Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss

Abstract

Even mothers who strongly want to breast feed their infants could have difficulty getting started. This prospective community-based study was an attempt to identify risk factors other than sociocultural barriers that arerelated to poor lactation outcomes. Risk factors were sought for suboptimal infant breastfeeding behavior (SIBB), delayed lactation, and excessive neonatal weight loss. Participants gave birth to a healthy single infant at term and were willing to try breast feeding exclusively for at least 30 days. Trained lactation consultants provided guidance in such areas as correct positioning, demand feeding, and avoidance of supplements, and also evaluated infant breastfeeding behavior using the Infant Breast-feeding Assessment Tool. Weight loss exceeding 10% of birth weight on day 3 was considered excessive. The mean maternal age was 30.6 years and 56% of mothers were primiparous. Nearly 80% of subjects were non-Hispanic whites. The average educational level was high. These mothers expressed strongly positive attitudes toward breast feeding. SIBB was found in 49% of infants at baseline, 22% on day 3 and 14% on day 7. It correlated significantly with primiparity on days 0 and 3, with cesarean section (day 0 in multiparas), and with flat or inverted nipples. Other significant correlates of SIBB included using nonbreast milk fluids in the first 2 days of life, use of a pacifier, stage II labor lasting longer than 1 hour, and a maternal body mass index (BMI) greater than 27 kg/m 2 . Lactation was delayed in 22% of women, more frequently in primiparas, after cesarean section, and women having a prolonged second stage of labor, a high material BMI, flat or inverted nipples, or (in primiparas) a birth weight greater than 3600 g. Excessive weight loss was observed in 12% of neonates. It correlated with primiparity, a long labor, the use of labor medication (by multiparas), and infant status at birth. Excessive weight loss was 7.1-fold more likely if lactation was delayed and 2.6-fold more likely if SIBB was present on the first day of life.