Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview.

Abstract

IntoductionThe recent interest in maternity ward practices demonstrated by international health agencies' is justified. Rooming-in can have a beneficial impact on the health of the newborn,2-4 and, as this review will show, there are strong reasons to believe that beneficial infant feeding policies in the maternity ward can contribute to lactation success. In 1989, the World Health Organization (WHO), in conjunction with the United Nations Children's Fund (UNICEF),1 made several recommendations to promote breast-feeding in institutions that provide maternity services. These recommendations included rooming-in throughout the hospital stay, breast-feeding on demand, early initiation of breast-feeding, breast-feeding guidance by health personnel, and avoidance of supplementary fluids. Given the high number ofbirths attended in clinics or hospitals worldwide,4,5 an in-depth assessment of the impact of such policies is worthwhile.In 1980, Winikoff and Baer6 concluded that maternity ward policies similar to those advocated by WHO and UNICEF could have a positive impact on breast-feeding. However, they did not fully address the methodological limitations of the studies included in their review. Although Margen et al.7 recognized that the majority of such studies did not account for confounders, they too concluded that lactation performance can be improved by encouraging mother-infant contact, providing breast-feeding information, and restricting bottle-feeding. follow-up, but that in-hospital formula supplementation and breast-feeding support without phone follow-up had no significant impact. Their review did not consider policies such as discharge packs, rooming-in, and breast-feeding on demand, and it did not include any studies in developing countries.Considering the limitations of these previous reviews, it is worthwhile to reexamine this issue. The intent of our review is to examine the plausibility of a causal relationship between maternity ward practices and lactation success, using the procedures ofmeta-analysis whenever possible. MethudsThis review is restricted to articles on the relationship between maternity ward practices and lactation success published in English or Spanish between 1951

Alimentación del recién nacido en el periodo de posparto inmediato

“…Otra limitación frecuente en los estudios de este tipo es la de presentar los hechos como "exposición presente o ausente", sin tener en cuenta aspectos cualitativos del inicio del amamantamiento (interacciones vinculares, posturas, mensajes acordados), como se señala en una revisión sobre este tema. 10 Por ejemplo, en estudios experimentales, las intervenciones facilitan un contacto precoz y prolongado de la madre y el niño; en el nuestro hay mucha precisión en cuanto al tiempo transcurrido entre el parto y el primer contacto (cuando se daba al menos durante cinco minutos), pero hay heterogeneidad en la calidad del contacto, por tratarse de diferentes instituciones.…”

Relationship Between Perinatal Counseling and Incidence of Breastfeeding in an Inner-City Population

“…The incidence of breastfeeding is related to several factors, including maternal characteristics (e.g., education, age, parity), environment (e.g., presence of significant others, family support, cultural background), and health care and social work professionals (e.g., perinatal counseling, distribution of commercial discharge packs including formula, and the Women, Infants, and Children Program). [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Women with previous experience breastfeeding were less likely to attend education sessions, whereas those abusing drugs such as cocaine or heroin were counseled against breastfeeding and were not candidates for breastfeeding education sessions. Although we would agree that the apparent effectiveness of our program does indeed support the findings of Brent et al 1 that the combination of education and maternal support from knowledgeable health care providers can influence the incidence and duration of breastfeeding in this population, our study was not properly designed to reach that conclusion.…”

“…[1][2][3][4][5][6][7][8] Factors affecting the incidence and duration of breastfeeding include: maternal education, ethnicity, socioeconomic class, age, family support, maternal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children Program, and support from the medical community and institutional policy. [1][2][3][4][5][6][7][8][9][10] Recent studies have also shown that the medical community itself is ill-prepared to adequately support breastfeeding at both the physician and institutional levels. 10 -14 A prospective, randomized, controlled study by Brent et al 1 showed that perinatal education and counseling of primipara women in a low-income, inner-city population doubled the incidence of breastfeeding from 32% to 61% and its median duration from 33 to 88 days.…”

Epidural Analgesia and Lactation

“…Perez-Escamilla et al [39] performed a meta-analysis of studies that correlated maternity ward practices with lactation success. The meta-analysis indicated that commercial discharge packs had an adverse effect on lactation performance.…”