Predictors and documented reasons for formula supplementation of breastfed babies in a New Zealand, 'Baby-Friendly' hospital

Stefanie Kalmakoff
30 March 2015


Kalmakoff, S. (2015). Predictors and documented reasons for formula supplementation of breastfed babies in a New Zealand, 'Baby-Friendly' hospital (A thesis submitted in fulfilment of the degree of Master of Midwifery at Otago Polytechnic, Dunedin New Zealand) [PDF 2.106MB]


Exclusive breastfeeding is seen as the gold standard in infant feeding. The Baby-Friendly Hospital Initiative (BFHI) has been adopted globally to support exclusive breastfeeding from birth. Formula supplementation is known to be negatively associated with breastfeeding establishment and duration especially if given during the hospital stay. Little research has been done on the BFHI and breastfeeding outcomes in New Zealand, particularly in relation to formula supplementation.

The aim of the study was to determine predictors and explore documented reasons for formula supplementation of breastfed babies in a large Baby-Friendly hospital.

Electronic hospital records of all healthy term or near term, singleton, mother/baby pairs birthed in 2012 (n = 1530) and records of formula supplementation were examined retrospectively and analysed to find factors associated with formula supplementation of breastfed babies during the hospital stay.

Fifteen percent of these breastfed babies were supplemented during the hospital stay. Analysis by multiple regression found supplementation was independently associated with overweight BMI category, primiparity, use of analgesia, earlier gestation, shorter duration of skin-to-skin contact, and use of postpartum uterotonics. Reasons for supplementation were recorded for 170/234 babies (73%). The most common reasons were for insufficient milk, maternal request and hypoglycaemia.

Determination of the risk factors for formula supplementation of babies in hospital may assist practitioners to identify mothers and babies which need greater support, antenatally, during labour, and in the first hours and days after birth. The findings support the Baby-Friendly policies and practices of early skin-to-skin contact for at least an hour in duration. The results highlight the need for targeted support to be given to mothers of high BMI, mothers and babies exposed to analgesia during birth and to uterotonics post birth and also for babies who are late preterm, but cared for in the postnatal ward. The findings also expose areas in which further research may ultimately lead to less supplementation of breastfed babies in hospital. 

Stephanie Kalmakoff's thesis was supervised by Sally Baddock and Tricia Thompson. 



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