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Breastfeeding rates rise if newborn’s bath delayed, Cleveland Clinic study finds – cleveland.com

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Breastfeeding rates rise if newborn’s bath delayed, Cleveland Clinic study finds – cleveland.com

CLEVELAND, Ohio—The Cleveland Clinic has changed its policy on bathing newborns after a study by the nursing team at Hillcrest Hospital found that delaying a baby’s first bath significantly increased exclusive (no supplemental formula) breastfeeding rates.

Delivery teams now wait at least 12 hours after birth to bathe newborns at all Clinic hospitals except Akron General, which is still implementing the change.

Typically a baby is given a sponge bath quickly after birth because in the past, people were “kind of grossed out” by the natural coating of blood and amniotic fluid covering the baby, study author and nursing professional development specialist Heather DiCioccio said. At Hillcrest where DiCioccio works, most babies had been bathed within two hours of birth, she said.

“That’s how we’ve always done it,” she said, but she and others at the hospital could find no good rationale for the practice. “We finally got to the point of saying ‘why?’”

The Clinic study was prompted by an increasing number of mothers delivering at Hillcrest in 2014 and 2015 requesting delayed bathing , said DiCioccio.

“Moms were coming into the hospital with this request as part of their written birth plan,” she said. “They were reading it on the internet on mom blogs, and their friends were telling them about it.”

The hospital has been trying to increase its exclusive breastfeeding rate to meet an internal goal of 72 percent. The U.S. Department of Health and Human Services’ Healthy People 2020 goal is to increase the proportion of infants who are breastfed (at least initially) to about 82 percent.

Beginning in April of 2016, DiCioccio and the nurses at Hillcrest Hospital in Mayfield Heights implemented the delayed bathing policy and then compared about 500 babies who had the immediate bath prior to the change with another 500 who were bathed at least 12 hours after birth.

In-hospital exclusive breastfeeding rates in the delayed-bath group of mom-baby pairs shot up from 59.8 percent before the intervention to 68.2 percent after the intervention. The study was published today in the Journal of Obstetric, Gynecological and Neonatal Nursing.

With a delayed bath, nurses wipe blood off, but then immediately give the baby to mom to be held skin-to-skin, a practice which has many known benefits, including bonding, temperature regulation and easing breastfeeding.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding at least until the child’s first birthday. Research shows that breastfeeding benefits the development of the brain as well as the immune and digestive systems of children, and reduces maternal illnesses such as breast and ovarian cancer.

There are a lot of reasons why delaying a bath might benefit babies, DiCioccio said.

First, it’s known that allowing mom and baby skin-to-skin time after birth reduces stress in the newborn, which may make it easier for babies to start breastfeeding. Baths also tend to increase stress in newborns and can make them cold. Cold, stressed babies are less likely to breastfeed, according to some research.

And initiating breastfeeding quickly has benefits to both mom and baby. “We’re starting to see that the earlier we can get the babies to latch… the better mom’s milk supply will be,” DiCioccio said.

Also, some research indicates there may be a smell cue in the amniotic fluid that encourages breastfeeding. Another study has shown that the suckling response among newborns, which is practiced in the womb, remained for longer when newborns were exposed to their own amniotic fluid.

Lastly, babies are born with a waxy coating called vernix, which acts like a layer of warmth, skin protectant and moisturizer, which is stripped when a baby is bathed.

All women delivering at University Hospitals labor and delivery units are encouraged to delay bathing by 24 hours, according to a spokeswoman for the hospital system. At MetroHealth, first baths are delayed by at least eight hours, and sometimes more, said hospital spokeswoman Tina Arundel. Occasionally parents prefer not to have their babies bathed at the hospital at all, and those wishes are honored, she said.

DiCioccio said that families delivering at Hillcrest had an easier time adjusting to the change in policy than their nurses initially did.

“We’ve only had a couple moms who have refused to have their baths delayed,” she said. In those cases nurses will honor the parents’ request and bathe the baby earlier, after explaining the benefits of waiting.

The immediate bath can still be of benefit to babies born to mothers with HIV or active herpes infections in order to reduce the risk of transmission, DiCioccio said, and under these circumstances the hospital will not recommend delayed bathing.

The idea of delaying the newborn bath has been around for a number of years, but there has been little published research on the effects of such policies. In June of 2017, a nurse at a Chicago-area hospital system found that delaying first baths by about 14 hours decreased rates of hypothermia by more than half, and rates of low blood sugar, or hypoglycemia, by one-third. After nine months of the changed policy, rates of hypothermia and hypoglycemia had dropped even further, and breastfeeding rates increased from a little over half to more than two-thirds.

The World Health Organization advises delaying bathing at least 24 hours after birth. Regulating a baby’s temperature with immediate skin-to-skin contact reduces the risk of illness, which can be a bigger risk for children born in developing countries.

At Hillcrest, mothers in the study were, on average, about 30 years old, predominantly white, married, and delivered their babies vaginally. White, Asian and Hispanic women are far more likely than black women to initiate and continue breastfeeding due to a combination of cultural norms and hospital practices encouraging formula use.

DiCioccio believes that delayed bathing will work in hospitals that serve more black mothers, and hopes the practice will spread widely. A similar intervention at Boston Medical Center, an urban safety-net hospital, in 2010 also increased the breastfeeding rate, which at the time was only 32 percent. Babies who had a bath delayed there by at least 12 hours had a 40 percent increased chance of breastfeeding, the study found.

“If we can get the breastfeeding rates up among the African-American moms, we can save lives,” DiCioccio said.

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