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With outpatient breastfeeding support and a home visitor program, early postpartum discharge doesn't reduce breastfeeding

Breastfeeding of newborns confers partial protection against infections and possibly against later chronic illnesses such as diabetes and asthma, and it enhances bonding between mother and infant. Yet only 64 percent of U.S. infants were breastfed at all in 1998, and just 45 percent of infants who began breastfeeding continued until 6 months of age.

Critics of 24-hour postpartum hospital stays have raised concerns that fewer hours of interaction with maternity ward professionals would lead to a decline in breastfeeding. However, a recent study found that hospital stays of 24 hours or less after normal vaginal deliveries did not adversely affect breastfeeding when combined with outpatient breastfeeding support and a home visitor program. The study was supported in part by the Agency for Healthcare Research and Quality (HS10060), and led by Stephen B. Soumerai, Sc.D., of Harvard Medical School.

The researchers examined the impact on breastfeeding of an HMO early discharge protocol of one postpartum overnight stay (preceded by increased prenatal preparation) followed by a nurse specialist home visit 48 hours after discharge for normal vaginal deliveries compared with a State-mandated minimum stay of 48 hours for such deliveries. The researchers retrospectively examined medical record data from a large HMO in eastern Massachusetts on 20,366 mother-infant pairs with normal vaginal deliveries between October 1990 and March 1998.

Postpartum stays of less than 2 nights rose from 29 to 65 percent when the early discharge program was implemented in fall 1994, then fell to 15 percent after implementation of the 48-hour State mandate in February 1996. Yet, the proportion of women who initiated breastfeeding rose gradually from 71 percent in the fourth quarter of 1990 to 82 percent in the first quarter of 1998. Continued breastfeeding for 3 months among those who began it remained constant at 73 percent. Even among minority, poor, and other vulnerable groups of women who are less inclined to breastfeed, there was no decline in breastfeeding associated with the shorter hospital stay.

More details are in "Effects on breastfeeding of changes in maternity length-of-stay policy in a large health maintenance organization," by Jeanne M. Madden, Ph.D., Dr. Soumerai, Tracy A. Lieu, M.D., M.P.H., and others, in the March 2003 Pediatrics 111(3), pp. 519-524.

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