title: Effects on breastfeeding of changes in maternity length-of-stay policy in a large health maintenance organization.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effects on breastfeeding rates of a private-sector early discharge program and a subsequent government mandate guaranteeing 48 hours of hospital coverage.
  
  
  METHODS
  Interrupted time-series analyses were conducted on retrospective data from the automated medical records of a large health maintenance organization in eastern Massachusetts. A population of 20 366 mother-infant pairs with normal vaginal deliveries between October 1990 and March 1998 was identified. This study period spanned the 2 interventions of interest: 1) the introduction of a new health maintenance organization protocol of 1 postpartum overnight hospitalization followed by a nurse home visit for normal vaginal deliveries, then 2) Massachusetts state minimum coverage legislation. Breastfeeding initiation and breastfeeding continuation among initiators (exclusive or with supplements) into the third month of life were determined through a text search of the first 90 days of infants' automated medical records.
  
  
  RESULTS
  Both policies had dramatic impacts on length of stay (LOS); postpartum LOS <2 nights rose from 29% of pairs to 65% when the early discharge program was implemented, then fell to 15% after the state mandate. Breastfeeding initiation, however, rose gradually from 71% in the fourth quarter of 1990 to 82% in the first quarter of 1998, with no changes after the interventions. Continuation of breastfeeding among those who initiated remained constant at 73%. Younger maternal age, primiparity, low socioeconomic status, and nonwhite race all were found to be risk factors for lower rates of breastfeeding (either initiation or continuation), but there was no evidence of a decline in breastfeeding associated with shorter LOS among these vulnerable groups.
  
  
  CONCLUSIONS
  Early postpartum discharge with outpatient breastfeeding support and a home visitor program has no adverse effects on initiation or continuation of breastfeeding.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Madden
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Mandl
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007902:Length of Stay / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008404:Massachusetts; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008895:Milk, Human; D009775:Obstetrics and Gynecology Department, Hospital / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors