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Home versus Hospital Breastfeeding Support for Newborns: A Randomized Controlled Trial

Authors

  • Patricia McKeever RN, PhD,

    1. Patricia McKeever is a Professor with the Faculty of Nursing, University of Toronto; Bonnie Stevens is a Professor with the Faculty of Nursing, University of Toronto; Karen-Lee Miller is a Research Associate with the Home and Community Care Evaluation and Research Centre, University of Toronto; Jo Watson MacDonell is the Director of Obstetrics for the Perinatal Program at the Sunnybrook and Women's College Health Sciences Centre, Toronto; Sharyn Gibbins is the Head of Interdisciplinary Research, Sunnybrook and Women's College Health Sciences Centre, Toronto; Denise Guerriere is an Assistant Professor with the Department of Health Policy, Management and Evaluation, University of Toronto; Michael S. Dunn is an Associate Professor with the Department of Paediatrics, University of Toronto; and Peter C. Coyte is a Professor of Health Economics with the Department of Health Policy, Management and Evaluation, University of Toronto.
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  • Bonnie Stevens RN, PhD,

    1. Patricia McKeever is a Professor with the Faculty of Nursing, University of Toronto; Bonnie Stevens is a Professor with the Faculty of Nursing, University of Toronto; Karen-Lee Miller is a Research Associate with the Home and Community Care Evaluation and Research Centre, University of Toronto; Jo Watson MacDonell is the Director of Obstetrics for the Perinatal Program at the Sunnybrook and Women's College Health Sciences Centre, Toronto; Sharyn Gibbins is the Head of Interdisciplinary Research, Sunnybrook and Women's College Health Sciences Centre, Toronto; Denise Guerriere is an Assistant Professor with the Department of Health Policy, Management and Evaluation, University of Toronto; Michael S. Dunn is an Associate Professor with the Department of Paediatrics, University of Toronto; and Peter C. Coyte is a Professor of Health Economics with the Department of Health Policy, Management and Evaluation, University of Toronto.
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  • Karen-Lee Miller MA, MSW,

    1. Patricia McKeever is a Professor with the Faculty of Nursing, University of Toronto; Bonnie Stevens is a Professor with the Faculty of Nursing, University of Toronto; Karen-Lee Miller is a Research Associate with the Home and Community Care Evaluation and Research Centre, University of Toronto; Jo Watson MacDonell is the Director of Obstetrics for the Perinatal Program at the Sunnybrook and Women's College Health Sciences Centre, Toronto; Sharyn Gibbins is the Head of Interdisciplinary Research, Sunnybrook and Women's College Health Sciences Centre, Toronto; Denise Guerriere is an Assistant Professor with the Department of Health Policy, Management and Evaluation, University of Toronto; Michael S. Dunn is an Associate Professor with the Department of Paediatrics, University of Toronto; and Peter C. Coyte is a Professor of Health Economics with the Department of Health Policy, Management and Evaluation, University of Toronto.
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  • Jo Watson MacDonell RN, MScN, IBCLC,

    1. Patricia McKeever is a Professor with the Faculty of Nursing, University of Toronto; Bonnie Stevens is a Professor with the Faculty of Nursing, University of Toronto; Karen-Lee Miller is a Research Associate with the Home and Community Care Evaluation and Research Centre, University of Toronto; Jo Watson MacDonell is the Director of Obstetrics for the Perinatal Program at the Sunnybrook and Women's College Health Sciences Centre, Toronto; Sharyn Gibbins is the Head of Interdisciplinary Research, Sunnybrook and Women's College Health Sciences Centre, Toronto; Denise Guerriere is an Assistant Professor with the Department of Health Policy, Management and Evaluation, University of Toronto; Michael S. Dunn is an Associate Professor with the Department of Paediatrics, University of Toronto; and Peter C. Coyte is a Professor of Health Economics with the Department of Health Policy, Management and Evaluation, University of Toronto.
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  • Sharyn Gibbins RN, PhD,

    1. Patricia McKeever is a Professor with the Faculty of Nursing, University of Toronto; Bonnie Stevens is a Professor with the Faculty of Nursing, University of Toronto; Karen-Lee Miller is a Research Associate with the Home and Community Care Evaluation and Research Centre, University of Toronto; Jo Watson MacDonell is the Director of Obstetrics for the Perinatal Program at the Sunnybrook and Women's College Health Sciences Centre, Toronto; Sharyn Gibbins is the Head of Interdisciplinary Research, Sunnybrook and Women's College Health Sciences Centre, Toronto; Denise Guerriere is an Assistant Professor with the Department of Health Policy, Management and Evaluation, University of Toronto; Michael S. Dunn is an Associate Professor with the Department of Paediatrics, University of Toronto; and Peter C. Coyte is a Professor of Health Economics with the Department of Health Policy, Management and Evaluation, University of Toronto.
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  • Denise Guerriere RN, PhD,

    1. Patricia McKeever is a Professor with the Faculty of Nursing, University of Toronto; Bonnie Stevens is a Professor with the Faculty of Nursing, University of Toronto; Karen-Lee Miller is a Research Associate with the Home and Community Care Evaluation and Research Centre, University of Toronto; Jo Watson MacDonell is the Director of Obstetrics for the Perinatal Program at the Sunnybrook and Women's College Health Sciences Centre, Toronto; Sharyn Gibbins is the Head of Interdisciplinary Research, Sunnybrook and Women's College Health Sciences Centre, Toronto; Denise Guerriere is an Assistant Professor with the Department of Health Policy, Management and Evaluation, University of Toronto; Michael S. Dunn is an Associate Professor with the Department of Paediatrics, University of Toronto; and Peter C. Coyte is a Professor of Health Economics with the Department of Health Policy, Management and Evaluation, University of Toronto.
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  • Michael S. Dunn MD,

    1. Patricia McKeever is a Professor with the Faculty of Nursing, University of Toronto; Bonnie Stevens is a Professor with the Faculty of Nursing, University of Toronto; Karen-Lee Miller is a Research Associate with the Home and Community Care Evaluation and Research Centre, University of Toronto; Jo Watson MacDonell is the Director of Obstetrics for the Perinatal Program at the Sunnybrook and Women's College Health Sciences Centre, Toronto; Sharyn Gibbins is the Head of Interdisciplinary Research, Sunnybrook and Women's College Health Sciences Centre, Toronto; Denise Guerriere is an Assistant Professor with the Department of Health Policy, Management and Evaluation, University of Toronto; Michael S. Dunn is an Associate Professor with the Department of Paediatrics, University of Toronto; and Peter C. Coyte is a Professor of Health Economics with the Department of Health Policy, Management and Evaluation, University of Toronto.
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  • Peter C. Coyte PhD

    1. Patricia McKeever is a Professor with the Faculty of Nursing, University of Toronto; Bonnie Stevens is a Professor with the Faculty of Nursing, University of Toronto; Karen-Lee Miller is a Research Associate with the Home and Community Care Evaluation and Research Centre, University of Toronto; Jo Watson MacDonell is the Director of Obstetrics for the Perinatal Program at the Sunnybrook and Women's College Health Sciences Centre, Toronto; Sharyn Gibbins is the Head of Interdisciplinary Research, Sunnybrook and Women's College Health Sciences Centre, Toronto; Denise Guerriere is an Assistant Professor with the Department of Health Policy, Management and Evaluation, University of Toronto; Michael S. Dunn is an Associate Professor with the Department of Paediatrics, University of Toronto; and Peter C. Coyte is a Professor of Health Economics with the Department of Health Policy, Management and Evaluation, University of Toronto.
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  • This project was supported by a grant from the Health Transition Fund, Health Canada, Ottawa, and by a financial contribution from The Hospital for Sick Children Foundation, Toronto, Ontario, Canada.

Address correspondence to Patricia McKeever, PhD, Faculty of Nursing, University of Toronto, 50 St. George Street, Toronto, Ontario, Canada, M5S 3H4.

Abstract

ABSTRACT: Background: The advantages of breastfeeding have been well established for both mothers and their infants. Existing research reports equivocal effects of early discharge and postpartum home care on breastfeeding success. The purpose of this study was to compare the effects of breastfeeding support offered in hospital and home settings on breastfeeding outcomes and maternal satisfaction for mothers of term and near-term newborns who experienced standard or early discharge.

Methods: In a randomized controlled trial with prognostic stratification for gestational age, 101 term and 37 near-term (35–37 weeks’ gestational age) mother-newborn pairs were randomized to either a standard care group (standard care and standard length of hospitalization) or an experimental group (standard hospital care with early discharge and home support from nurses who were certified lactation consultants). Data collection occurred before randomization, at discharge from hospital, and from 5 to12 days postpartum. Primary outcomes included breastfeeding rates and maternal satisfaction.

Results: More mothers of term newborns in the experimental group were breastfeeding exclusively at follow-up (p=0.02) compared with the control group. No significant breastfeeding differences occurred among mothers with near-term newborns in the experimental and standard care groups.

Conclusions: In-home lactation support appears to facilitate positive breastfeeding outcomes for mothers of term newborns. This may also be a beneficial model of postpartum care for mothers of near-term newborns; however, further research is required. The findings suggest implications for health caregivers and policy makers with respect to postpartum lactation and health care services. (BIRTH 29:4 December 2002)

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