The First Newborn Bath and Exclusive Breastfeeding Rates at Hospital Discharge
by Anne Eglash MD, IBCLC, FABM
Cut the cord, dry the baby, apply eye ointment, give a shot of vitamin K, and bathe the baby. Then give a bottle. That was the routine that I ‘grew up’ with in family medicine. Changes have come slowly over time, with the Baby Friendly Hospital Initiative leading the way in providing evidence-based strategies to improve in-hospital infant care to optimize successful breastfeeding. Every process improvement step is challenging for all of us, since we need to work in concert to prevent unsafe outcomes.
Recent research has found an effect of bath timing on exclusive breastfeeding rates at discharge.
The current research study made a splash in the media, bringing the issue to light for the lay public. The authors sought to improve their exclusive breastfeeding rates at discharge by delaying the bath. According to the authors, it has been unclear why delaying a bath improves exclusive breastfeeding rates at discharge. One theory is that the amniotic fluid on newborns’ skin provides a strong sensory cue, enhancing newborn suckling responses. Delaying the bath may also increase the time that infants are kept skin to skin, which we know enhances breastfeeding rates.
The study took place in a hospital in Ohio, where all infants born vaginally are placed skin to skin after birth, and infants with a cesarean birth are placed skin to skin 30 minutes after birth.
They compared exclusive breastfeeding rates for 448 infants undergoing the routine protocol of a bath at approximately 2 hours after birth, with 548 infants whose baths were delayed for at least 12 hours (on average about 18 hours after birth).
The 2 groups had no significant differences in demographic factors such as maternal age, socioeconomic status, or vaginal vs cesarean birth. They did not measure parity however. Breastfeeding initiation rates were similar between the 2 groups.
- The infants who had a delayed bath had higher body temperatures and were less likely to be hypothermic as compared to infants with a bath within 2 hours postpartum.
- Exclusive breastfeeding rates at discharge was ~83% for infants with a delayed bath, and ~77% for those bathed at 2 hours.
- Exclusive breastfeeding rates at discharge was ~68% for all infants with a delayed bath, and ~60% for those bathed at 2 hours.
- Infants born via cesarean with a delayed bath did not have an increased rate of exclusive human milk feeding at discharge as compared to the routine bath group.
See the Answer
To examine whether delayed newborn bathing would increase rates of in-hospital exclusive breastfeeding and plans to use human milk at discharge.
A retrospective, two-group, pre- and postintervention design.
At our facility, the initial bath was completed within 2 hours of birth, and the rate of in-hospital exclusive breastfeeding was low.
Couplets of mothers and healthy newborns (N ¼ 996).
Newborn baths were delayed at least 12 hours after birth. Pre- and postintervention data were retrieved from the hospital’s electronic medical record and administrative database. Univariate and multivariate analyses were completed.
Of 996 mother–newborn couplets, 448 were preintervention couplets, and 548 were postintervention couplets. Of all mothers, 64.2% were White, 66.4% were married, and 65.2% gave birth vaginally. Of all newborns, 51.5% were female, and the mean (standard deviation) birth weight was 7.4 (1.1) pounds. We found no differences in maternal or newborn characteristics by group. Median (25th percentile, 75th percentile) times from birth to first bath before and after the intervention were 1.9 (1.6, 2.3) and 17.9 (11.9, 25.0) hours, respectively (p<.001). In-hospital exclusive breastfeeding increased from 59.8% before the intervention to 68.2% after the intervention (p= .006). In multivariate modeling, in-hospital exclusive breastfeeding increased for all couplets after the intervention (odds ratio = 1.49, 95% confidence interval [1.14, 1.96]; p = .004) and with vaginal versus cesarean birth (odds ratio = 1.60, 95% confidence interval [1.14, 2.25]; p = .006). In addition, the postintervention discharge feeding plan reflected an increase in use of human milk.
Delaying the newborn bath was associated with increased in-hospital exclusive breastfeeding rates and use of human milk as a part of the discharge feeding plan.
Interestingly, the infants born via vaginal birth had improvement in exclusive breastfeeding rates but the infants born via cesarean did not. We already know from other literature that babies born via cesarean have lower breastfeeding initiation and duration rates (see CQW 26, Jan 2017). This study shows that delaying the bath for infants with cesarean births does not do enough to reduce the gap in breastfeeding success between vaginal and cesarean births. There are many other factors, such as delay in lactation and maternal pain that play a role in breastfeeding success.
It has been hypothesized that a delay in bathing reduces infant hypothermia, which may decrease infant suckling skills. These authors have provided evidence that infants with a delayed bath have higher body temperatures. So, if hospitals don’t value the benefit of delaying a bath to improve breastfeeding rates, at least they can make the decision to do so to prevent the risk of harmful infant hypothermia.