Breastfeeding twice as likely after home births than hospital births

The study from Trinity's Department of Public Health and Primary Care, which included over 17,500 women from the UK Millennium Cohort Study and 10,500 women from the 'Growing Up in Ireland' study found:

• Home birth is significantly associated with breastfeeding immediately after birth, and with continued breast feeding during the first 6 months.
• Home birth mothers were more likely to exclusively breastfeed for 6 months (22% vs 9%).World Health Organisation (WHO) guidelines recommend exclusive breastfeeding for the first six months of life.

Based on the collected data and on an analysis of factors surrounding home and hospital based birth, the study's researchers suggest a number of potential reasons for the stronger association between breastfeeding and home birth:

• 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. In contrast, 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.
• 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 breast feeding. 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 has been shown that formula supplementation in the early postnatal period reduces the likelihood of subsequent exclusive breast feeding and overall duration of breast feeding. Hospital births have been associated with formula supplementation. This 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 breast feeding issues.

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 research was published in the leading international journal BMJ Open.