Étude pilote des difficultés de mise en place de l'allaitement maternel des nouveau-nés à terme, en maternité : incidence et facteurs de risque

Abstract

Objectives To identify the incidence and risk factors of breastfeeding difficulties in maternity using 3 indicators: excess neonatal weight loss in maternity (EWL ≥ 10%), delayed onset of lactation (DOL ≥ 72 h) and suboptimal infant breastfeeding behaviour (SIBB = IBFAT score ≤ 10). Methods Descriptive and prospective survey from January 1st to March 15th of 2005. Mothers who gave birth to a healthy, single and term infant were included. Every day, the data were collected in maternity by nursing staff. Analysis of correlation by Spearman's coefficient or Fischer's test, bivariate and multivariate analysis of risk factors with logistic regression model. Results One hundred and eighteen dyads were included. Incidence of breastfeeding difficulties indicators was variable: SIBB day 0: 33.9%, SIBB day 3: 7.6%, DOL: 50%, EWL: 6.8%. Significant correlations between DOL and EWL (correlation coefficient [cc] < 0.6; P < 0.0043); between SIBB on day 0 and SIBB day 3 (cc = 0.289; P = 0.0015); between EWL and SIBB day 3 (cc = –0.187; P = 0.0418). In multiple logistic regression, significant association between SIBB day 0 and nipple type (OR = 15), between DOL and lack of previous breastfeeding experience (OR = 2.53), between EWL and elevated neonatal weight (OR = 1.22) and use of non breastmilk fluids > 60 ml (OR = 2.36). Conclusion Difficulties in the breastfeeding initiation are not uncommon. Influencing factors are not always modifiable. Breastfeeding couples considered at risk should be recognized and should benefit from a special lactation guidance in maternity and from a post-discharge follow-up.