Breastfeeding more likely after home birth

Women are much more likely to breastfeed if they give birth at home, a new Irish study has found.

Researchers in Trinity College Dublin (TCD) looked at more than 10,500 women from the ‘Growing Up In Ireland' study and 17,500 women from the UK Millennium Cohort study and found a strong link between home births and breastfeeding.

According to the findings, women were twice as likely to breastfeed after a planned home birth compared to a hospital birth. They were also significantly more likely to continue to breastfeed for at least six months.

Overall, 22% of home birth mothers exclusively breastfed for the first six months compared to 9% of mothers who gave birth in hospitals.

Currently in Ireland, breastfeeding rates are very low when compared to the European average. Around 60% of women in Ireland attempt breastfeeding compared to a European norm of around 90%. However, many of those who do attempt breastfeeding quit in the days and weeks after.

The researchers believe there may be a number of reasons for their findings, including the type of care that is involved. When a woman gives birth at home, her care is typically led by a midwife and in Ireland, self-employed community midwives are the primary carer for the mother and baby until the baby is two weeks old.

As a result, the mother tends to receive consistent advice and support from the same healthcare professional in the 14 days after the birth. In a hospital setting, there may be multiple professionals offering potentially inconsistent advice.

The researchers also noted that support in the post-partum period is essential. In Ireland, the usual model of care sees shared care between the obstetrician and GP, followed by a visit from a public health nurse (PHN) within 48 hours of coming home from hospital. However, this PHN visit is only achieved in 57-87% of cases, leaving some women without advice or support during those crucial 48 hours.

The TCD team also pointed out that interventions, such as the use of forceps, occur more frequently during hospital births and this may be stressful. Stress during birth has been linked to stalled breastfeeding. Similarly, there tends to be a bigger use of pain-relieving medication during hospital births, which can cause the infant to become lethargic, making it more difficult for them to latch on. Stress can also delay milk production in the mother.

Meanwhile, it has also been shown that when infants are given formula in the early postnatal period, this reduces the likelihood that they will be exclusively breastfed and it also reduces how long they will be breastfed for. Hospital births in Ireland have been associated with formula supplementation despite the fact that all maternity units are supposed to recommend breastfeeding unless medically indicated.

The researchers acknowledged that this may be because many units and hospitals are extremely busy and understaffed, making formula a more convenient solution to feeding problems.

"The key question that this work raises is when breastfeeding is so strongly recommended across the board by the medical profession, what causes lower rates of breastfeeding following hospital births? Hopefully this research can help us learn from the home birth model and identify the changes that could be implemented in standard hospital-based perinatal care to encourage and facilitate breastfeeding," commented the study's principal researcher, Dr Lina Zgaga.

Details of these findings are published in the journal, BMJ Open.

 

[Posted: Mon 15/08/2016]


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