are worrying, given the increasing proportion of hospital‐based births in Egypt and the country's improved but relatively high maternal and neonatal mortality rates. Obstacles to following evidence‐based protocols for normal labor require examination. (BIRTH 32:4 December 2005)     

Does Continuity of Care by Well‐Trained Breastfeeding Counselors Improve a Mother's Perception of Support?

Abstract: Background: Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care. Method: Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process‐oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales. Results: Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both control groups. Conclusions: After implementation of a process‐oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care, the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care. (BIRTH 33:2 June 2006)     

Impact of Postpartum Depression on the Mother‐Infant Couple

Abstract: Background : Few studies have explored the influence of postpartum depression on later life among mothers in Taiwan. The present follow‐up study aims to explore the effects of postpartum depression on the psychosocial health of mothers and on the overall development of their infants. Methods : Follow‐up evaluations were carried out on 29 postnatally depressed and 31 nondepressed mothers and their infants at 1 year after childbirth. Dependent variables were measured by means of five structured questionnaires. Results : Postnatally depressed mothers reported significantly higher perceived stress, but lower social support and self‐esteem than nondepressed mothers at 1 year after childbirth. The participants’ postpartum depression had no significant effect on their infants’ eight developmental areas, nor did depression influence their plans about the number of children to have in the future. Conclusions : Postpartum depression may have a negative influence on the psychosocial health of women, but it does not appear to influence the overall development of their infants and their family planning.     

Night Rooming‐in: Who Decides? An Example of Staff Influence on Mother's Attitude

Abstract: Background : In 1989 the World Health Organization and UNICEF introduced the “Ten Steps” for successful breastfeeding. One step suggests that a mother and her newborn baby should remain together day and night during the hospital stay. The purpose of this study was to investigate, first, whether or not mothers in our hospital roomed‐in with their babies at night, second, the attitudes of mothers toward night rooming‐in and their feelings of closeness to their babies, and third, how mothers perceived hospital staff attitudes toward night rooming‐in. Methods : All mothers ( n = 132) of Nordic ancestry and with good knowledge of the Swedish language, who were admitted to the maternity wards during a 2‐week period at Karolinska University Hospital, Stockholm, Sweden, answered a questionnaire on demographic background data and their current night rooming‐in practices, including an attitude scale. Results : Most study mothers were positive toward night rooming‐in, regardless of whether they had roomed in with their babies at night (93% positive) or not (73% positive). Mothers who had not roomed‐in with their babies were more likely to perceive that the staff believed their babies should stay in the nursery compared with those mothers who practiced night rooming‐in (z = ?2.733, p = 0.006). Mothers not rooming‐in with their babies scored closeness to their babies as less important than those mothers who roomed‐in with their babies (z = ?3.780, p = 0.0002); they also were more worried about their own and their babies’ sleep (z = ?2.321, p = 0.02) and disturbing noises (z = ?3.487, p = 0.0005). Conclusions : Mothers who left their babies in the nursery at night more often perceived that the staff believed their babies should stay in the nursery, rating closeness between mother and infant lower. Hence, negative staff attitudes toward night rooming‐in may implicitly suggest to mothers that closeness between mothers and babies is not important.     

The effect of empowerment program on “perceived readiness for discharge” of mothers of premature infants

Objectives: Poor readiness of mothers to take care of their premature infant at the time of hospital discharge is associated with potential adverse consequences. The aim of this study was to examine the effect of empowerment program on “perceived readiness for discharge” of mothers of premature infants at the time of discharge.

Methods: A quasi-experimental before–after study design with consecutive inclusion of all mother–child pairs was used to conduct the study. Eighty mothers and their premature infants (40 pairs of mother–infant in the experimental group and 40 pairs of mother–infant in the control group) were recruited in the study. The program to empower the parents was implemented as a 3-stage training plan for the experimental group. “Parent discharge readiness” questionnaire was completed by mothers before intervention and at discharge time, and was evaluated by nurses at discharge time. The groups were compared in terms of readiness for discharge according to the scores given by mothers and nurses.

Results: At discharge time, there was a statistically significant difference between technical readiness of control and experimental groups according to mothers’ self-report (p?<?0.001) and nurse evaluation (p?<?0.0001). Also, there was a statistically significant difference between emotional readiness of mothers in control and experimental groups according to mothers’ self-report (p?<?0.0001) and nurse evaluation (p?=?0.003).

Conclusion: The implementation of empowerment program is an effective strategy to promote the readiness of mothers of premature infants at discharge time.     

Predictors and Outcomes of Postpartum Mothers' Perceptions of Readiness for Discharge after Birth

Objective: To identify predictors and outcomes of postpartum mothers' perceptions of their readiness for hospital discharge.
Design: A correlational design with path analyses was used to explore predictive relationships among transition theory-related variables.
Setting: Midwestern tertiary perinatal center.
Participants: One hundred and forty-one mixed-parity postpartum mothers who had experienced vaginal birth or Cesarean delivery of normal healthy infants.
Methods: Before hospital discharge, patients completed questionnaires about sociodemographic characteristics, hospitalization factors, quality of discharge teaching, and readiness for discharge. Three weeks postdischarge, mothers were contacted by telephone to collect coping difficulty and health care utilization data.
Main Outcome Measures: Readiness for Hospital Discharge Scale, Post-Discharge Coping Difficulty Scale, Utilization of postdischarge services.
Results: Quality of discharge teaching, specifically the relative difference in the amount of informational content needed and received and the skills of nurses in delivering discharge teaching, explained 38% of the variance in postpartum mothers' perceptions of discharge readiness. Readiness for discharge scores explained 22% of the variance in postdischarge coping difficulty scores. Nurses' skills in delivery of discharge teaching, coping difficulty, patient characteristics, and birth hospitalization factors were predictive of utilization of family support and postdischarge health care services.
Conclusion: A trajectory of influence was evident in the sequential relationships of quality of discharge teaching, readiness for discharge, postdischarge coping, and utilization of family support and health care services. Transitions theory provided a useful framework for conceptualizing and investigating the transition home after childbirth.     

Preparation for Discharge,Maternal Satisfaction,and Newborn Readmission for Jaundice: Comparing Postpartum Models of Care

ABSTRACT: Background: Physiological jaundice generally appears between the third and fifth days of life. The danger of hyperbilirubinemia is therefore a major challenge when postpartum hospital stays are short, and part of the responsibility for screening for signs of jaundice is assumed by the mother. The objective of this study was to identify the model of postnatal continuity of care most likely to prepare mothers for discharge, to reduce newborn readmission for jaundice, and to enhance maternal satisfaction. Methods: An epidemiological study was conducted in regions operating under 3 different models of postnatal continuity of care. Eligible mothers were those who had spent less than 60 hours in hospital after an uncomplicated vaginal delivery. Of this group, 70.8 percent participated in telephone interviews conducted 1 month after their deliveries (n = 1,096). Newborns who had presented with signs of jaundice were identified through statements from their mothers. Results: Of the participating newborns, 45.5 percent presented with signs of jaundice, and 3.2 percent were readmitted for jaundice during the first week of life. The follow‐up procedures used in regions operating under a community‐based model most closely followed the recommendations of health authorities and featured a high level of mothers’ satisfaction. In the region operating under a mixed hospital model, mothers reported signs of jaundice significantly more often, and postdischarge services received by mothers were less effective at allaying their fears compared with other models. Phototherapy was offered in the home only in the region operating under a mixed ambulatory model, and no readmissions for jaundice were recorded in this region. Conclusions: An effective coordination between community‐based perinatal services and hospital‐linked home phototherapy in the form of an integrated network appears to be an essential condition for improved monitoring of newborns’ health since it fosters a follow‐up that is focused not only on jaundice but also on mothers’ and newborns’ needs while reducing the costs generated by newborn readmissions. (BIRTH 34:2 June 2007)     

Learning Needs of Postpartum Women: Does Socioeconomic Status Matter?

Abstract: Background : Little is known about how information needs change over time in the early postpartum period or about how these needs might differ given socioeconomic circumstances. This study's aim was to examine women's concerns at the time of hospital discharge and unmet learning needs as self‐identified at 4 weeks after discharge. Methods : Data were collected as part of a cross‐sectional survey of postpartum health outcomes, service use, and costs of care in the first 4 weeks after postpartum hospital discharge. Recruitment of 250 women was conducted from each of 5 hospitals in Ontario, Canada (n = 1,250). Women who had given vaginal birth to a single live infant, and who were being discharged at the same time as their infant, assuming care of their infant, competent to give consent, and able to communicate in one of the study languages were eligible. Participants completed a self‐report questionnaire in hospital; 890 (71.2%) took part in a structured telephone interview 4 weeks after hospital discharge. Results : Approximately 17 percent of participants were of low socioeconomic status. Breastfeeding and signs of infant illness were the most frequently identified concerns by women, regardless of their socioeconomic status. Signs of infant illness and infant care/behavior were the main unmet learning needs. Although few differences in identified concerns were evident, women of low socioeconomic status were significantly more likely to report unmet learning needs related to 9 of 10 topics compared with women of higher socioeconomic status. For most topics, significantly more women of both groups identified learning needs 4 weeks after discharge compared with the number who identified corresponding concerns while in hospital. Conclusions : It is important to ensure that new mothers are adequately informed about topics important to them while in hospital. The findings highlight the need for accessible and appropriate community‐based information resources for women in the postpartum period, especially for those of low socioeconomic status. (BIRTH 32:2 June 2005)     

Specialized care for twin gestations: improving newborn outcomes and reducing costs

OBJECTIVE: To compare newborn outcomes and costs of hospital stays for twins born to mothers receiving care in a specialized twin clinic with a research-based care protocol and one consistent caregiver versus twins whose mothers received standard prenatal care. DESIGN AND SETTING: A retrospective, historical cohort study conducted in a high-risk obstetric clinic in central Texas. PATIENTS: Thirty women pregnant with twins received specialized care. The comparison group consisted of 41 women pregnant with twins who received standard care. INTERVENTIONS: An advanced practice nurse provided prenatal care, which included weekly clinic visits, home visits, and 24-hour availability for phone support. OUTCOME MEASURES: Gestational age at birth, birth weight, length of stay in the neonatal intensive-care unit (NICU), and hospital charges for the newborns. RESULTS: No newborns of less than 30 weeks gestation were born to women in the specialized care group, the mean birth weight was 249 g (SD +/- 77) higher, days in the NICU were reduced from a mean of 17 to 7, and hospital charges were $30,000 less per infant. CONCLUSIONS: Newborn outcomes were improved and length of stay and hospital charges were significantly reduced for newborns whose mothers had received care in the specialized twin clinic.     

Validity and reliability of the Perceived Readiness for Discharge After Birth Scale

Objective:  To assess the psychometric properties of a scale measuring mothers' perceptions of readiness for discharge after birth.
Design:  Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge.
Setting: Tertiary-level perinatal center in the Midwestern United States.
Participants:  1,462 postpartum mothers.
Intervention:  None.
Main outcome measures:  Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.
Results:  Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breastfeeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales.
Conclusions:  The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers' perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems. JOGNN , 35, 34-45; 2006.DOI: 10.1111/J.1552-6909.2006.00020.x     

Early Hospital Discharge in Maternal and Newborn Care

This article highlights the historic precedence of early discharge practices and the debate regarding length of stay for new mothers and newborns in the United States. Although the documented effects of early discharge on maternal and newborn health are inconsistent, research findings universally support follow‐up care for mothers and infants within 1 week of hospital discharge. Research is needed to identify the components and timing of follow‐up care to optimize maternal and newborn outcomes.     

Postpartum Positioning and Attachment Education for Increasing Breastfeeding: A Randomized Trial

Background: Although lactation experts suggest that a correct positioning and attachment technique reduces breastfeeding problems and enhances long‐term breastfeeding, evidence from randomized trials is lacking. The objective of this study was to evaluate the effect of postpartum positioning and attachment education on breastfeeding outcomes in first‐time mothers. Method: A randomized trial was performed in a public hospital in Adelaide, South Australia, where 160 first‐time mothers were randomly allocated to receive either structured one‐to‐one education (experimental group) or usual postpartum care (control group) within 24 hours of birth. The primary outcome was breastfeeding at 6 weeks and 3 and 6 months postpartum; other outcomes were nipple pain and trauma in hospital and at 6 weeks and 3 and 6 months, and satisfaction with breastfeeding. Results: No significant differences occurred in breastfeeding rates between the groups at each endpoint, although a trend in the direction of lower rates was seen at each endpoint in the experimental group. This group reported less nipple pain on days 2 (p= 0.004) and 3 (p= 0.04), but this was not sustained on follow‐up. No differences were observed in nipple trauma in hospital or in self‐reported nipple pain and/or trauma at the three endpoints. Experimental group women were less satisfied with breastfeeding at 3 and 6 months postpartum when using a one‐item measure; however, a multiple‐item measure showed no significant differences at the three endpoints. Conclusions: The intervention did not increase breastfeeding duration at any assessment time or demonstrate any differences between the groups on secondary outcomes. The trend toward lower breastfeeding rates in the experimental group suggests a need for a larger trial to evaluate whether or nor postpartum positioning and attachment education may negatively affect breastfeeding.     

Hospital differences in special care nursery use for newborns of gestational diabetic mothers

Objective: Relatively healthy newborns of mothers with gestational diabetes mellitus (GDM) sometimes receive unwarranted surveillance. We studied the relationship between hospital characteristics and special care nursery use and total length of stay among GDM deliveries.

Methods: We identified GDM deliveries at 44 USA member hospitals of the National Perinatal Information Center from 2007 to 2011. To study low risk, relatively healthy newborns with presumed discretion in special care nursery use, we analyzed 43?444 singleton newborns with only minor or moderate complications and WHO were not preterm or low birthweight.

Results: Among eligible newborns, 6% received special care, but this ranged from 1% to 16% across 44 hospitals studied. Unadjusted associations suggested special care nursery use was highest in academic teaching hospitals, the Midwest, hospitals with?≥40% Medicaid births, and hospitals with a high supply of special care nursery beds. However, after controlling for clustering within hospitals, there were no significant associations between hospital characteristics and special care nursery use or length of stay.

Conclusions: Hospital-level variation in special care nursery use and length of stay of relatively healthy newborns of mothers with GDM is unexplained by hospital characteristics and suggests other operational or management factors impacting utilization of newborn care resources.     

The little things: perceptions of breastfeeding support

OBJECTIVE: To describe how maternal-child staff nurses support breastfeeding mothers during the postpartum hospital stay and how these mothers perceive the support received from the nurses. DESIGN: Ethnographic. SETTING: Data were collected at a community hospital in southeastern Florida. PARTICIPANTS: Unstructured interviews were conducted with seven maternal-child nurses caring for breastfeeding mothers. The investigator observed 12 nurses' interactions with breastfeeding mothers and newborns. Eight breastfeeding mothers were interviewed, using a semistructured guide, in the hospital before discharge and at 2 and 6 weeks postpartum. RESULTS: Nurses supported breastfeeding mothers by providing information and interpersonal support. Breastfeeding mothers expected the nurses to support their feeding efforts by providing information, encouragement, and interpersonal support. CONCLUSION: Health care providers can help breastfeeding mothers, but the support offered must be the kind that mothers want.     

Does Postpartum Length of Stay Affect Breastfeeding Duration? A Population‐Based Study

Abstract: Background: Short postpartum hospital stays may leave inadequate time for women to receive assistance with breastfeeding. Women leaving the hospital early may also have household responsibilities that could interfere with breastfeeding. This study examined the relationship between postpartum length of stay and breastfeeding cessation. Methods: This study used data from 10,519 respondents to the California Maternal and Infant Health Assessment (MIHA) surveys from 1999 to 2001. MIHA is an annual statewide stratified random sample, population‐based study of childbearing women in California. Survival analysis was used to examine the relationship between length of stay and length of time breastfeeding. Women were asked about the number of nights their infant stayed in the hospital at birth, whether they breastfed, and if so, the age of the child when they stopped. Hospital stay was defined in three categories: standard (2 nights for a vaginal delivery, 4 nights for a cesarean section), or shorter or longer than the standard stay. Results: Approximately 88 percent of women initiated breastfeeding. Unadjusted predictors of breastfeeding cessation included short or long postpartum stay; young maternal age; Hispanic, African American, or Asian/Pacific Islander race/ethnicity; being unmarried; low income or education level; primiparity; being born in the 50 United States or the District of Columbia; smoking during pregnancy; and low infant birthweight. After adjustment for potential confounders, women with a short stay remained slightly more likely to terminate breastfeeding than women with a standard stay (relative risk, 1.11, 95% confidence interval 1.01, 1.23). Conclusion: Women who leave the hospital earlier than the standard recommended stay are at somewhat increased risk of terminating breastfeeding early. (BIRTH 30:3 September 2003)     

Epidural analgesia: breast-feeding success and related factors

Objective

to compare the early breast-feeding behaviours of full-term newborns whose mothers had received epidural analgesia (EDA) during an uncomplicated labour, with a group of newborns whose mothers had not received EDA.

Design and setting

a retrospective comparative study design was used and the study was carried out in a labour ward in Stockholm, Sweden between January 2000 and April 2000. The ward has about 5500 deliveries per year.

Participants

all maternity records of women who had received EDA during labour (n=585) were included in the study. For each EDA record, a control record was selected, matched for parity, age and gestational age at birth. Women with emergency caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation or an intra-uterine death, as well as neonates with an Apgar score <7 at 5 mins were excluded. After exclusion, the study population consisted of 351 healthy women and babies in each group.

Method

logistic regression was performed. The dependent variables: (1) initiation of breast feeding after birth; (2) artificial milk given during hospital stay; and (3) breast feeding at discharge were studied in response to: (a) parity; (b) gestational age at birth; (c) length of first and second stage of labour; (d) administration of oxytocin; (e) administration of EDA; and (f) neonatal weight, as independent variables.

Findings

significantly fewer babies of mothers with EDA during labour suckled the breast within the first 4 hours of life [odds ratio (OR) 3.79]. These babies were also more often given artificial milk during their hospital stay (OR 2.19) and fewer were fully breast fed at discharge (OR 1.79). Delayed initiation of breast feeding was also associated with a prolonged first (OR 2.81) and second stage (OR 2.49) and with the administration of oxytocin (OR 3.28). Fewer newborns of multiparae received artificial milk during their hospital stay (OR 0.58). It was also, but to a lesser extent, associated with oxytocin administration (OR 2.15). Full breast feeding at discharge was also positively associated with multiparity (OR 0.44) and birth weight between 3 and 4 kg (OR 0.42).

Key conclusions

the study shows that EDA is associated with impaired spontaneous breast feeding including breast feeding at discharge from the hospital. Further studies are needed on the effects of EDA on short- and long-term breast-feeding outcomes.