Unlimited suckling time improves breast feeding

ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

BACKGROUND

Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that women are provided with high-quality evidence to inform their feeding decisions.

OBJECTIVES

To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 February 2016), CINAHL (1981 to 23 February 2016), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (10 May 2016).

SELECTION CRITERIA

We planned to include randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form would have been eligible for inclusion if sufficient data were available. Studies using a cross-over design would not have been eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed for inclusion all potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary.

MAIN RESULTS

No studies were identified that were eligible for inclusion in this review.

AUTHORS' CONCLUSIONS

This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns. It is recommended that no changes are made to current practice guidelines without undertaking robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Future exploratory research is needed on baby-led breastfeeding that takes the mother's perspective into consideration.

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

BACKGROUND

Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that mothers are provided with high-quality evidence to inform their feeding decisions.

OBJECTIVES

To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2013), CINAHL (1981 to 13 November 2013), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (6 November 2013).

SELECTION CRITERIA

Randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form were eligible for inclusion if sufficient data were available. Studies using a cross-over design were not eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We independently assessed for inclusion all the potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary.

MAIN RESULTS

No studies were identified that were eligible for inclusion in this review.

AUTHORS' CONCLUSIONS

This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns, therefore no conclusions could be taken at this point. It is recommended that no changes are made to current practice guidelines without undertaking further robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Further research is needed to also evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding on successful breastfeeding, for healthy newborns. However, conducting such a study, particularly a randomised controlled trial is unlikely to receive ethical approval, as the issue of obtaining informed consent from new mothers or mothers-to-be for randomisation between baby-led and scheduled breastfeeding is a difficult one and it is likely that the Baby Friendly Hospital Initiative practices would prohibit such a study.

Factors influencing the duration of exclusive breastfeeding in a group of Turkish women

This study was conducted to evaluate the influence of demographic characteristics, hospital practices, maternal psychosocial factors, and knowledge about infant feeding and breast milk on duration of breastfeeding. The mothers of 91 healthy, term infants delivered at a university hospital between June 1998 and December 1998, and first seen in the well-child unit within 10 days of delivery, participated in the study. Forty-nine (54%) infants were exclusively breastfed at 4 months of age. Cox regression analysis showed a negative association between formula supplementation during the hospital stay and duration of exclusive breastfeeding. The median age for starting non-breast milk liquids was 1 month for those who received formula in the hospital and 3 months for those who did not (P = .001). The hospital practices were more predictive of the duration of exclusive breastfeeding in this study group than mothers' knowledge of infant feeding or psychosocial factors. Thus, hospital practices should be reevaluated.

Changing nursing practice through research utilization: consistent support for breastfeeding mothers

This research utilization project was designed to increase staff nurse support for four early postpartum breastfeeding practices: initiation in the delivery room, high frequency feedings, unlimited suckling time, and no supplementation. Research links these practices with lower neonatal bilirubin values and an earlier onset of lactation. An organizational approach to research utilization was taken to encourage nurses to support mothers in the desired breastfeeding practices. A before and after design was used to evaluate the extent to which the intended patient outcomes were achieved with the practice changes. The percent of infants having bilirubin tests decreased significantly. No significant differences were observed in mean bilirubin levels, incidence of hyperbilirubinemia, or lactation onset. The project promoted state-of-the-science nursing care and helped our nurses become more adept in using research to guide practice.

Breast engorgement: patterns and selected outcomes

For 14 days following birth, 114 breastfeeding mothers rated their level of breast engorgement twice daily, using a six-point engorgement scale. Individual engorgement ratings were plotted by intensity over time to provide a visual display of each subject's breast engorgement experience. Four distinct patterns of breast engorgement emerged; mothers experienced either a bell-shaped pattern, a multi-modal pattern, a pattern of intense engorgement, or a pattern of minimal engorgement. Characteristics of mothers and infants, and feeding frequency were similar across the four breast engorgement patterns.

The occurrence of breast engorgement

This study describes breast engorgement during days 1-14 postpartum of 114 first and second time vaginal- and cesarean-delivery breastfeeding mothers. Most mothers reported experiencing their most intense engorgement after hospital discharge. Previous breastfeeding experience of the mother is a more critical variable than parity in predicting engorgement. Second time breastfeeding mothers experienced engorgement sooner and more severely than did first time breastfeeding mothers, regardless of delivery method. Anticipatory guidance by the care provider is discussed in an effort to enhance the experience of the breastfeeding dyad.

Research utilization: an overview

Nursing practice needs to be research based, not only to provide the best possible care to patients but also to ensure that nursing as a profession continues to grow. Criteria to help nurses determine how and when to implement research-based practice changes are presented. Forces that facilitate research utilization are discussed, as are barriers to research utilization. Areas of research that are ready to be implemented in women's health, obstetric, and neonatal nursing are presented.

No effect of birth centre care on either duration or experience of breast feeding, but more complications: findings from a randomised controlled trial

OBJECTIVE

to study the effect of birth centre care on the duration of breast feeding, breast feeding complications, and women's experiences of breast feeding.

DESIGN

randomised controlled trial.

SETTING

in-hospital birth centre at South Hospital, Stockholm, and standard obstetric care in the Greater Stockholm area.

SUBJECTS

1230 women with expected date of birth between October 1989 and February 1992, interested in participating in a birth centre trial, and meeting medical low-risk criteria. 617 women were allocated to the experimental group offered birth centre care (EG), and 613 to the control group offered standard obstetric care (CG).

MAIN OUTCOME MEASURES

duration of breast feeding, breast feeding complications such as sore nipples, engorgement, milk stasis, and mastitis, and women's experiences of breast feeding.

FINDINGS

no difference was found between EG and CG in the duration of breast feeding. Ninety-three per cent in both groups were breast feeding exclusively two months post partum. The average number of months of breast feeding, exclusively or partly, when investigated one year after the birth was 8.6 in EG and 8.5 in CG. No difference was observed in women's experiences of breast feeding, but rather more women in EG than in CG reported sore nipples, 36% and 30% respectively (p = 0.03), and milk stasis, 26% and 19% respectively (p = 0.002).

CONCLUSIONS

birth centre care had no effect on the duration of breast feeding, or on women's experiences of breast feeding. Prenatal attitudes were probably more significant predictors of these outcomes than differences in the two modes of maternity care in this population of highly breast feeding-motivated women. The larger proportion of sore nipples and milk stasis in the EG might have been due to earlier discharge, or to midwives less skilled in assisting with breast feeding at the birth centre than in the postpartum wards.

Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview

OBJECTIVES

The purpose of this review is to examine the plausibility of a causal relationship between maternity ward practices and lactation success.

METHODS

Studies were located with MEDLINE, from our personal files, and by contacting researchers working in this field. Of the 65 studies originally reviewed, 18 met our inclusion criteria (i.e., hospital-based intervention, experimental design with randomization procedures, or quasi-experimental design with adequate documentation).

RESULTS

Meta-analysis indicated that commercial discharge packs had an adverse effect on lactation performance. The impact of early mother-infant contact on lactation success was unclear. Rooming-in and breast-feeding guidance in a rooming-in context had a beneficial impact on breast-feeding among primiparae. Breast-feeding on demand was positively associated with lactation success. In-hospital formula supplementation of 48 mL per day was not associated with poor breast-feeding performance.

CONCLUSIONS

Hospital-based breast-feeding interventions can have a beneficial effect on lactation success, particularly among primiparous women.

Experiences of primiparous breast-feeding mothers in the first days following birth

This study describes the breast-feeding patterns of 59 neonates and the experiences of their primiparous mothers during the early postpartum period. The results showed that most mothers and babies in this group had significant difficulties during the first 2 days after birth and that 33% of the mother-baby pairs were still having problems latching or sucking on discharge from hospital (fourth to fifth postpartum days). Of the mothers who were still having problems on leaving the hospital, 84% had given up breast-feeding by 8 weeks, most of them by 2 weeks following hospital discharge.

Insufficient milk supply among black and white breast-feeding mothers

The purpose of this study was to investigate whether ethnicity is associated with insufficient milk supply (IMS) among breast-feeding mothers. A major reason reported by mothers for early termination or introduction of formula and/or solids is insufficient milk. A retrospective survey was conducted among 42 black and 148 white breast-feeding mothers participating in the WIC program in a midwestern state. The results suggested that: (1) the incidence of IMS was similar for black and white mothers; (2) controlling for education, black mothers initiated breast-feeding later and stopped sooner; IMS mothers fed less frequently and for shorter periods; and (3) controlling for education, there were no ethnic differences in the determinants or indicators of IMS.

Predictors of breast-feeding duration among WIC and non-WIC mothers

Many women cease breast-feeding during the first eight weeks after childbirth. Few studies have assessed the relationship of social status to the duration of breast-feeding. This research identified variables that predicted breast-feeding duration for the first eight weeks postpartum among mothers enrolled in the Women, Infants, and Children (WIC) program and those not enrolled. Participation in the WIC program was used as a criterion for measuring socioeconomic status. A total of 400 mothers completed the survey: 200 WIC and 200 non-WIC. A combination of five variables--introduction of formula, maternal perceived success, frequency of breastfeeding, income, and time of initiation of breast-feeding after delivery--explained 48% of the variance in the duration of breast-feeding. The best predictor, introduction of formula, alone accounted for 30% of the variance. There was no difference between aggregates with respect to breast-feeding duration. Findings suggest that a number of variables can be used to identify those at risk for unsuccessful or curtailed breast-feeding, with introduction of formula being the most detrimental.

Insufficient milk supply

A review of the literature reveals the phenomenon of insufficient milk supply (IMS) as being the most likely potential problem for the breastfeeding mother. This article discusses possible determinants and indicators of insufficient milk supply and proposes a conceptual definition and model.

Breast engorgement: contributing variables and variables amenable to nursing intervention

The focus of this study was to identify variables that correlate significantly with breast engorgement and that might be amenable to nursing interventions. Data on the initiation of feeding, frequency of feedings, feeding duration, rate of milk maturation, and supplementation were obtained of 54 women. These variables were found to be significantly correlated with breast engorgement.

Time limitation for early breastfeeding

To prevent nipple soreness, mothers who are breastfeeding are counseled to limit the time their infant feeds in the early postpartum period. No evidence supports this method of prevention. To the contrary, nursing and medical literature report that this practice is not effective and that its use should be discontinued. Nursing interventions to prevent nipple problems are presented.