Initiative to Improve Exclusive Breastfeeding by Delaying the Newborn Bath

Objective: To examine whether delayed newborn bathing would increase rates of in-hospital exclusive breastfeeding and plans to use human milk at discharge.

Design: A retrospective, two-group, pre- and postintervention design.

Setting/local problem: At our facility, the initial bath was completed within 2 hours of birth, and the rate of in-hospital exclusive breastfeeding was low.

Participants: Couplets of mothers and healthy newborns (N = 996).

Intervention/measurements: Newborn baths were delayed at least 12 hours after birth. Pre- and postintervention data were retrieved from the hospital's electronic medical record and administrative database. Univariate and multivariate analyses were completed.

Results: Of 996 mother-newborn couplets, 448 were preintervention couplets and 548 were postintervention couplets. Of all mothers, 63.3% were White, 67.8% were married, and 67.1% gave birth vaginally. Of all newborns, 49.6% were female, and the mean (standard deviation) birth weight was 3.3 kg (0.50). We found no differences in maternal or newborn characteristics by group. Median (25th percentile, 75th percentile) times from birth to first bath before and after the intervention were 1.9 (1.6, 2.3) and 17.9 (11.9, 25.0) hours, respectively (p < .001). In-hospital exclusive breastfeeding increased from 59.8% before the intervention to 68.2% after the intervention (p = .006). In multivariate modeling, in-hospital exclusive breastfeeding increased for all couplets after the intervention (odds ratio = 1.49, 95% confidence interval [1.14, 1.96]; p = .004) and with vaginal versus cesarean birth (odds ratio = 1.60, 95% confidence interval [1.14, 2.25]; p = .006). In addition, the postintervention discharge feeding plan reflected an increase in use of human milk.

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.