Breastfeeding Within the First Hour Postpartum
by Anne Eglash MD, IBCLC, FABM
In July 2018, UNICEF and WHO published Capture the Moment; Early initiation of breastfeeding: The best start for every newborn. This document highlights the critical need for newborns to breastfeed within the first hour of life, as a means of decreasing infant mortality globally, and establishing breastfeeding for the long term. In addition, skin-to-skin contact with mom immediately after birth stabilizes the infant temperature, and allows the infant to establish healthy bacteria from mother’s skin.
Globally, newborns who begin breastfeeding 2-23 hours after birth have a 33% increased risk of dying as compared to newborns who breastfeed within the first hour. Newborns who begin breastfeeding after 24 hours of age have twice the rate of death.
There are several barriers to breastfeeding within the first hour. These include outdated practices in birthing facilities, lack of support and guidance on breastfeeding, and lack of knowledge about implementing breastfeeding immediately after a cesarean birth at a time of skyrocketing cesareans internationally.
- High-income countries have a greater % of newborns who initiate breastfeeding within the first hour.
- Having a skilled birth attendant increases the likelihood of breastfeeding within the first hour.
- The United States has the highest documented rate of breastfeeding within the first hour after birth.
- Globally, 2 out of 5 infants are put to the breast within the first hour of life.
- Breastfeeding within the first hour is twice as high among vaginal births as compared to cesarean births.
- The majority of infants who receive some sort of non-mother’s milk supplement in the first few days after birth are not breastfed within the first hour after birth.
See the Answer
For those of you who are interested in the international perspective on birthing and breastfeeding, this is a fast and informative read.
Interestingly, high-income countries have lower rates of breastfeeding within the first hour as compared to lower and middle-income countries. I was surprised to find out that the US, like several other high-income countries, does not collect data on this measure.
There is not an association between having a skilled birthing attendant and likelihood of breastfeeding within the first hour. This report considers lack of training of skilled birth attendants to be a lost opportunity. If we train birth attendants, such as physicians, nurses, and midwives, on the importance of early skin-to-skin and early breastfeeding, we could see an increased rate of breastfeeding within the first hour, as long as birthing institutions facilitate changes.
The report recommends that 1) countries increase funding to improve breastfeeding knowledge and training, especially to implement breastfeeding within an hour, 2) full implementation of the International Code of Marketing of Breastmilk Substitutes, 3) enhance the quality of care in birthing facilities by using evidence-based infant feeding management , 4) improve access to individuals who are trained in breastfeeding support, 5) strengthen the link between birthing facilities and communities, and empower families to expect breastfeeding support from their outpatient providers, and 5) develop a monitoring system for gathering data on the rates of breastfeeding with the first hour.