The First Newborn Bath and Exclusive Breastfeeding Rates at Hospital Discharge

The following information is taken from the January 29, 2019 newsletter from “IABLE”, the Institute for the Advancement of Breastfeeding and Lactation Education, regarding the research article “Initiative to Improve Exclusive Breastfeeding by Delaying the Newborn Bath” from JOGNN, the Journal of Obstetric, Gynecologic and Neonatal Nursing, January 2019.

Newborn infant baby getting his first bath in the hospital. Cute little boy is bundled up and receiving a sponge bath by a nurse in his hospital room

For decades, the hospital routine at delivery was cut the cord, dry the baby, apply eye ointment, give a shot of vitamin K, bathe the baby and then give a bottle. Changes have come slowly but the Baby Friendly Hospital Initiative has led the way in providing evidence-based strategies to improve in-hospital infant care to optimize successful breastfeeding. Recent research has found an effect of bath timing on exclusive breastfeeding rates at discharge.

The current research study made a splash in the media, bringing the issue to light for the lay public. The authors sought to improve their exclusive breastfeeding rates at discharge by delaying the bath. According to the authors, it has been unclear why delaying a bath improves exclusive breastfeeding rates at discharge. One theory is that the amniotic fluid on newborns’ skin provides a strong sensory cue, enhancing newborn suckling responses. Delaying the bath may also increase the time that infants are kept skin to skin, which we know enhances breastfeeding rates.

The study took place in a hospital in Ohio, where all infants born vaginally are placed skin to skin after birth, and infants with a cesarean birth are placed skin to skin 30 minutes after birth.

They compared exclusive breastfeeding rates for 448 infants undergoing the routine protocol of a bath at approximately 2 hours after birth, with 548 infants whose baths were delayed for at least 12 hours (on average about 18 hours after birth).

The 2 groups had no significant differences in demographic factors such as maternal age, socioeconomic status, or vaginal vs cesarean birth. They did not measure parity however. Breastfeeding initiation rates were similar between the 2 groups.

According to this study, the following discoveries were made regarding the relationship between delaying a bath after 12 hours postpartum and exclusive breastfeeding rates at discharge:

  1. The infants who had a delayed bath had higher body temperatures and were less likely to be hypothermic as compared to infants with a bath within 2 hours postpartum.
  2. Exclusive breastfeeding rates at discharge was ~68% for all infants with a delayed bath, and ~60% for those bathed at 2 hours.
  3. Infants born via cesarean with a delayed bath did not have an increased rate of exclusive human milk feeding at discharge as compared to the routine bath group.

Conclusion:

Delaying the newborn bath was associated with increased in-hospital exclusive breastfeeding rates and use of human milk as a part of the discharge feeding plan.

IABLE Comment by Anne Eglash MD, IBCLC, FABM:

Interestingly, the infants born via vaginal birth had improvement in exclusive breastfeeding rates but the infants born via cesarean did not. We already know from other literature that babies born via cesarean have lower breastfeeding initiation and duration rates (see CQW 26, Jan 2017). This study shows that delaying the bath for infants with cesarean births does not do enough to reduce the gap in breastfeeding success between vaginal and cesarean births. There are many other factors, such as delay in lactation and maternal pain that play a role in breastfeeding success.

It has been hypothesized that a delay in bathing reduces infant hypothermia, which may decrease infant suckling skills. These authors have provided evidence that infants with a delayed bath have higher body temperatures. So, if hospitals don’t value the benefit of delaying a bath to improve breastfeeding rates, at least they can make the decision to do so to prevent the risk of harmful infant hypothermia.

The following comments are from Diane Erdmann RN BSN IBCLC:

I worked as a postpartum and nursery nurse in the hospital in the 1970’s 80’s and 90’s. Back then, babies were kept with moms in Labor and Delivery for one hour after birth and then were brought to the nursery for their initial assessment including weight, vital signs, eye ointment and Vitamin K shot. Then we bathed them and put them under the warmer. When their temperature was stabilized, we bundled them up in blankets and took them to the mom’s room to be breastfed. Many of these babies struggled with breastfeeding and frequently got cold. We did not do skin to skin back then and did not realize the benefits of it for keeping baby warm and improving breastfeeding. So back the babies went to the nursery to go under the warmer and eventually be stabilized. Now doing skin to skin immediately after birth is standard of care in the Omaha hospitals. The next step will be to spread the word on the benefits of delaying the newborn bath to keep babies warm and help them imprint on their moms. I also encourage moms not to limit skin to skin for just that first hour after birth- do it as much as possible in the hospital and as well when they get home. It is great for babies and also helpful for mom’s milk supply and the special bonding that takes place between moms and their breastfed babies.

If you have any questions, please contact Diane Erdmann by email or calling (402) 707-1696.