The reasons why women with small for gestational age babies stop breastfeeding : a thesis presented in partial fulfilment of the requirements for the Master of Arts in Midwifery at Massey University

Abstract

There has been a multitude of research literature on breastfeeding benefits, incidence and duration of breastfeeding, characteristics of women who breastfeed and formula feed, and variables associated with breastfeeding initiation and success in the 'general' breastfeeding population. Unfortunately there has been very little written about breastfeeding in women who deliver small for gestational age (SGA) babies. The literature has demonstrated that women with SGA babies have different characteristics to women in the general breastfeeding population as illustrated in the adjacent literature review. The literature review, which accompanies this thesis, has highlighted the multiple advantages associated with breastfeeding, which may be particularly beneficial for SGA babies. Whether women delivering SGA babies have different breastfeeding experiences, or reasons for discontinuing breastfeeding, however has never been investigated. The research presented in this thesis is part of a randomised-controlled trial entitled "The effect of educational information on the duration of breastfeeding in small for gestational age babies". Only one arm of this larger study has been analysed due to the restraints of a 75-point thesis. The full program of study is in progress. The primary aim of this arm was to determine why women with small for gestation age babies stop breastfeeding. Other influences on breastfeeding success were also investigated to determine if these external influences were statistically significant. The findings from this research project have demonstrated that women with SGA babies have the same breastfeeding concerns as women in the general breastfeeding population. The most commonly cited reason for stopping breastfeeding were concerns about 'not enough milk'. Forty four percent of the women cited the midwife as being the most 'valuable' support with their breastfeeding experience. Overall the women with SGA babies had very good breastfeeding rates at 3 and 6 months postnatally compared with the general breastfeeding population statistics. This is a credit to the midwives caring for these women and babies and may also be related to the fact that term SGA babies have been undernourished in utero and can often be hungry babies with 'catching up' to do. These research findings also support the idea that the introduction of supplementary bottles administered on the postnatal wards can have a detrimental effect on future breastfeeding success. However, small for gestational age infants are at increased risk of hypoglycaemia and supplemental feeding may be necessary if the infant is feeding poorly or shows evidence of hypoglycaemia. Any strategies that can improve the breastfeeding duration for SGA infants can result in a wide range of health benefits. The adjacent literature review demonstrates that breastfeeding is the best form of infant feeding and may be even more so for small term babies.