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 Neonatal falls are increasingly recognized as a postpartum safety
risk, with as many as 1,600 newborn falls occurring in U.S.
hospitals each year, researchers note in Pediatrics. While this
represents a miniscule fraction of all births, doctors are
increasingly concerned that at least some of these falls may be
resulting from new mothers falling asleep while breastfeeding babies
in their hospital beds.
To assess the potential for breastfeeding programs to influence the
risk of newborn falls, researchers looked at three cases that
happened after one hospital initiated several changes designed to
support breastfeeding and mother-baby bonding.
"To encourage successful breastfeeding, it is important to keep
mothers and babies together in one room, as much as possible," said
lead study author Dr. Colleen Hughes Driscoll of the University of
Maryland School of Medicine in Baltimore.
"This practice is somewhat different from earlier decades when
babies spent a significant part of the postpartum hospitalization in
the nursery, away from their mother," Driscoll said by email.
"Though this separation was likely a barrier to successful
breastfeeding, it may have provided additional opportunities for
mothers to rest and recover."
The researchers examined data on newborn falls recorded in medical
records from January 2011 to February 2018. They also looked at data
on breastfeeding from medical records and from patient surveys done
starting in 2015 as part of a new effort to support breastfeeding
and rooming-in at the hospital.
Three falls occurred within one year of starting a range of
breastfeeding supports the hospital needed to implement in order to
be designated as a "baby friendly hospital." Qualifying as
Baby-Friendly, under the joint WHO and UNICEF program that created
the designation, requires policies that include educating families
to make informed decisions about infant feeding, encouraging mothers
to hold babies skin-to-skin right after birth, allowing rooming-in
and offering lactation support.
"We found that as we improved our ability to support mothers with
successful breastfeeding there was a surge in newborn falls,"
Driscoll said. "This suggests that we may be adding to the burden of
maternal fatigue, and increasing the risk of newborn falls."
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Not all of the falls exclusively involved breastfeeding, however.
Maternal exhaustion did appear to play a role in all three cases.
In one instance, a mother fell asleep while breastfeeding and woke
up to discover the baby crying on the hospital floor. The infant had
a skull fracture but was sent home that evening, only to arrive at
the emergency room at age 7 weeks with seizures.
Another case involved a baby that was initially breastfed, but
switched to formula. This baby's mother fell asleep while burping
the infant after a bottle; the baby later fell to the floor when
cries startled the mother awake. This baby had cuts and a bump on
its head, but no fracture.
With the final case, a mother fell asleep while breastfeeding and
the baby fell, landing unharmed on a pillow on the floor.
While these cases should serve as a reminder that hospitals and new
parents need to take precautions to prevent falls, they shouldn't
discourage breastfeeding or rooming-in, said Dr. Michael Goodstein
of WellSpan Health in York, Pennsylvania.
"Mothers should notify staff if they are feeling drowsy, so they
don't fall asleep while caring for the baby," Goodstein, who wasn't
involved in the study, said by email. "Mothers should also make use
of their support people (in hospital and at home) if they are
concerned that they may fall asleep while breastfeeding in bed."
"At home it is preferred that night breastfeeding occur in the bed,
with hazardous materials (pillows, comforters, loose sheets) kept
away from the infant," Goodstein added. "Mothers should never feed
the baby on a couch - this is the most dangerous place for a baby,
with risk of SIDS or suffocation increasing up to 70 times."
SOURCE: https://bit.ly/2F28kMA Pediatrics, online December 28, 2018.
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