The Ontario Mother and Infant Survey: Breastfeeding Outcomes
Sheehan, D. et al. J. Hum Lact 17:211-219, 2001
Although Canada still lags behind Scandinavian countries in initiation and duration rates of breastfeeding, breastfeeding practices continue to improve as documented by the recently published Ontario Mother and Infant Survey by Debbie Sheehan and team working from McMaster University in Hamilton. As part of a larger survey, the breastfeeding patterns component reports on the results of five study sites as well as identifying the risk factors associated with early cessation of breastfeeding.
The cross-sectional survey asked 1250 mothers to complete a self-administered questionnaire before discharge at five hospital sites. Of these 875 also participated in a telephone interview four weeks after discharge. Breastfeeding rates varied amongst the five centres. The lowest initiation rate (82%) and the lowest continuations rate (76%) were seen in more remote northern communities. These communities also had the highest proportion of low-income and non-partnered women. Where women had access to a large urban teaching hospital setting, initiation rates (96%) and breastfeeding continuation at four weeks (77%) were highest. The latter also had the largest proportion of culturally diverse women. Declines in breastfeeding within the first four weeks ranged from 13 to 24 % with the majority switching to artificial feeding within the first seven days (40 to 63%).
Early cessation variables were determined using logistic regression analysis and included:
not completing high school intention of breastfeeding less than four weeks
not expecting to rely on a mother-to-mother support group one or more visits to a family physician
longer than 48 hours in hospital after birth unable to access breastfeeding help when needed
receiving advice, information on artificial feeding before or after baby was born
The authors highlight the need for support and help during the first two weeks plus interventions for vulnerable women to address their special needs. Since the publication of the Ontario Mother and Infant Survey, the Province of Ontario has initiated a Postpartum Home Visiting program with options for longer hospital stay, a telephone call from a public health nurse within 24 hours of discharge and a home visit offered to all postpartum mothers. The call and home visit are expected to have a positive impact on breastfeeding rates; however, longer hospital stays have been shown to have a deterrent effect on breastfeeding.
