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Breastfeeding twice as likely after home birth

Study of mothers in UK and Ireland may provide important clues to help improve breastfeeding rates

Ingrid Torjesen

Wednesday, 10 August 2016

Pregnant women who plan to give birth at home are twice as likely to breastfeed than women who plan to give birth at hospital, a study* in BMJ Open shows.

Researchers at Trinity's Department of Public Health and Primary Care analysed data 10 604 mother–infant pairs from the Growing Up in Ireland (GUI) cohort and 17,521 pairs from the UK Millennium Cohort Study (UKMCS) cohort.

In GUI, 61% (n=6427) of mothers initiated breastfeeding, 22% (n=2292) continued to breastfeed for at least six months, and 9% (n=968) breastfed exclusively for six months. In UKMCS, 67% (n=11 774) initiated breastfeeding, 22% (n=3768) continued to breastfeed for at least six months and 1% (n=226) breastfed exclusively for six months.

Home birth was found to be significantly associated with breastfeeding at all examined time points. The adjusted OR after a home birth of breastfeeding at birth, 8 weeks, 6 months was 1.90 (95% CI 1.19 to 3.02), 1.78 (1.18 to 2.69), 1.85 (1.23 to 2.77), respectively, according in the GUI cohort, and 2.49 (1.84 to 3.44), 2.49 (1.92 to 3.26), 2.90 (2.25 to 3.73) respectively in the UKMCS.

World Health Organisation (WHO) guidelines recommend exclusive breastfeeding for the first six months of life, and the adjusted odds ratio of doing so after a home birth was 2.77 (1.78 to 4.33) and 2.24 (1.14 to 4.03) in the GUI and UKMCS cohorts respectively.

Principal researcher on the study, Associate Professor of Epidemiology in Trinity, Dr Lina Zgaga, said: "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."

The researchers pointed out that the level of support and type of care offered by each birth option is very different. In a home birth, care is typically midwife-led as opposed to physician-led. Multiple health professionals are involved in care following hospital birth, potentially providing unpredictable and inconsistent input. There is also a difference in the level of training related to lactation amongst carers with midwives typically receiving more education in this area.

They added that the non-clinical setting of a home birth can facilitate immediate and prolonged skin to skin contact post-partum, which is widely considered to have a positive effect on the initiation of breastfeeding and mother infant bonding. Interventions such as forceps or vacuum-assisted delivery that occur more frequently during labour in hospital may be stressful, and stress during birth has been linked to stalled breastfeeding. Similarly, hospital births are associated with greater usage of pain-relieving medications, which can cause lethargy in the infant and delay milk production in the mother.

It also been shown that formula supplementation in the early postnatal period reduces the likelihood of subsequent exclusive breastfeeding and overall duration of breastfeeding. Hospital births have been associated with formula supplementation, they said, which may be due to busy, understaffed clinical settings, where formula feeding may be found to be a more convenient solution to feeding problems than diagnosis and treatment of breastfeeding issues.

* Quigley C, et al. Association between home birth and breast feeding outcomes: a cross-sectional study in 28 125 mother–infant pairs from Ireland and the UK. BMJ Open 2016;6:e010551. DOI:10.1136/bmjopen-2015-010551

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