Delaying a newborn's first bath helps boost breastfeeding rates

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Delaying the bathing of newborns for at least 12 hours after birth is associated with significant improvements in exclusive breastfeeding while in hospital and with mothers being more likely to have feeding plans on discharge that include human milk (exclusively or in addition to formula).

"Our results provide new information on the benefits of delayed bathing after hospital discharge," say the authors of a new study, published online in the Journal of Obstetric, Gynecologic & Neonatal Nursing.

"Although our findings need to be replicated in other studies, they reinforce the connection between delayed bathing and greater likelihood of newborn breastfeeding that may extend into the post-discharge feeding plan and practice," said nursing specialist Heather Condo DiCioccio, DNP, RNC-MNN, at the Cleveland Clinic Hillcrest Hospital, in Ohio USA.

Skin-to-skin contact between the newborn and mother immediately after birth has well-known benefits and is urged as part of usual care, but the rationale for delayed bathing, recommended by the World Health Organisation (WHO) and other organisations, has been less clear.

Theories surround the idea that newborns recognise the scent of amniotic fluid as a sensory cue prompting them to breastfeed, with one study indicating that newborn suckling responses were indeed extended when exposed to their own amniotic fluid. And early bathing of newborns has also been associated with hypothermia in the baby, which is also thought to affect breastfeeding rates.

Changing practice in one hospital

With efforts to reach their breastfeeding goals falling short, Condo DiCioccio and colleagues implemented a departmental intervention whereby nurses were encouraged to wait for 24 hours before bathing newborn babies, or at the very least a minimum of 12 hours. Prior to the intervention, the initial bath was completed within 2 hours of birth.

To evaluate the program's effects, the authors compared data on 448 mother–newborn couplets in hospital prior to the intervention with 548 couplets post-intervention. There were no significant differences in the mothers or newborns between the groups. Among the mothers, 63.3% were white and 67.1% had vaginal births. Their mean age was 30.3 years.

With a shift in the median time from birth to first bath from 1.9 hours to 17.9 hours post-intervention, the rates of in-hospital exclusive breastfeeding (without any formula) increased from 59.8% to 68.2% (P = .006).

And after multivariate adjustment for factors including birth type (vaginal vs caesarean), in-hospital exclusive breastfeeding increases were seen for all couplets after the intervention (odds ratio [OR], 1.49; P = .004).

The odds of an intent to use human milk exclusively at discharge meanwhile increased by 35% post-intervention (P = .02).

The benefits of delaying newborn bathing on breastfeeding rates were most apparent among those who gave birth vaginally, however.

Delaying bathing also led to a greater likelihood of normal temperature among newborns, building on prior work that has demonstrated this, the researchers say. "In the Association of Women's Health, Obstetric and Neonatal Nurses [AWHONN] neonatal skin care practice guideline, rationale for delaying the first bath was related to newborn thermoregulation, which was substantiated by our research and discussed in previous reports," the authors state.

The benefits of changes to bathing procedures are worth the effort

The authors note that although implementation of the delayed bathing changes requires some adjustment, the benefits are worthwhile.

"Although diffusion of the practice change in the post-intervention period took time to achieve, nurses were able to embrace the change and incorporated it into the standard of care for mother–newborn couplets. Hospitals should consider current policies regarding the timing of healthy newborn care and alter the timing of the initial healthy newborn bath as needed to meet the recommendations of the World Health Organisation, Agency for Healthcare Research and Quality, and AWHONN," the authors said.