Objective: Professional organizations recommend at least breastfeeding 8 times in 24 hours. However, it is unclear whether this recommendation applies to the first 24 hours after delivery. Nevertheless, institutional policy follows the recommendation of feeding every 3-4 hours. For a variety of physiologically adaptive behaviors, breastfed infants feed less frequently during the first 24 hours of life than the formula fed infants. There is a concern over what is the normal number of feeding episodes during the first 24 hours after delivery. To address this concern this study was conducted to determine breastfeeding frequency and infant elimination patterns during the first 24 hours of extrauterine life in a minimal medical intervention environment.

Design: Retrospective, descriptive study design.

Setting: A freestanding, non-profit birth center located in Northeastern Ohio.

Patients/Participants: Healthy mothers who were 18 years and older with uncomplicated vaginal delivery, clear amniotic fluid, and chose to breastfeed in 2009 and 2010. Infant inclusion criteria include singleton, fullterm, 5-minute APGAR score > 7, no apparent facial deformity/malformation, and no identified medical problems.

Methods: IRB approval and letter of cooperation from the birth center were obtained. A research data collection tool was developed and used for the study.

Results: A total of 110 randomly selected charts were reviewed. On average, mothers were 28.9 years old, had 4.9 pregnancies (gravida), and had delivered 3.3 times (para) prior to current delivery; their infants weighed 3556 grams at birth. On average, first breastfeeding occurred 1 hour post-delivery and 8.2 breastfeeding sessions (SD: 1.4, range: 5-12) took place within the first 24 hours. More than 50% of the infants did not receive any supplement (e.g. formula, glucose water). Within the first 24 hours, the infants voided 2.6 times (SD: 1.6, range: 0-8) and had 3.5 bowel movements (SD: 1.6, range: 1-8).

Conclusion/Implications for nursing practice: Infants born to mothers who gave birth in a minimal medical intervention environment (e.g. no epidural anesthesia, no prolong intravenous fluids, and no induction) breastfed on average 8 times and eliminated about 3 times in the FIRST 24 hours postbirth. Before definitive conclusion can be drawn about what would be considered the “natural” behaviors of breastfed infants in the first 24 hours of life, prospective studies are needed to examine the number and quality of breastfeeding in other minimal medical intervention facilities.

 Keywords:   breastfeeding, newborns, minimal medical intervention environment