Maternal Perception of the Onset of Lactation Is a Valid, Public Health Indicator of Lactogenesis Stage II

Abstract

Test weighing is the "gold standard" for documenting lactogenesis stage II. However, this method is impractical for use in population studies. Maternal perception of the timing of the onset of lactation may be a useful proxy for lactogenesis stage II. This study seeks to validate maternal perception of the onset of lactation as a marker of lactogenesis stage II. Women (n = 60) were recruited after cesarean delivery. Beginning at 24 h postpartum (pp), the onset of lactation was assessed 3 times daily by both test weighing and maternal perception. Delayed onset of lactation was defined as follows: 1) milk transfer < 9.2 g/feeding at 60 h pp and 2) maternal perception >/= 72 h pp. Misclassification analyses were conducted. Multivariate logistic regression, bivariate analyses and Cox survival analyses were used to evaluate the determinants and consequences of delayed onset of lactation, using both definitions. The sensitivity and specificity of delayed maternal perception as an indicator of delayed lactogenesis were 71.4 and 79.3%, respectively. Four risk factors for low milk transfer were significant (P: < 0.05) or nearly significant (P: </= 0.08) predictors of delayed perception of the onset of lactation. The effects of low milk transfer and delayed maternal perception on breast-feeding duration were similarly modified by intended breast-feeding duration. The magnitude and directionality of the ss coefficients for the milk transfer and perception variables were consistent. On the basis of these results, we conclude that maternal perception of the onset of lactation is a valid public health indicator of lactogenesis stage II.

Risk factors for excess weight loss and hypernatremia in exclusively breast-fed infants

“…Previous reports have demonstrated the importance of early initiation of breast-feeding post-delivery for successful lactation (21)(22)(23). In this study, there was no difference between cases and controls in the frequency of feeding in the 2 days prior to review but there was a significant delay in the age of the neonate at first feeding in the dehydrated group, in particular for babies delivered by cesarean section.…”

Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk Infants: An RCT

“…Infants were excluded if they had lost $10% of their birth weight, had received formula or water, required a higher level of care than a Level 1 nursery or had mothers who were ,18 years old, could not speak English or Spanish, or were making mature milk as assessed by a previously validated technique. 29 Infants were weighed per hospital routine rather than for the purpose of study enrollment. Informed consent was obtained from all mothers by a study doctor or nurse.…”

“…To assess compliance with assigned randomization group, and assess when mature milk production began, a research assistant called mothers daily using a previously validated technique. 29 A research assistant blinded to group allocation assessed outcomes by telephone at 1 week and 1, 2, and 3 months. Our primary outcomes was formula use at 1 week.…”

Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study

“…This has been a traditional method of determining timing of lactogenesis stage II and has been shown to correlate with actual timing of this stage. 33 …”