More breastfeeding with early hospital discharge?
I have heard that women are more likely to breastfeed when they are discharged early from the hospital. Is this true, and if so, why?Question:
A recent study did show that breasfeeding occurred at higher rates among those with earlier discharge in the group evaluated. (Margolis, L and B. Schwartz. 2000)
Hospital routines, such as scheduled feedings, separation of mother and baby and introduction of bottles, do tend to interfere with breastfeeding. The longer the mother stays in the hospital, results in exposing mother and baby to these hazards for a longer period of time.
The study also suggested that physicians were more likely to discharge mothers earlier who fell into categories already known to breastfeed more frequently. Those categories include: mothers who took prenatal instruction, mothers with better financial resources and those with higher education levels. The doctors may have discharged these mothers earlier because they viewed them as more capable.
In my opinion, the higher breastfeeding rate with early discharge may also be because mothers who are given more choice about timing of discharge may also have more control over decisions that impact breastfeeding.
This study looked at women giving birth in 1988, before managed care had exerted a strong influence on discharge timing, so the mothers in this study were discharged early by either the recommendation of their physician or because of personal preference. These women were not discharged early because of the financial concerns of their insurance company. Mothers and babies with complications were excluded from this study so all of the couplets in the study had similar birth outcomes.
Conflicting advice in the hospital may also be a deterrent to breastfeeding. (Coreil J, et al 1995) Many mothers report their biggest breastfeeding frustration is the inconsistency of advice offered by the hospital staff on the mother-baby unit. When mothers are home they can "do their own thing" and seek out advice from professionals they trust and with whom they have an ongoing relationship.
Breastfeeding may be easier in the home because most new mothers feel more comfortable there. The physical surroundings of one's own home are generally better for breastfeeding. Hospital beds are notoriously difficult to get comfortable in for breastfeeding and the lack of privacy may also negatively impact the breastfeeding experience.
Another possibility that may be relevant now, but was not usually available in 1988 when the study was done, might be better access to home nursing services, including a visit with a lactation consultant. Some insurers will currently allow mothers to choose between an additional day in the hospital or home nursing services. Because visiting nurses generally can provide more time and greater individualization of care they may be better able to address breastfeeding concerns, especially if a lactation visit is included in the mother's insurance plan. This was not a part of the study, but may impact breastfeeding rates of mothers discharged early currently.
I don't think that early discharge by itself is the answer to increase breastfeeding rates. I think a lot has to do with the quality of breastfeeding support in the hospital and the support system the mother will have when she arrives home. The mothers who are leaving the hospital early may be better informed about breastfeeding and have good home support systems in place to assist in the early postpartum period. It may be those factors, rather than the timing of discharge, that improved the breastfeeding rate in the studied group.
Early discharge, by itself, without other supports for the mother, may actually decrease breastfeeding rates because it may put babies and mothers at a higher risk for some postpartum complications and readmission to the hospital as some have suggested, that would negatively impact breastfeeding. (Rirodan & Auerbach 1999)
I agree with the conclusions drawn in the study. It is suggested that the improvement in breastfeeding rates is more related to giving mothers and clinicians the control to assess and provide the appropriate amount of professional support and determine their length of hospital stay on an individual basis, not determined by costs alone.
- Coreil J, et al., "Health Professionals and Breastfeding counseling: client and provider views, Journal of Human Lactation 11 (4) 1995, pp 265-271.
- Margolis, L and B. Schwartz, "The Relationship Between the Timing of Maternal Postpartum Hospital Discharge and Breastfeeding", Journal of Human Lactation, 16(2) 2000 pp121-128.
- Riordan, J. and Auerbach, K. Breastfeeding and Human Lactation, Jones and Barlett, Boston, 1999. p. 311.