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Feeding infants directly at the breast during the postpartum hospital stay is associated with increased breastfeeding at 6 months postpartum: a prospective cohort study
  1. Della A Forster1,2,
  2. Helene M Johns1,2,
  3. Helen L McLachlan1,3,
  4. Anita M Moorhead1,2,
  5. Kerri M McEgan4,
  6. Lisa H Amir1
  1. lJudith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, Melbourne, Victoria, Australia
  2. 2Royal Women's Hospital, Melbourne, Victoria, Australia
  3. 3School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
  4. 4Mercy Hospital for Women, Heidelberg, Victoria, Australia
  1. Correspondence to Professor Della Forster; d.forster{at}


Objective To explore whether feeding only directly from the breast in the first 24–48 h of life increases the proportion of infants receiving any breast milk at 6 months.

Design A prospective cohort study.

Setting Three maternity hospitals in Melbourne, Australia.

Participants 1003 postpartum English-speaking women with a healthy singleton term infant, who intended to breast feed, were recruited between 2009 and 2011. Women were excluded if they or their infant were seriously ill. 92% (n=924) were followed up at 6 months postpartum.

Primary and secondary outcome measures Main exposure variable —type of infant feeding in hospital up to time of study recruitment (24–48 h postpartum), categorised as ‘fed directly at the breast only’ or ‘received at least some expressed breast milk (EBM) or infant formula’. Primary outcome—proportion of infants receiving any breast milk feeding at 6 months postpartum. Secondary outcomes—proportion of infants receiving only breast milk feeding at 6 months; breast milk feeding duration; and maternal characteristics associated with giving any breast milk at 6 months.

Results Infants who had fed only at the breast prior to recruitment were more likely to be continuing to have any breast milk at 6 months than those who had received any EBM and/or infant formula (76% vs 59%; adjusted OR 1.76, 95% CI 1.24 to 2.48 (adjusted for parity, type of birth, breastfeeding intention, breastfeeding problems at recruitment, public/private status, epidural for labour or birth, maternal body mass index and education)).

Conclusions Healthy term infants that fed only directly at the breast 24–48 h after birth were more likely to be continuing to breast feed at 6 months than those who received any EBM and/or formula in the early postpartum period. Support and encouragement to initiate breastfeeding directly at the breast is important.


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