LLLI Center for Breastfeeding Information
Journal Abstract of the Month for March 2007
“Interruptions to Breastfeeding Dyads on Postpartum Day 1 in a University Hospital”
Authors: B Morrison, S Ludington-Hoe, GC Anderson
J Obstet Gynecol Neonatal Nurs. 2006 Nov/Dec 35: 709-716
Imagine you have a new job that requires some serious on-the-job training. You need to really focus on what you are doing so you can learn the basics efficiently. Now imagine on your first day that every few minutes someone opens your office door and enters. Some of the visits are short, some are long; some visitors are welcome, some are intrusive. Is it any wonder that you might find it challenging to learn much of anything with all those interruptions? This article takes a revealing look at a new mother’s first day “on the job” as she learns to breastfeed amid interruption after interruption.
This study is based on continuous observations of the interruptions experienced by 29 new mothers during their first postpartum day in a large Midwestern university hospital. The purpose of the study was to investigate the effect of the interruptions on the breastfeeding experience. All mothers in the study indicated their intention to breastfeed before delivery, as well as their willingness to take part in the study. The babies were all healthy, full term, vaginal delivery singleton births and were rooming in with their mothers in private rooms.
“Interruptions” were defined to be anybody opening the hospital room and coming in, as well as phone calls. If two or more people entered at the same time they were each counted as separate interruptions, since it was thought that the mother would have to respond to each person entering the room. The fathers of the babies were also counted as interruptions when they entered the room. Other interruptions included the primary RN assigned to the mother, visitors, grandparents, dietary personnel, physicians and midwives, photographers, housekeeping, miscellaneous staff, and incoming phone calls.
The fetal environment is safe, warm, free from germs, and has little need for its own immune system. He is protected by his mother’s immune system. Until, that is, the newborn finds itself on the outside of the womb and thus surrounded by all manner of microorganisms and other foreign substances called antigens. The presence of these antigens helps stimulate the newborn’s immune system, primarily through mucosal surfaces such as the gut and respiratory structures.
A research assistant was seated outside the mother’s room from 8am to 8pm (with shift changes every 4 hours). The interruptions were timed, as well as the intervals between the interruptions. The mothers also kept a log with the source of the interruption and its purpose
A literature review had uncovered a number of studies that indicated that a mother’s experience with breastfeeding might be affected by interruptions. One of the earliest was the 1984 Report of the Surgeon General’s Workshop on Breastfeeding and Human Lactation which indicated that these interruptions might have a negative effect on breastfeeding.
The 29 mothers who completed the study were subjected to a staggering total of 1,555 interruptions during that 12-hour period on their first postpartum day! Each mother-baby couple experienced an average of 54 interruptions, with a mean of 4.5 per hour. The mean duration of the interruptions was 17 minutes, and ranged from a 1 second peek in the door to 7.9 hours.
Mothers and their families had a total of 691 episodes of time alone, with an average of 24 episodes per family. These time-alone periods lasted an average of 15 minutes. Half of these periods lasted for 9 minutes or less, with 1 minute being the most common length for time alone!
But What About Breastfeeding?
In addition to logging interruptions, attempts to breastfeed and complete feedings were also counted. The 29 mother/baby pairs logged 154 attempts and feedings, with a median of 5 per mother, and a range of 2 to 10 times. The average duration of a breastfeeding session was 20 minutes—which included a number of sessions that lasted 0 minutes since someone interrupted as soon as the baby was put to the breast and immediately removed because of the intrusion.
The Mothers' Reactions
At the end of the day mothers were asked about their experiences:
1. How do you feel about the interaction and breastfeeding experiences with your baby today?
Typical responses: “They [breastfeeding sessions] were good, but it was hard having visitors; probably would have done it [breastfeeding] more. Tried to squeeze it in when visitors left.” “Not too many visitors, but the phone calls did make it harder to concentrate on the baby. The nurses’ visits helped because they showed me different techniques.”
2. Did you and your baby have enough quiet/uninterrupted time together?
Typical responses: “I had a very busy day and though I do feel I gave a lot of time and spent a lot of time together, I did feel very pressured.” “Wish we had more [alone time]. Both baby and myself were tired and I wanted to sleep with her. But every time I tried, we got interrupted.” “I felt like someone was constantly interrupting us and when we were able to breastfeed I felt rushed and worried that someone else would be coming in soon.”
What Does This Study Mean to LLL Leaders?
The time after a baby is born should be one filled with the new parents getting to know their newborn. This is a time for learning to breastfeed, and learning to recognize those subtle cues that a baby signals his need for his mother and for the breast. Mothers often feel awkward and on display, and their efforts to breastfeed may be hampered by feelings of modesty—especially in front of a parade of well-meaning visitors.
Some hospitals are recognizing the need for quiet time and no visitor periods, but we can help the mothers we work with prepare for the postpartum period—regardless of where the birth happens:
- Suggest that mothers-to-be ask friends and family to wait a few days before visiting to allow the new family to rest and get to know each other.
- Suggest that the mother have someone—be it the baby’s father or other support person—be available to run interference to eliminate as many interruptions as possible.
- A “Do Not Disturb” sign on the door can help.
- Enlist the nurses to help cut down on unnecessary visits and to group procedures (where possible).
Not every postpartum experience is going to be as interrupted as the ones in this major hospital, and some interruptions are necessary. Making the mothers—and nurses and other potential visitors—aware of the problem can go a long way to lessening the impact.
US Department of Health and Human Services. (1984). Report of the Surgeon General’s workshop on breastfeeding and human lactation (DHHS Publication No. HRS-D-MC-84-2). Rockville, MD.
abstract by Melissa Clark Vickers, Huntingdon, TN USA