Professional organizations recommend breastfeeding at least eight times in 24 hours. However, it is unclear whether this recommendation applies to the first 24 hours after birth. Nevertheless, institutional policy follows the recommendation of feeding every 3 to 4 hours. For a variety of physiologically adaptive behaviors, breastfed infants feed less frequently during the first 24 hours of life than the formula-fed infants. There is a concern over what is the normal number of feeding episodes during the first 24 hours after birth. This study was conducted to determine breastfeeding frequency and infant elimination patterns during the first 24 hours of extrauterine life in an environment with minimal medical intervention.
Retrospective, descriptive study design.
A freestanding, nonprofit birth center in Northeastern Ohio.
Healthy mothers who were 18 years and older with uncomplicated vaginal birth, clear amniotic fluid, and chose to breastfeed in 2009 and 2010. Infant inclusion criteria included singleton, full-term, 5-minute Apgar score >7, no apparent facial deformity/malformation, and no identified medical problems.
Institutional Review Board approval and letter of cooperation from the birth center were obtained. A research data collection tool was developed and used for the study.
A total of 110 randomly selected charts were reviewed. On average, mothers were 28.9 years old, had 4.9 pregnancies, and had given birth 3.3 times prior to the current birth; their infants weighed 3,556 g at birth. On average, first breastfeeding occurred 1 hour postdelivery, and 8.2 breastfeeding sessions (SD: 1.4, range: 5-12) took place within the first 24 hours. More than 50% of the infants did not receive any supplement (e.g., formula, glucose water). Within the first 24 hours, the infants voided 2.6 times (SD: 1.6, range: 0-8) and had 3.5 bowel movements (SD: 1.6, range: 1-8).
Conclusion/Implications for Nursing Practice
Infants born to mothers in an environment with minimal medical intervention (e.g., no epidural anesthesia, no prolonged intravenous fluids, and no induction) breastfed on average eight times and eliminated three times in the first 24 hours after birth. Before definitive conclusion can be drawn about what would be considered the normal behaviors of breastfed infants in the first 24 hours of life, prospective studies are needed to examine the number and quality of breastfeeding sessions in other minimal medical intervention facilities.