Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg

Abstract

Background: There are not many studies exploring parity differences in early lactation performance and the results obtained are fairly often contradictory. The present study investigated the effect of different maternity home practices in St. Petersburg, Russia, as well as of physiological breast engorgement and maternal mood, on milk production in primi- and multiparous women on day four. The amount of milk was studied in relation to the duration of "nearly exclusive" breastfeeding.

Methods: 176 mother-infant pairs were randomised into four groups according to an experimental two-factor design taking into account infant location and apparel. Data were recorded in the delivery ward at 25-120 minutes postpartum and later in the maternity ward. Group I infants (n = 37) were placed skin-to-skin in the delivery ward while Group II infants (n = 40) were dressed and placed in their mother's arms. Both groups later roomed-in in the maternity ward. These infants had the possibility of early suckling during two hours postpartum. Group III infants (n = 38) were kept in a cot in the delivery and maternity ward nurseries with no rooming-in. Group IV infants (n = 38) were kept in a cot in a delivery ward nursery and later roomed-in in the maternity ward. Equal numbers per group were either swaddled or clothed. Episodes of early suckling were noted. Number of breastfeeds, amount of milk ingested (recorded on day 4 postpartum) and duration of "nearly exclusive" breastfeeding were recorded. Intensity of breast engorgement was recorded and a Visual Analogue Scale measured daily maternal feelings of being "low/blue".

Results: On day four, multiparas had lower milk production than primiparas when they were separated from their infants and breastfeeding according to the prescriptive schedule (7 times a day; Group III). In contrast, there was no difference in milk production between multi- and primiparous mothers in the groups rooming-in and feeding on demand (Groups I, II and IV), although multiparas had higher numbers of feedings than primiparas. In addition during the first three days postpartum, multiparous mothers had higher perception of physiological breast engorgement and lower intensity of feeling "low/blue" than primiparous mothers. Early suckling was shown to positively affect milk production irrespective of parity. Thus Group I and II infants who suckled within the first two hours after birth ingested significantly more milk on day 4 than those who had not (284 and 184 ml respectively, SE = 14 and 27 ml, p = 0.0006).Regression analyses evaluated factors most important for milk production and found in Groups I and II for primiparous women that early suckling, intensity of breast engorgement and number of breastfeeds on day 3 were most important. Intensity of feeling "low/blue" was negatively related to amount of milk ingested. The significant factor for multiparous women was early suckling. Similar results were obtained in Groups III and IV; however, in primiparous mothers, engorgement was the most important factor and in multiparous women it was rooming-in. Amount of milk produced on day 4 was strongly correlated to a duration of "nearly exclusive" breastfeeding (p < 0.0001).

Conclusion: The present data show that ward routines influence milk production. As our data suggest that milk production in primi- and multiparous women may be differently influenced or regulated by complex factors, further research is needed.

Figure 1

Flow diagram. Definition of the treatment groups: "Skin-to-skin group" – comprised of infants lying skin-to-skin on their mother's chest 25–120 minutes after birth at the delivery ward with later rooming-in at the maternity ward. "Mother's arms group" – comprised of dressed infants lying on their mother's chest 25–120 minutes after birth at the delivery ward with later rooming-in at the maternity ward. "Nursery group" – comprised of dressed babies kept in a cot in a labour ward nursery 25–120 minutes after birth and remained at the maternity ward nursery without rooming-in with their mothers. "Reunion group" – comprised of dressed babies kept in a cot in a labour ward nursery 25–120 minutes after birth, but then taken to the maternity ward for rooming-in with their mothers.

Figure 2

A photo of Russian swaddled baby.

Figure 3

A photo of Swedish baby in clothes.

Figure 4

Box plot for overall mean breastmilk volume on day 4 in four treatment groups in primi- (a) and multiparous (b) mothers. Milk volume was lower in group III (Nursery group), but this difference was significant only in multiparous mothers (Kruskal-Wallis, H = 14.68, p value = 0.0021).

Figure 5

Bar plot for overall mean number of breastfeeds during day 1 – day 3 in all mothers belonging to the three rooming-in groups (means and SE). The number of breastfeeds was significantly higher in multiparous mothers (repeated measures ANOVA, F_1,108 = 6.57, p value = 0.0117 and Fisher's PLSD p values 0.0363 – 0.0001).

Figure 6

Bar plot for estimation of physiological breast engorgement (described by the mothers as "breast fullness/tension") during day 1 – day 3 in all mothers (means and SE). The perception of breast engorgement was significantly higher in multiparous mothers (repeated measures ANOVA F_1,145 = 4.10, p value = 0.0446).

Figure 7

Bar plot for perception of feeling "low/blue" (Visual Analogue Scale) during day 1 – day 3 in all mothers (means and SE). The feeling "low/blue" was significantly higher graded by primiparous mothers than by multiparous mothers (repeated measures ANOVA F_1,146 = 7.57, p value = 0.0067).

Figure 8

Bar plot for overall mean breast-milk volume on day 4 in two treatment groups (Skin-to-skin gr. and Mother's arms gr.) in primi- (a) and multiparous (b) mothers, who's babies were exposed or not to early suckling (suckling within first two hours after birth) (means and SE). Milk volume was significantly higher if babies had early suckling, both in primiparous (ANOVA F_1,34 = 4.63, p value = 0.0386) and multiparous mothers (ANOVA F_1,33 = 9.0, p value = 0.0051).

Figure 9

Box plot for the duration of "nearly exclusive" breastfeeding in four treatment groups in primi- (a) and multiparous (b) mothers. There was no significant differences in the duration of "nearly exclusive" breastfeeding between groups both in primi- and multiparous mothers.