UCSF

Breastfeeding (BF) is a health-promoting behavior and exclusive BF has proven economic and ecologic benefits to individuals and societies. Yet Healthy People 2010 BF objectives for exclusive BF remain unmet and prevalence is lowest for low-income populations. The purpose of this descriptive longitudinal study of 126 predominantly low income and ethnically diverse mother-infant dyads was to compare maternal and infant factors associated with nighttime BF behavior between exclusive BF dyads and supplemented dyads. Descriptive statistics, repeated measures ANOVA, independent t-tests, and Chi-square tests were used for analysis.

BF behavior was categorized as either 1) exclusive BF, defined as 100% BF or breastmilk feeding on all three nights, or 2) supplementation, defined as any formula during any of the three nights.

Compared to women in supplementation (n=59), women in exclusive BF (n=67) were older, more likely Caucasian, working at 36 weeks pregnant but not working at 1 month postpartum, in a relationship, and getting less help with baby at night. There was no group difference in objective sleep at the last month of pregnancy assessment. At one month postpartum, women in the supplementation group averaged 30 minutes less night sleep compared to women in the exclusive BF group.

Compared to infants who were supplemented (n=54), infants who were exclusively breastfed (n=66) were significantly more likely to room-in with mothers in hospital and receive a home visit. They were statistically larger at birth, although the difference in size may not be clinically relevant.

Assessment of sleep in new mothers is important for BF maintenance and more effort is needed to promote exclusive BF among younger women, African Americans and women of Asian descent. Rooming-in practice in the hospital after birth should be encouraged, as it was significantly associated with exclusive BF behavior at one month postpartum in this diverse sample of new families. Future research using a qualitative approach would be ideal to discover how nighttime feeding for new mothers evolves over time, their motivation for BF, and their network of influence in support of BF behavior. Findings from qualitative research will be useful in developing an effective intervention for BF maintenance.