The first 72 hours: Hospital routines may undermine breastfeeding
An evidence review of international research suggests widespread misconceptions within the medical community about early milk production, pacifiers and breast pumps may be undermining breastfeeding success in the critical first days after birth.
The first three days following a baby's birth may inadvertently hinder breastfeeding success, according to a review of international research published in the Journal of Maternal-Fetal & Neonatal Medicine. Experts at Sapienza University of Rome found that common clinical practices and beliefs surrounding breastfeeding during this critical period are not supported by current evidence.
Lead author Maria Di Chiara, a pediatrician specializing in neonatology, noted that mothers often feel overwhelmed by the fear of insufficient milk supply, despite their commitment. However, the review suggests that colostrum—the first milk produced after birth—is usually sufficient to meet newborns' needs. Additionally, the use of pacifiers and electric breast pumps in the first days after birth does not reduce breastfeeding duration or exclusivity.
The findings come at a time when breastfeeding rates remain below global targets. The World Health Organization recommends exclusive breastfeeding for the first six months of a baby's life, but fewer than half of infants worldwide are exclusively breastfed for that duration, with significantly lower rates in many high-income countries.
The study, led by experts at Sapienza University of Rome, reviewed 78 published sources from countries including the U.S., Italy, Germany, Australia, India, and Mexico. These sources included randomized controlled trials, systematic reviews, meta-analyses, and observational cohort studies that addressed evidence gaps relevant to breastfeeding in the first 48-72 hours postpartum.
The researchers found that common misconceptions included the belief that colostrum is insufficient to meet a newborn's needs and that pacifier use interferes with breastfeeding. The review also found that routine use of electric breast pumps in the first days after birth is not supported by evidence. Instead, hand expression is generally preferred when milk expression is needed.
Di Chiara emphasized that these first few days are crucial for establishing breastfeeding. Ensuring that parents receive advice and support based on the best available evidence could significantly improve breastfeeding outcomes.
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