Early Essential Newborn Care and Exclusive Breastfeeding at Hospital Discharge
by Anne Eglash MD, IBCLC, FABM
According to the authors of this week’s study, breastfeeding in the first hour after birth and EBF for the first 6 months are associated with a reduced risk of childhood illness, death, and maternal illness. Countries in East Asia and the Pacific have the lowest rates of early initiation and EBF, which contribute to their rates of infant and childhood mortality. The researchers in this study evaluated data from the Action Plan for Healthy Newborn Infants in the Western Region, implemented in 2014-2020 in 150 hospitals among 8 countries (Cambodia, China, Lao People’s Democratic Republic, Mongolia, Papua New Guinea, Philippines, Solomon Islands, and Vietnam). The initiative focuses on simple interventions around birth that have been shown to prevent infant illness and death, including prolonged skin-to-skin contact (SSC), feeding based on infant cues, rooming-in, and elimination of the promotion of infant formula. Enhanced breastfeeding support at delivery and postpartum is also provided.
The authors found that EBF discharge was 3.5-5.6 times more likely if mothers were allowed uninterrupted SSC for at least 30 minutes after birth, no matter whether she had a vaginal or cesarean birth.
- The longer a mother was SSC the more likely she was to initiate breastfeeding early (early = during initial uninterrupted SSC).
- Breastfeeding rates at discharge were significantly lower in facilities that had infant formula company products available, such as towel, bottles, and t-shirts.
- Rooming-in between mother and infant was associated with higher breastfeeding rates at discharge.
- Having a companion, chosen by the mother, with her during labor was associated with higher breastfeeding rates.
See the Answer
To explore the association between early essential newborn care (EENC) policy, practice and environmental interventions and breastfeeding outcomes.
Cross-sectional observational study. Setting 150 national, provincial and district hospitals implementing EENC in eight countries in East Asia and the Pacific.
1383 maternal interviews, chart reviews and environmental assessments during 2016 and 2017. Main outcome measures Exclusive breastfeeding (EBF), that is, feeding only breastmilk without other food or fluids since birth and before discharge, and, early breastfeeding initiation, that is, during skin-to-skin contact (SSC) with the mother without separation.
Fifty-nine per cent of newborns initiated breastfeeding early and 83.5% were EBF. Duration of SSC showed a strong dose–response relationship with early breastfeeding initiation. SSC of at least 90 min was associated with 368.81 (95% CI 88.76 to 1532.38, p<0.001) times higher early breastfeeding. EBF was significantly associated with SSC duration of 30–59 min (OR 3.54, 95% CI 1.88 to 6.66, p<0.001), 60–89 min (OR 5.61, 95% CI 2.51 to 12.58, p<0.001) and at least 90 min (OR 3.78, 95% CI 2.12 to 6.74, p<0.001) regardless of delivery mode. Non-supine position (OR 2.80, 95% CI 1.90 to 4.11, p<0.001), rooming-in (OR 5.85, 95% CI 3.46 to 9.88, p<0.001), hospital breastfeeding policies (OR 2.82, 95% CI 1.97 to 4.02, p<0.001), quality improvement mechanisms (OR 1.63, 95% CI 1.07 to 2.49, p=0.02) and no formula products (OR 17.50, 95% CI 5.92 to 51.74, p<0.001) were associated with EBF.
EENC policy, practice and environmental interventions were associated with breastfeeding outcomes. To maximise the likelihood of early and EBF, newborns, regardless of delivery mode, should receive immediate and uninterrupted SSC for at least 90 min.
In this study, SSC was the most important factor in early breastfeeding initiation. In this study, ‘early breastfeeding’ meant breastfeeding while the dyad was still engaged in initial, uninterrupted SSC. With every 30-minute increase in SSC duration, the likelihood of early breastfeeding increased greatly. This was regardless of vaginal or cesarean birth. The authors mention that longer periods of SSC may help to ameliorate the negative effects of cesarean birth on breastfeeding.
The researchers reported that the EBF at discharge was 67.8% among infants not placed SSC after birth, and 92.7% for infants placed SSC for 60-90 minutes. The authors hypothesize that not all infants are ready to feed immediately after birth, and the average time of first breastfeeding is about 50 minutes postpartum. For that reason, it makes sense to encourage uninterrupted SSC for at least 60-90 minutes. Staying SSC also helps to prevent early cord clamping, early bathing, and other procedures that may stress out the infant such as weighing and administration of medications.
They also described a 25% EBF for newborns in facilities with formula company-sponsored products, and 89.7% among newborns at facilities that prohibited these products.