By Jennie Bever Babendure, PhD, IBCLC
In the Jan/Feb 2012 edition of the American Journal of Maternal Child Nursing, Barbara Morrison and Susan Ludington-Ho published a study looking at Interruptions to Breastfeeding Dyads in an LDRP Unit(1). They observed the doors to the rooms of 30 breastfeeding mother-infant dyads in a community hospital birthing center from 8AM to 8PM on post-delivery day 1, and found that mothers were interrupted an average of 53 times in that 12 hour period. The average duration of interruptions (18.5+/- 34.5min) was longer than the average duration of time alone (15.4+/-17.3 min), and half of the episodes of time alone lasted 10 minutes or less.
As mothers in the study reported that they spent an average of 25.68 minutes (+/-16.7) at each breastfeeding session, these interruptions were likely to impact early breastfeeding when frequent breast stimulation is critical. In fact, breastfeeding frequency was moderately negatively correlated with the number of interruptions. Additionally, the authors found that a mother’s satisfaction with her breastfeeding experiences was significantly correlated with her perception of amount of time alone with her infant, and when mothers felt interruptions interfered with breastfeeding; they found the interruptions more annoying.
Although I was astonished at the number of interruptions this study found in a 12 hour period (consistent with an earlier study in a university hospital(2)), I was not surprised that frequent interruptions impact breastfeeding. Given attitudes in the United States about breastfeeding in public, mothers may feel self-conscious about baring their breasts to visitors, nurses, and other hospital staff members while learning to breastfeed. Ideal amounts of skin-to-skin contact and relaxation may be difficult to accomplish when mothers feel they need to keep one eye on the door and a cover-up at the ready. Even when this isn’t the case, a mother who finds herself continually interrupted to place her lunch order, talk to visitors, answer the phone, have her vitals checked, and talk to physicians may delay or shorten breastfeeding sessions.
Not surprisingly, the majority of the women in the study only met the minimum recommended number of breastfeeding sessions (4 times in 12 hours), and several mothers fed their babies only 2 or 3 times for less than 15 minutes in that time frame. As infrequent and inadequate breastfeeding sessions can rapidly progress to infant weight loss and supplementation, this finding is particularly relevant to the cause of increasing breastfeeding duration and exclusivity. Coupled with this, frequent interruptions may prevent mothers from getting the rest they need to recover from childbirth and have the energy for frequent nighttime feedings.
Undoubtedly, many interruptions are necessary and unavoidable; however Morrison and Ludington-Hoe have a number of suggestions to minimize the impact on breastfeeding. These include:
- Discuss the importance of alone time, Kangaroo care, frequent breastfeeding and limited visitors during prenatal visits, classes and tours.
- Cluster care, plan care activities with mothers to enable quiet times, use door signs to signal time alone, and institute “quiet” times when no visitors or staff enter rooms.
- Minimize rounds and discontinue 24/7 visiting hours.
In our efforts to translate high breastfeeding initiation rates into longer breastfeeding duration, we must continue to remove barriers to establishing a successful breastfeeding relationship. As we think about how to best accomplish this task, minimizing the frequency of interruptions to mothers and baby may be a simple step in the right direction.
1. Morrison BP, RN, FNP, CNM; Ludington-Hoe, Susan PhD, RN, CNM, FAAN. Interruptions to Breastfeeding Dyads in an LRDP Unit. American journal of Maternal Child Nursing 2012;37(1):36-41.
2. Morrison B, Ludington-Hoe S, Anderson GC. Interruptions to breastfeeding dyads on postpartum day 1 in a university hospital. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing 2006;35(6):709-716.
Jennie Bever Babendure, PhD, IBCLC
I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.
Lactation Matters Editor’s Note: Just to add, Jennie has a brand new addition to the family. Welcome Noah Lev, born on Oct 28, 2011, who is breastfeeding beautifully! Congratulations !
Nice to see this research repeated. Thanks for bringing it to light. One of the Baby-Friendly hospitals my hospital has been in contact with has a “nap time” for all mom. Each mother and her nurse negotiates the exact time frame for this nap time, and the nurse helps enforce a two hour period during which the mother and her partner will be left alone with their baby. This hospital reports that the nap time helps mothers cope with “2nd Night” issues better. The nap time also helps us model in the hospital what we want families to do at home–sleep during the day when the baby is sleeping.
Two hour nap time is an awesome idea! Great article!
In my opinion the issue is not what a otcaatiln consultant might bill it is ensuring appropriate insurance coverage for otcaatiln services (including Medicaid). It should be mandated that insurance pays for the services of an IBCLC just as they cover visits with other allied health professionals. When my milk came in, our baby’s latch shallowed up and caused abrasions. Fortunately my mom had breastfed us kids and was able to help, but I called the IBCLCs at the hospital where we delivered which is when I learned that they couldn’t provide hands-on assistance after the baby had been discharged (due to liability reasons). They referred me to a local IBCLC in private practice, who came to our home for a lengthy and very helpful consult. Fortunately my husband and I had the financial means to pay, although I believe her fee was very reasonable. She was honest about her fees up-front and provided a special form/bill and a sample appeal letter that we could have used to try to get insurance reimbursement. After that I started attending a hospital support group and the IBCLC there is apparently able to bill insurance directly (she’s an APRN as well). My OB’s APRN is a otcaatiln consultant too, as is the APRN at our daughter’s pediatrician’s office and if we needed help, a visit to either of them would cost us only the normal office visit copay (however I don’t know if they’re IBCLCs). IBCLCs are allied health professionals and go through extensive training to become certified. I believe they deserve fair compensation for their time. Doctor’s visits are only affordable for most of us because we have insurance to cover much of the bill! In my mind, an IBCLC is an allied health professional, and otcaatiln services should be covered just like physical or occupational therapy would be.
This is a wonderful article and observation. Thank you.
Great article. I do hope hospital begin to realize that those minor interruptions do play into the breastfeeding relationship. When I had my first child, my husband and I had to take a “parenting class.” We weren’t told this until my discharge day. Not only that, the baby wasn’t allowed to attend and there was only 1 happening that day. Of course, my daughter wanted to nurse at that exact moment. The nurse was so upset with me because she was nursing when we were to report to class. She said, “You won’t be able to go home if you don’t do this.” I just wanted out of there, so reluctantly I gave my daughter to the nursery staff. About 30 mins into this “class”, which really only went over bathing and diaper changing and postpartum care that the nurses had already done with me, my daughter started SCREAMING and screaming and screaming. The nurse conducting the class remarks that someone isn’t happy. I add it was my baby and asked if we were almost finished because she wanted to finish nursing. We had to sit there another 30 mins. My daughter was screaming the entire time. It was horrible. I think her birthing experience (induction) coupled with this distance from me lead her to be a very different nurser. This hospital also had the policy of coming in at 6 am and taking all infants to the nursery so the pediatricians could do rounds and not have to go looking for all the babies. What was really funny and what I didn’t realize later was that I had a general physician who attended the birth and was my daughter’s doctor, too.
Ugh! I hope research like this will lead to policy changes that prevent other moms and babies from having to deal with things like that.
This was one of the primary reasons that factored into my decision to opt for a home birth with my third child.
What a great policy! I love that they have thought about making mom’s life easier down the line by encouraging the first nap!
Now the trick is to publicize! The hospital where my 2nd son was born felt like there was a party going on 24/7. Too many visitors and allowed to be noisy at all hours. I couldn’t wait to get out!
Another change I would like to see is more acceptance of things like nursing and pumping in the NICU. After two months, I was tired of going off to the freezing cold pumping room so I dragged the pump into the NICU. It was like I’d committed a crime. Really, I was just so tired and trying to pump every 2 hours round the clock was killing me.
. The number of hours I spend with a new cenilt face to face is 2-3 hours per visit. I write a detailed report to the mother’s physician and one to the baby’s physician, talk to both doctors, follow up by phone for free, do the accounting, order the supplies,talk to the insurance companies,offer a free online breastfeeding webinar every week, read the journals, have ongoing discussions with other IBCLCs on how to improve our skills and knowledge, go to as many conferences as I can to continue learning so that when the day is done there is little money left over to make a living on. I have asked many IBCLCs in private practice if they make a living without doing something else such as speak and/or sell products. The answer I hear? No. The problem is that insurance companies do not consider IBCLCs a valuable part of the healthcare team. To make a living you have to make money. Until they do there will be few and far between lactation consultants pouring their lifeblood into helping mothers and babies breastfeed. Those of us that do depend on those families that have enough money to set priorities of how they will spend it. And that will always mean that we can not help everyone. That is the reason I offer my class for free.Debbie
Very useful post. It was very useful. I was searching exaxtly for this. Thank you for your effort. I hope you will write more such useful posts.
Very useful blog. It was very useful. I was looking exaxtly for this. Thank you for your effort. I hope you will write more such useful posts.
It is important to ncgoerize the difference between the IBCLCs other types of breastfeeding support providers.IBCLCs are allied health professionals who provide clinical care specifically for crisis intervention and unusual/ difficult problems. They work in hospitals, clinic, doctore28099s office, or mothers home. Their approach is problem oriented, short-term assistance, episodic, usually in person and requires frequent physical contact. They use equipment more frequently due to the nature of problems they manage. They are in a position of authority and may give direct advice or instructions. As medical providers they must adhere to standards to complete documentation and reporting that is required and have liability insurance coverage. They have defined clinical competencies, scope of practice, ethical principals and disciplinary procedures to maintain their certification. They have extensive education and clinical requirements prior to also passing an exam and becoming certified.Other lactation training programs and certifications have been created for professionals and volunteers to equip them with basic knowledge of lactation support. Generally these are 15 to 45 hour courses designed to be add-on credentials for persons who have contact with pregnant and lactating women.The exception is found in Leche League Leaders who have more extensive training to provide information and encouragement, mainly through personal help, to all mothers who want to breastfeed their babies. La Leche League Leaders focus on preventive care and the normal and natural course of breastfeeding. They may work in their own home, mothere28099s home, or at meetings. The care is life-style oriented, long-term, ongoing and usually by phone, with rare physical contact. They are mothers who volunteer as they are able.They rarely uses equipment because they are not dealing with difficult breastfeeding problems. Leaders can offer mothers choices, but give no direct advice or instruction. Their work has an emphasis on listening skills. They do keep a Leadere28099s log, but are not required to report this anywhere. They follow La Leche League guidelines and protocols.