Determinants of successful breastfeeding initiation in healthy term singletons: a Swiss university hospital observational study

Abstract

Aims: Breastfeeding significantly benefits mothers and infants. We aimed to identify the determinants of its successful initiation. Methods: A retrospective study of 1893 mothers delivering healthy term singletons at a Swiss university hospital from 1/2008 to 3/2009 determined the associations between multiple breastfeeding and early postpartum parameters by univariate and multiple regression analysis. Results: Multiparity was associated with nursing exclusively at the breast at discharge (P < 0.001), less use of maltodextrin supplement (P < 0.05), bottle/cup (both P < 0.001), but more pacifier use (P < 0.05). Among obese mothers, nursing exclusively at the breast at discharge was less frequent, and use of all feeding aids more frequent, than among normal-weight women (both P < 0.001). Neuraxial anesthesia was associated with use of maltodextrin and bottle (both P < 0.05) compared to no anesthesia. Delayed first skin-to-skin contact and rooming-in for < 24 h/day were each associated with maltodextrin and cup (P < 0.05). Nursing exclusively at the breast at discharge was less frequent (P < 0.001), and bottle use more frequent (P < 0.05), in women with sore nipples than in those without. Conclusions: Obesity is a potent inhibitor of breastfeeding initiation. Delivery without anesthesia by a multi parous normal-weight mother, followed by immediate skin-toskin contact, rooming-in for 24 h/day, and dedicated nipple care, provides the best conditions for successful early postpartum breastfeeding without the need for feeding aids or nutritional supplements.

Risk factors for exclusive breastfeeding lasting less than two months—Identifying women in need of targeted breastfeeding support

“…It has been noted that first time mothers have a high use of EDA [14], and studies show that EDA can affect the infant in a way that postpones the first breastfeeding session [21,22]. The borderline association in the multivariate analysis between a higher maternal BMI and EBF < two months postpartum is in line with previous studies [9,10]. Subjective emotional distress was independently associated with EBF < two months postpartum.…”

“…Compared to vaginal birth, cesarean section includes several aspects that can affect breastfeeding rates, such as anesthesia [10], and separation [24], between mother and newborn. In Uppsala University Hospital, the newborn is taken out of the operating theatre as a routine, for observation and assessment, and when the mother is under observation postoperatively, the separation is extended, and the newborn will be cared for by the mother’s partner in the maternity ward.…”

“…Healthcare professionals in facilities providing maternity services and care for infants should give mothers information about breastfeeding and support the initiation of breastfeeding within half an hour of birth [4], as timing of the first breastfeeding session after birth seems to have an impact on breastfeeding duration [5–7]. Breastfeeding and breastfeeding duration, in particular, are negatively associated with socio-demographic variables [8–10], depression during pregnancy [11–13], and obstetric variables such as the use of epidural anesthesia [14] and way of giving birth [11]. …”

Formula supplementation in hospital and subsequent feeding at discharge among women who intended to exclusively breastfeed: An administrative data retrospective cohort study

“…Consistent with findings from other studies, women who experienced a birth with more intervention (induction, general or epidural/spinal analgesia, instrumental, or cesarean) were also more likely to have infants who were supplemented . These factors are all interrelated and are likely to result in delayed initial feeding or reduced early skin‐to‐skin contact, both of which significantly affect the establishment of breastfeeding . Current guidelines in NSW are aimed at reducing interventions in labor and birth, and have the potential to be associated with improved breastfeeding rates.…”

Using text messaging to obtain weekly data on infant feeding in a Danish birth cohort resulted in high participation rates

“…Traditional maternal factors that have favoured breastfeeding have been a higher level of education, increasing age, nonsmoking status, normal weight, multiparity and avoiding infant formula supplementation in the first few days after birth (6,19,21). A Swiss study also revealed an association between nipple soreness and pacifier use with nonexclusive breastfeeding at the time of hospital discharge (22). In addition, other factors previously shown to be associated with breastfeeding cessation have been the mother's perception of the father's attitude towards breastfeeding, uncertainty regarding the quantity of breast milk and returning to work (23,24).…”