Objective. Some mothers have difficulty initiating lactation even when highly motivated to breastfeed. The purpose of this study was to determine the incidence of and risk factors for suboptimal infant breastfeeding behavior (SIBB), delayed onset of lactation, and excess neonatal weight loss among mother-infant pairs in a population with high educational levels and motivation to breastfeed.
Methods. All mothers residing in Davis, California, who gave birth to a healthy, single, term infant at 1 of 5 area hospitals during the 10-month recruitment period in 1999 were invited to participate if they were willing to attempt to breastfeed exclusively for at least 1 month. Lactation guidance was provided and data were collected in the hospital (day 0) and on days 3, 5, 7, and 14. Infant breastfeeding behavior was evaluated by trained lactation consultants using the Infant Breastfeeding Assessment Tool. Onset of lactation was defined based on maternal report of changes in breast fullness. Infant weight loss was considered excessive if it was ≥10% of birth weight by day 3.
Results. Of the 328 eligible mothers, 280 (85%) participated in the study. The prevalence of SIBB was 49% on day 0, 22% on day 3, and 14% on day 7. SIBB was significantly associated with primiparity (days 0 and 3), cesarean section (in multiparas, day 0), flat or inverted nipples, infant status at birth (days 0 and 3), use of nonbreast milk fluids in the first 48 hours (days 3 and 7), pacifier use (day 3), stage II labor >1 hour (day 7), maternal body mass index >27 kg/m2 (day 7) and birth weight <3600 g (day 7). Delayed onset of lactation (>72 hours) occurred in 22% of women and was associated with primiparity, cesarean section, stage II labor >1 hour, maternal body mass index >27 kg/m2, flat or inverted nipples, and birth weight >3600 g (in primiparas). Excess weight loss occurred in 12% of infants and was associated with primiparity, long duration of labor, use of labor medications (in multiparas), and infant status at birth. The risk of excess infant weight loss was 7.1 times greater if the mother had delayed onset of lactation, and 2.6 times greater if the infant had SIBB on day 0.
Conclusions. Early lactation success is strongly influenced by parity, but may also be affected by potentially modifiable factors such as delivery mode, duration of labor, labor medications, use of nonbreast milk fluids and/or pacifiers, and maternal overweight. All breastfeeding mother-infant pairs should be evaluated at 72 to 96 hours’ postpartum.
Comments
Response to Moritz regarding weight loss of breastfed infants
In response to the letter by Dr. Michael Moritz, we can provide the following additional information about the infants in our study (Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss. Pediatrics 2003; 112: 607- 619). In all cases in which the infant had a weight loss greater than or equal to 10% of birth weight, both the mother and the infant's health care provider were notified. Our lactation consultants worked with the mother and the health care provider to evaluate the situation and assist in correcting whatever problems were evident with regard to infant latch or other breastfeeding difficulties. In some cases, supplemental infant formula was used (usually temporarily). This is the topic of a separate manuscript, currently in preparation. We do not have data on how many infants needed phototherapy. Only one infant was re-admitted to the hospital. This infant was jaundiced and had lost 11% of birth weight, and was re-admitted on day 3.
What are the dangers of breastfeeding?
I read with interest the detailed article by Dewey et al documenting the difficulties in initiating breastfeeding during the first week of life. In this report they noted that over 12% of breastfed infants had greater than10% weight loss by the third day of life. There was no mention though of breastfeeding complications requiring hospitalization, phototherapy or supplemental infant formula. I would appreciate if the authors would provide additional data regarding re-hospitalization of infants during the first week of life, the need for phototherapy, supplemental infant formula, and what interventions were taken when infant weight loss exceeded 10% of birth weight.