The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum

BACKGROUND The caesarean section (c-section) rate in Canada is 27.1%, well above the 5-15% of deliveries suggested by the World Health Organization in 2009. Emergency and planned c-sections may adversely affect breastfeeding initiation, milk supply and infant breastfeeding receptivity compared to vaginal deliveries. Our study examined mode of delivery and breastfeeding initiation, duration, and difficulties reported by mothers at 4 months postpartum. METHODS The All Our Babies study is a prospective pregnancy cohort in Calgary, Alberta, that began in 2008. Participants completed questionnaires at <25 and 34-36 weeks gestation and approximately 4 months postpartum. Demographic, mental health, lifestyle, and health services data were obtained. Women giving birth to singleton infants were included (n = 3021). Breastfeeding rates and difficulties according to mode of birth (vaginal, planned c-section and emergency c-section) were compared using cross-tabulations and chi-square tests. A multivariable logistic regression model was created to examine the association between mode of birth on breastfeeding duration to 12 weeks postpartum. RESULTS More women who delivered by planned c-section had no intention to breastfeed or did not initiate breastfeeding (7.4% and 4.3% respectively), when compared to women with vaginal births (3.4% and 1.8%, respectively) and emergency c-section (2.7% and 2.5%, respectively). Women who delivered by emergency c-section were found to have a higher proportion of breastfeeding difficulties (41%), and used more resources before (67%) and after (58%) leaving the hospital, when compared to vaginal delivery (29%, 40%, and 52%, respectively) or planned c-sections (33%, 49%, and 41%, respectively). Women who delivered with a planned c-section were more likely (OR = 1.61; 95% CI: 1.14, 2.26; p = 0.014) to discontinue breastfeeding before 12 weeks postpartum compared to those who delivered vaginally, controlling for income, education, parity, preterm birth, maternal physical and mental health, ethnicity and breastfeeding difficulties. CONCLUSIONS We found that when controlling for socio-demographic and labor and delivery characteristics, planned c-section is associated with early breastfeeding cessation. Anticipatory guidance around breastfeeding could be provided to women considering a planned c-section. As well, additional supportive care could be made available to lactating women with emergency c-sections, within the first 24 hours post birth and throughout the early postpartum period.