Decreasing in-hospital formula use improves breastfeeding outcomes but does not ameliorate the need for post-discharge follow-up support

Background: Within the same community hospital (3300 births/year), a lactogenesis study coincided with a quality improvement (QI) initiative to increase in-hospital exclusive breastfeeding (EBF). This provided a natural opportunity to explore Pre-QI versus Post-QI changes in mothers' breastfeeding experience during the initial days post-hospital discharge. Methods: Representative samples of mother-infant dyads admitted to normal (level-I) care were screened and those who initiated breastfeeding enrolled Pre-QI (N=33) and Post-QI (N=33, one year later). Data were collected from maternity records, maternity-unit IBCLC evaluations, and post-discharge interviews at 72-96 hours. Post-QI versus Pre-QI cohorts were compared using chi-square (prevalence) and t-test (mean). Results: Maternal characteristics were similar between cohorts. Mean length of stay was 53+13 hours. Comparing Post-QI versus Pre-QI, breastfeeding initiation increased (90% versus 78%), and among those who initiated BF, EBF throughout 0-72 hours increased (89% versus 58%). Timely onset of lactogenesis among primiparas increased (75% versus 53%). Newborn weight loss and bilirubin at discharge were similar between cohorts. At the post-discharge interview, fewer Post-QI had a current milk supply concern (26% versus 36%), but more had current concerns regarding infant suckle (41% versus 33%) and nipple/breast discomfort 52% versus 39%); and the prevalence of any concern remained high (70% versus 67%). Conclusion: A hospital QI effort increased exclusive breastfeeding, even beyond the hospital stay, and first-time mothers were more likely to experience timely onset of lactogenesis. However, strong breastfeeding support in the hospital does not lessen new mothers' need for continued access to breastfeeding support in the first days post-discharge.