Aust. Paediatr. J.
(1979), 151271-274
Breast Feeding Success and Failure JEAN STARLING1, D. M. FERGUSSON2, L. J. HORWOOD3, B. TAYLOR4 Department of Paediatrics, Christchurch Clinical School of Medicine, Christchurch Hospital, Christchurch, New Zealand.
Starling, J., Fergusson, D. M., Horwood, L. J. and Taylor, B. (1979). Aust. Paediatr. J., 15, 271-274. Breast feeding success and failure. The factors influencing the success or failure of breast feeding were assessed in 1121 mothers. Of the 81% who intended to breast feed, 52% failed to achieve their desired duration. Over three quarters of the failures occurred In the first 3 months of life, and the major explanation given for failure was inadequate lactation. Among the factors associated with failure to achieve breast feeding intentions were complementary feeding in the maternity hospital and limited motherlchild contact in the first few days after birth. Better educated mothers, those in two parent families and older mothers were more likely to succeed, as were those who received encouragement from family, professional and lay support groups. Factors that showed no relation to success or failure were motherlchild contact at birth, antenatal education, maternal race, and parity or discouragement from any source. INTRODUCTION Breast feeding is generally accepted as the optimal method of infant feeding. Amongst the benefits claimed are: a decreased risk of infantile gastrointestinal problems (Grulee et a/., 1935; Fergusson et a/., 1978), eczema and other allergic disorders (Matthew et a/., 1977), psychological benefits for both mother and child (Newton and Newton, 1967), and other advantages (Taylor, 1977). Recent studies show an increasing acceptance of breast feeding by New Zealand women (Hood et a/., 1978; Dawson et a/., 1979). At the same time many experience problems in sustaining breast feeding for the desired length of time. This paper examines the breast feeding history of a group of 1121 mothers and considers the following issues: 1. The frequency of success and failure. 2. The mothers’ reasons for stopping breast feeding. 3. The effects of antenatal education and hospital practices on success and failure. 4. The relationship between social background and success and failure. 5. The effects of encouragement and discouragement on breast feeding. 6. The number of breast feeding mothers who feel the need for further assistance. METHOD The data was collected during the first three stages of the Christchurch Child Development Study (Fergusson et a/., 1978). In this project a birth cohort of infants has been examined at three points. Shortly after birth each infant’s mother was interviewed using a structured schedule which examined amongst other things, her antenatal history, social background and breast feeding intentions. Further interviews were conducted at 4 months and one year and included questions about breast feeding history and the assistance the mother had received or felt she required. 1. Medical Student 2. Principal Investigator 3. Research Assistant 4. Senior Lecturer
Received March 22.1979
The initial cohort comprised 1262 infants born to 1248 mothers; at one year 1180 infants and 1169 mothers remained in the study. This represented 94% of the initial cohort. In the present analysis only those mothers who had remained with their children throughout the first year of life were considered. This gave a sample of 1121 mothers. RESULTS (a) The incidence of Breast Feeding and the Dlstrlbution of Breast Feeding Failure. Of the 1121 mothers, a total of 904 (81%)) expressed a desire to breast feed. The median intended time of weaning was 6 months. Figure 1 shows the frequency with which mothers who intended to breast feed failed to achieve their sta4ed objectives over the first 11 months of the infant’s life. The data is limited to the 840 mothers who gave a definite estimate of their intended length of breast feeding. The rate of failure is most marked In the first 3 months of life and thereafter reduces rapidly: of the 434 women who failed to achieve their objective, 81% had failed by the time their infant was 3 months old. By 11 months, 52% of all breast feeding women had failed to achieve their intended duration of breast feeding. (b) Reasons Glven by the Mother for Breast Feeding Failure. The 434 mothers who failed to reach their objectives were asked about their reasons for failure (Table I).Thirty-eight per cent of mothers said that their milk supply was inadequate and 18.2% said that their milk supply had ceased. These problems were most common in the first 4 months, and were experienced by almost two-thirds of the women who failed during this period. Other reasons were: 23.7% of the mothers subjectively felt that the baby was not responding well to breast feeding and 14.2% found breast feeding too physically demanding; nipple problems caused 14.1% of mothers to stop and 9.2% stopped on their doctor’s advice. Few women stopped breast feeding because they did not like the experience (3.2%), found it socially Inconvenient (3.7%), or because they were working (0.7%).
272
AUSTRALIAN PAEDlATRlC JOURNAL
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I
to success. Women who spent more than 12 hours per day with their infants were more likely to be successful than those women who did not. 3. There was a significant relationship between complementary feeding in hospital and breast feeding success or failure. Women whose infants were given complementary feedings in hospital were more likely to fail than women whose infants were not. Partial correlation coefficients were computed to control for the effects of maternal education, age and parity on the associations shown in Table II. This analysjs showed that the findings remained virtually unaltered when the effects of maternal age, education and parity were taken into account.
I 1 2 3 4 5 6 7 8 91011
MONTHS FROM DELIVERY Figure 1. Proportions of breast feeding women failing to achieve their breast feeding objectives in each month from birth. (c) The Effects of Antenatal Education and Hospital Practices on Breast Feeding Failure. Table II shows, for the 840 mothers with a known intended length of breast feeding, the risk of failure cross tabulated by the woman’s antenatal attendance, the time elapsed before holding the infant after birth, the time per day the infant spent with the mother in the maternity unit and the use of cows’ milk based complementary feedings in hosDital. The results show: 1. There was no significant relationship between antenatal education or the time elapsing from birth until the mother held the infant and the risk of failure. 2. That the amount of time per day the woman spent with her infant in the maternity unit was significantly related
(d) The Effects of the Mother’s Social Characteristics on Breast Feeding Failure. Table 111 shows the proportions of women failing to achieve their breast feeding objectives cross tabulated by social background. Failure varies with the mother’s social characteristics, in particular, younger women failed more often than older women. Those with higher educational qualifications were more successful than women with no formal qualifications. Solo mothers were significantly less successful than mothers in two parent families. Neither maternal race nor parity were significantly related to success or failure. Since the apparent association between maternal education, solo parenthood and breast feeding success could reflect the common effects of maternal parity and age, partial correlation coefficients controlling for both age and parity were computed. The results showed that the association between failure, education and solo parenthood could not be explained by the common effects of maternal age or parity. TABLE II Breast feeding failure by antenatal history and hospital practices ~
Variable
Number
% failing at breast feedins
1. Antenatal education a) Attended classes b) Did not attend
343 497
49.0% 53.5%
2. Time before mother held baby after birth a) Immediately b) 1 4 hours c) 5-8 hours d) 9-12 hours e) 13+ hours
739 43 27 19 10
51 2% 46.5% 63.0% 57.9% 60.0%
3. Hours/day baby with mother in maternity unit * * a) Less than 12 hours b) 12 hours or more
6 89 151
53.4% 43.7%
4. Complement feeding (i.e. milk other than breast milk) * f f * a) Fed complements b) Not fed complements
489 3 51
57.5% 43.6%
ff
TABLE I Reasons given by mothers for breast feeding failure
Reason for Failure Never started Inadequate milk supply Milk supply ceased Doctors advice Nipple problems Too physically demanding Socially inconvenient Baby not responding well Mother working Mother did not like breast feeding Husband objected
Number
Percentage
24 165 79 40 61 62 16 103 3 14 1
5.5% 38.0% 18.2% 9.2% 14.1 % 14.3% 3.7% 23.7% 0.7% 3.2% 0.2%
NOTE: Percentages do not sum to 100% as some mothers gave more than one reason for failure.
840 N.S.
* * p
(1979), 151271-274
Breast Feeding Success and Failure JEAN STARLING1, D. M. FERGUSSON2, L. J. HORWOOD3, B. TAYLOR4 Department of Paediatrics, Christchurch Clinical School of Medicine, Christchurch Hospital, Christchurch, New Zealand.
Starling, J., Fergusson, D. M., Horwood, L. J. and Taylor, B. (1979). Aust. Paediatr. J., 15, 271-274. Breast feeding success and failure. The factors influencing the success or failure of breast feeding were assessed in 1121 mothers. Of the 81% who intended to breast feed, 52% failed to achieve their desired duration. Over three quarters of the failures occurred In the first 3 months of life, and the major explanation given for failure was inadequate lactation. Among the factors associated with failure to achieve breast feeding intentions were complementary feeding in the maternity hospital and limited motherlchild contact in the first few days after birth. Better educated mothers, those in two parent families and older mothers were more likely to succeed, as were those who received encouragement from family, professional and lay support groups. Factors that showed no relation to success or failure were motherlchild contact at birth, antenatal education, maternal race, and parity or discouragement from any source. INTRODUCTION Breast feeding is generally accepted as the optimal method of infant feeding. Amongst the benefits claimed are: a decreased risk of infantile gastrointestinal problems (Grulee et a/., 1935; Fergusson et a/., 1978), eczema and other allergic disorders (Matthew et a/., 1977), psychological benefits for both mother and child (Newton and Newton, 1967), and other advantages (Taylor, 1977). Recent studies show an increasing acceptance of breast feeding by New Zealand women (Hood et a/., 1978; Dawson et a/., 1979). At the same time many experience problems in sustaining breast feeding for the desired length of time. This paper examines the breast feeding history of a group of 1121 mothers and considers the following issues: 1. The frequency of success and failure. 2. The mothers’ reasons for stopping breast feeding. 3. The effects of antenatal education and hospital practices on success and failure. 4. The relationship between social background and success and failure. 5. The effects of encouragement and discouragement on breast feeding. 6. The number of breast feeding mothers who feel the need for further assistance. METHOD The data was collected during the first three stages of the Christchurch Child Development Study (Fergusson et a/., 1978). In this project a birth cohort of infants has been examined at three points. Shortly after birth each infant’s mother was interviewed using a structured schedule which examined amongst other things, her antenatal history, social background and breast feeding intentions. Further interviews were conducted at 4 months and one year and included questions about breast feeding history and the assistance the mother had received or felt she required. 1. Medical Student 2. Principal Investigator 3. Research Assistant 4. Senior Lecturer
Received March 22.1979
The initial cohort comprised 1262 infants born to 1248 mothers; at one year 1180 infants and 1169 mothers remained in the study. This represented 94% of the initial cohort. In the present analysis only those mothers who had remained with their children throughout the first year of life were considered. This gave a sample of 1121 mothers. RESULTS (a) The incidence of Breast Feeding and the Dlstrlbution of Breast Feeding Failure. Of the 1121 mothers, a total of 904 (81%)) expressed a desire to breast feed. The median intended time of weaning was 6 months. Figure 1 shows the frequency with which mothers who intended to breast feed failed to achieve their sta4ed objectives over the first 11 months of the infant’s life. The data is limited to the 840 mothers who gave a definite estimate of their intended length of breast feeding. The rate of failure is most marked In the first 3 months of life and thereafter reduces rapidly: of the 434 women who failed to achieve their objective, 81% had failed by the time their infant was 3 months old. By 11 months, 52% of all breast feeding women had failed to achieve their intended duration of breast feeding. (b) Reasons Glven by the Mother for Breast Feeding Failure. The 434 mothers who failed to reach their objectives were asked about their reasons for failure (Table I).Thirty-eight per cent of mothers said that their milk supply was inadequate and 18.2% said that their milk supply had ceased. These problems were most common in the first 4 months, and were experienced by almost two-thirds of the women who failed during this period. Other reasons were: 23.7% of the mothers subjectively felt that the baby was not responding well to breast feeding and 14.2% found breast feeding too physically demanding; nipple problems caused 14.1% of mothers to stop and 9.2% stopped on their doctor’s advice. Few women stopped breast feeding because they did not like the experience (3.2%), found it socially Inconvenient (3.7%), or because they were working (0.7%).
272
AUSTRALIAN PAEDlATRlC JOURNAL
25
I
to success. Women who spent more than 12 hours per day with their infants were more likely to be successful than those women who did not. 3. There was a significant relationship between complementary feeding in hospital and breast feeding success or failure. Women whose infants were given complementary feedings in hospital were more likely to fail than women whose infants were not. Partial correlation coefficients were computed to control for the effects of maternal education, age and parity on the associations shown in Table II. This analysjs showed that the findings remained virtually unaltered when the effects of maternal age, education and parity were taken into account.
I 1 2 3 4 5 6 7 8 91011
MONTHS FROM DELIVERY Figure 1. Proportions of breast feeding women failing to achieve their breast feeding objectives in each month from birth. (c) The Effects of Antenatal Education and Hospital Practices on Breast Feeding Failure. Table II shows, for the 840 mothers with a known intended length of breast feeding, the risk of failure cross tabulated by the woman’s antenatal attendance, the time elapsed before holding the infant after birth, the time per day the infant spent with the mother in the maternity unit and the use of cows’ milk based complementary feedings in hosDital. The results show: 1. There was no significant relationship between antenatal education or the time elapsing from birth until the mother held the infant and the risk of failure. 2. That the amount of time per day the woman spent with her infant in the maternity unit was significantly related
(d) The Effects of the Mother’s Social Characteristics on Breast Feeding Failure. Table 111 shows the proportions of women failing to achieve their breast feeding objectives cross tabulated by social background. Failure varies with the mother’s social characteristics, in particular, younger women failed more often than older women. Those with higher educational qualifications were more successful than women with no formal qualifications. Solo mothers were significantly less successful than mothers in two parent families. Neither maternal race nor parity were significantly related to success or failure. Since the apparent association between maternal education, solo parenthood and breast feeding success could reflect the common effects of maternal parity and age, partial correlation coefficients controlling for both age and parity were computed. The results showed that the association between failure, education and solo parenthood could not be explained by the common effects of maternal age or parity. TABLE II Breast feeding failure by antenatal history and hospital practices ~
Variable
Number
% failing at breast feedins
1. Antenatal education a) Attended classes b) Did not attend
343 497
49.0% 53.5%
2. Time before mother held baby after birth a) Immediately b) 1 4 hours c) 5-8 hours d) 9-12 hours e) 13+ hours
739 43 27 19 10
51 2% 46.5% 63.0% 57.9% 60.0%
3. Hours/day baby with mother in maternity unit * * a) Less than 12 hours b) 12 hours or more
6 89 151
53.4% 43.7%
4. Complement feeding (i.e. milk other than breast milk) * f f * a) Fed complements b) Not fed complements
489 3 51
57.5% 43.6%
ff
TABLE I Reasons given by mothers for breast feeding failure
Reason for Failure Never started Inadequate milk supply Milk supply ceased Doctors advice Nipple problems Too physically demanding Socially inconvenient Baby not responding well Mother working Mother did not like breast feeding Husband objected
Number
Percentage
24 165 79 40 61 62 16 103 3 14 1
5.5% 38.0% 18.2% 9.2% 14.1 % 14.3% 3.7% 23.7% 0.7% 3.2% 0.2%
NOTE: Percentages do not sum to 100% as some mothers gave more than one reason for failure.
840 N.S.
* * p
