Review articleBreastfeeding initiation and support: A literature review of what women value and the impact of early discharge
Introduction
Since the 1940s when hospitalised childbirth became the ‘norm’, length of postnatal stay following vaginal birth has altered dramatically globally.1, 2 In the 1950s, staying six to 14 days was common practice following a normal vaginal birth.1, 2 This decreased to four days in the 1970s, then to less than 48 h in the 1990s in some settings.2, 3 In the Australian setting in 1995, 4.5 days was the average postnatal length of stay and in 2014 it had reduced to less than 24–48 h following uncomplicated vaginal birth.4, 5, 6
Two reasons have been given for the reduction in length of postnatal stay; namely, reducing health expenditure and improving women’s satisfaction.2, 3 Significant health budget cuts have occurred in Australia in recent years, and reducing length of hospital stay is one way of lowering health costs.7 Early discharge is intended to improve maternal satisfaction by offering advantages such as autonomy, increased sense of belonging, promoting a feeling of responsibility and participation, and facilitating family support in a comfortable home environment.2, 3, 8, 9
A 2009 Cochrane review evaluated the safety, effectiveness and impact of early discharge policies, in terms of health outcomes for mothers and babies, postnatal satisfaction rates, costs to health care and broader impact on families.1 Ten trials included in this review found no significant differences of infant and maternal readmissions and breastfeeding rates following early discharge.1 Furthermore, substantial variations in defining early discharge and antenatal and postnatal services proved difficult to draw compelling conclusions.1 The World Health Organisation10 recommend exclusively breastfeeding infants until six months of age, with the Australian breastfeeding rate at six months only 14%.11 It remains unknown whether or not there is an impact of early discharge on breastfeeding initiation, and maternal satisfaction of breastfeeding support. A significant concern is women returning home before their milk production has established, and possibly receiving inadequate support. Once discharged from hospital women are left to rely on community based resources such as domiciliary midwives, maternal and child nurses, and peer support organisations such as Australian Breastfeeding Association or La Leche League. This may lead to early cessation of breastfeeding and potential for increases in future morbidity and mortality rates.2, 12
The initial intent of this review was to examine literature surrounding maternal perception of breastfeeding initiation and support after early discharge within 24 h of birth. Due to inconsistent definitions of early discharge worldwide and minimal literature using the 24 h definition, research defining early discharge up to 72 h postpartum is included.
The purpose of this review is to critically appraise the evidence about what women value relating to breastfeeding initiation and support, and the impact early discharge may have on these values and practices. The literature search strategy and critical appraisal approaches, collation of themes and discussion of the findings, limitations and conclusions of this integrative review will be addressed.
Section snippets
Search strategy and selection process
A literature search was conducted identifying publications describing breastfeeding initiation and early discharge after birth. The search was completed during August and September 2015 and included four electronic databases predominately used to disseminate midwifery research; Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Scopus and PsycINFO. The initial search focused on early discharge and breastfeeding as broad concepts. A second search focused on breastfeeding
Discussion
The literature highlighted early discharge does not have a standardised definition, and ranges anywhere within six to 72 h following birth.15, 24 The literature also provided insight into the seven things women value and deem essential to establish breastfeeding. The evolving question is—does early discharge impact these factors?
It seems several values, namely trust and security, practical breastfeeding support, breastfeeding education, positive attitudes and emotional support, and consistent
Conclusion
The purpose of this review was to explore what women value in relation to breastfeeding initiation and support, and investigate the impact early discharge can have on these values. We found that the definition of early discharge fluctuates country-to-country, setting-to-setting, varying between six to 72 h of birth. Seven key values in relation to breastfeeding initiation and support were identified. Of these, five values were most influenced by individual midwives’ practice rather than early
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