News Release

Study: Shorter hospital stays not reducing breastfeeding

Peer-Reviewed Publication

University of North Carolina at Chapel Hill

Shorter hospital stays following childbirth have raised concerns, including the possibility that new mothers may be less likely to breastfeed their infants.

A new University of North Carolina at Chapel Hill study, however, indicates that that's not true, researchers say. For reasons that are unclear, early discharge actually increases the chance that babies will be breastfed.

A report on the findings appears in the May issue of the Journal of Human Lactation. Authors are Drs. Lewis H. Margolis, associate professor of maternal and child health, and J. Brad Schwartz, research associate, both at the UNC-CH School of Public Health.

"Using data from 1988, before managed care had become so influential in health-care decision-making, we analyzed social, economic and health services factors associated with discharge timing and breastfeeding," Margolis said. "Low income and lack of insurance, less than a high school education and inadequate prenatal care were more likely to be associated with early discharge, as well as not breastfeeding."

Simultaneous analysis of risk factors for early discharge and breastfeeding, however, indicated that contrary to conventional wisdom, early discharge increased the likelihood that mothers breastfed their infants, he said.

The study suggests two conclusions, the physician said.

"First, when clinicians and mothers were more free to engage in decision-making about discharge timing, they were able to make decisions that supported breastfeeding, even when the risk factors by themselves suggested that mothers might not breastfeed," he said. "Second, hospital routines -- separation of mothers and infants, use of water in bottles, adherence to feeding schedules rather than feeding on demand -- often work against development of good breastfeeding habits."

Earlier studies have demonstrated that hospitals as a group are not conducive to breastfeeding, Margolis said. Some hospitals have begun trying to change that by hiring lactation consultants and making themselves more "baby friendly."

Information used in the analysis came from the National Maternal and Infant Health Survey in 1988, which was the last time the nationally representative survey was conducted.

"Virtually every professional health organization from certified nurse midwives through the American Academy of Pediatrics, the American Public Health Association and the World Health Organization has strongly advocated breastfeeding as the best source of nutrition for infants at least up to 6 months of age and preferably beyond that," Margolis said. "Anything we can do in the hospital environment or in the general environment to increase breastfeeding would be beneficial to infants."

Within the past few months, a major managed-care organization announced that it would give physicians more leeway in decision-making about their patients.

"That is encouraging since rigid rules for when patients must be discharged are less desirable than encouraging clinicians and patient to work together in making this kind of decision," he said. "That's part of what a professional is supposed to do - look at the evidence and come to a good decision. It looks like we are moving in that direction again."

Margolis emphasized that findings from the new study do not provide justification for early discharge but should encourage managed-care plans to adopt policies that support physician decision-making.

Besides the ideal balance of nutrients babies need, breast milk provides antibodies to protect them against infections, the physician said. The physical contact strengthens bonds between mother and child and stimulates release of hormones infants need for growth and development.

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The David and Lucille Packard Foundation supported the research.
Note: Margolis can be reached at 919-966-5974.

UNC-CH School of Public Health contact: Lisa Katz, 919-966-7467.
News Services contact: David Williamson, 962-8596.



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