Identification of Risk Factors for Delayed Onset of Lactation

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Abstract

Objective To identify infant feeding, socioeconomic, demographic, and delivery-related factors that affect women's self-reported timing of the onset of lactation.

Design Longitudinal survey of women from day 1 postpartum until self-reported onset of lactation. Subjects were interviewed in person on day 1 postpartum, then surveyed daily by telephone regarding infant feeding method, breast symptoms, and perception of whether the onset of lactation had occurred. Medical records were reviewed.

Subjects/setting Data were collected from 192 women after they gave birth to a healthy, term singleton.

Statistical analyses performed χ2 Analyses were used to identify variables associated with delayed onset of lactation (onset of lactation ≥72 hours postpartum). Multivariate logistic regression was used to identify the independent association of each significant variable with delayed onset of lactation.

Results Risk factors for delayed onset of lactation included white/Hispanic ethnicity, heavy/obese body build, delivery of offspring by unscheduled cesarean delivery, vaginal delivery with prolonged stage 2 labor, infant birth weight less than 8 lb, and exclusive formula-feeding before the onset of lactation.

Applications/conclusions Women who are at risk for delayed onset of lactation need additional breast-feeding support during the first week postpartum. During their hospitalization, these women should be instructed about the normal lactation process and the possibility that onset of lactation may occur later than 72 hours postpartum. Frequent nursing should be recommended, as delayed onset of lactation was associated with the lack of infant suckling.

JAm Diet Assoc. 1999;99:450-454.

Section snippets

Study Design

This longitudinal study followed up a convenience sample of 192 women recruited at Hartford Hospital (Hartford, Conn) on day 1 postpartum after delivery of a healthy, term singleton. The study was conducted between December 1996 and May 1997 and was approved by the human subjects committees at the University of Connecticut and Hartford Hospital. Our sampling goal was to recruit 100 primiparous women and 50 women who had had a cesarean delivery. On the 3 days per week during which subjects were

Results

The women in this study were primarily white, did not smoke, breast-fed their infants, had a prepregnancy body mass index less than 27, and on average had at least 2 years of college education (Table 1). The type of anesthesia received during vaginal delivery was as follows: none (4.3%), local (20.7%), epidural (75.0%). During cesarean delivery, women received a spinal (40.4%), epidural (51.9%), or general (7.7%) anesthetic. More than 75% of the women chose to breast-feed and were

Discussion

This article presents a comprehensive analysis of risk factors for delayed onset of lactation. Although other authors have evaluated individual factors that may affect the timing of onset of lactation (6), (17), it is difficult to make direct comparisons between our results and those of previous studies because of the unique nature of our study. Most of the other studies (6), (17) did not provide information on maternal body build, duration of labor, and infant birth weight, which were shown to

Applications

This research can be used to develop a profile of women at risk for delayed onset of lactation. Women at risk include those who undergo unscheduled cesarean delivery or a vaginal delivery with stage 2 labor that lasts more than 1 hour, are of heavy/obese body build, or give birth to an infant whose birth weight is less than 8 lb. During their postpartum hospitalization, these women should be provided with additional breast-feeding support and should be instructed about the normal lactation

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