Objective: The purpose of this study was to describe the impact of length of hospital stay on initiation and continuation of breastfeeding, problems, and resource use. Design: Descriptive correlational Population, Sample, Setting, Years: Target population included women with cesarean and vaginal delivery discharged with their baby following an uncomplicated post-partum and neonatal hospital stay. A cohort-type sample of 1140 women participated in the study from a Midwestern tertiary medical center with an annual rate of 3900 births/year. Concepts: Feeding method, breastfeeding problems, unscheduled use of service, hospital length of stay Method: Data for this study included (a) demographic (b) clinical (c) payor (d) feeding method in the hospital and at 6 weeks (e) socio-economic status (f) breastfeeding problems, and (g) use of unscheduled services. Data were collected in the hospital and via a structured telephone interview at 6 weeks from July 1996 through June 1997. Findings: 64.6% of women who participated initiated breastfeeding in the hospital. By six week 60.9% of women who initiated breastfeeding continued to breastfeed. 15.3% of women who quit breastfeeding began a combination of breast and bottle feeding, and 23.7% quit breastfeeding altogether and were bottle-feeding. One quarter of the women who quit breastfeeding did so within the first week post-discharge, and close to two thirds of the women who quit had done so by week three. Women who initiated breastfeeding were older, had higher socioeconomic status, were White, married, and had PPO insurance carrier. Women who bottle fed were younger, 25% were unemployed, three times as many Black women bottle fed than breastfed, and one half of women who bottle fed were not married. Women who continued breastfeeding were older, had a higher socioeconomic status than women who bottle fed. Women who delivered vaginally and initiated breastfeeding stayed in the hospital longer than women who did not initiate breastfeeding regardless of their parity. Women who delivered vaginally and initiated breastfeeding in the hospital had a longer length of hospital stay - but this longer stay did not make a difference in terms of the feeding method used at six weeks. For women who delivered by cesarean section, hospital length of stay was not different for women who initiated breastfeeding and length of hospital stay did not affect the six-week feeding method . There were no statistical differences across hospital length of stay among the three groups of women (breastfeeding, combination breastfeeding and bottle-feeding, and bottle-feeding) in terms of breast and nipple problems or in use of unscheduled services Conclusion: In this study there was no evidence that shortened length of stay had an impact on breastfeeding. There was a small, but noteworthy, group of women who used a combination method of breast and bottle feeding-a phenomena that has been underreported in the literature. There were significant socio-demographic differences in initial choices of feeding method and in subsequent continuation of breastfeeding across the first six weeks postpartum. Mothers reported substantial numbers of feeding-related problems and unscheduled services across the first six weeks postpartum. Traditional programs of post-partum care have not been designed typically to address the ongoing needs of mothers and babies as they learn and adapt their feeding patterns. The fact that nearly 40% of breastfeeding women in this study changed from breastfeeding to combination or bottle feeding during the postpartum period suggests that support was not readily available, easily accessible, or provided in anticipation of the decision to quit breastfeeding. Initiating and continuing breastfeeding is a process that could be perceived as a type of behavior change. Behavior change theory may offer expanded potential for understanding and influencing feeding choices and behaviors. Implications: Using patient-centered Intervention designed to match physical, psychological and social characteristics of each women might increase breastfeeding rates. Combination breast/bottle feeding is not always indicative of quitting and should be supported. Follow-up during the first 2 weeks postpartum provides an opportunity to identify women contemplating quitting and additional interventions can be used to prevent or forestall quitting. Breastfeeding is a type of behavior change and interventions need to be expanded to foster beliefs, abilities, and social contacts to support breastfeeding. Postpartum care services need to be redesigned to meet the demands for information, support, and problem resolution during the first weeks following discharge.
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