Abstract
Objective
Breastfeeding difficulties are the most common reason for breastfeeding cessation, particularly in the early postpartum. Caesarean delivery is associated with earlier breastfeeding cessation than is the case with vaginal delivery, but differences in breastfeeding difficulties by mode of delivery have not been thoroughly examined. Our objective was to explore the association between Caesarean delivery and types of breastfeeding difficulties.
Methods
We conducted a secondary analysis of data from a prospective cohort study of mothers who delivered full-term, singleton infants in Calgary, Alberta, Canada (N = 418). Women completed self-report questionnaires during the delivery hospitalization. Mode of delivery was defined as vaginal or Caesarean, and further classified as planned or unplanned Caesarean. Breastfeeding difficulties were measured using the Breastfeeding Experiences Scale and operationalized with binary variables for presence of various types of maternal (i.e. physical, supply, social) and infant (i.e. latch, behaviour/health) difficulties that were reported as moderate to unbearable. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs).
Results
Overall, 37.1% of women had a Caesarean delivery and 80.9% experienced a breastfeeding difficulty during the delivery hospitalization. Of the difficulties studied, Caesarean delivery was significantly associated with low milk supply (AOR = 1.62, 95% CI = 1.16–2.28) and infant behaviour/health difficulties (AOR = 1.33, 95% CI = 1.01–1.75). The association with low milk supply persisted when examining both planned (AOR = 2.42, 95% CI = 1.19–4.92) and unplanned (AOR = 2.21, 95% CI = 1.16–4.22) Caesarean deliveries.
Conclusion
Mothers who deliver by Caesarean have higher odds of reporting low milk supply and infant behaviour/health difficulties than women who deliver vaginally.
Résumé
Objectif
Les difficultés d’allaitement sont la principale raison de l’arrêt de l’allaitement, surtout au début de la période du postpartum. L’accouchement par césarienne est associé à un arrêt de l’allaitement plus précoce qu’avec l’accouchement par voie vaginale, mais les différences dans les difficultés d’allaitement selon la voie d’accouchement n’ont pas été étudiées à fond. Nous avons voulu explorer les associations entre l’accouchement par césarienne et les types de difficultés d’allaitement.
Méthode
Nous avons effectué une analyse secondaire des données d’une étude prospective de cohortes de mères ayant accouché à terme d’un bébé unique à Calgary (Alberta) au Canada (N = 418). Les femmes ont rempli des questionnaires d’autoévaluation durant leur hospitalisation après l’accouchement. Pour la voie d’accouchement, les répondantes avaient le choix entre un accouchement par voie vaginale ou par césarienne, puis par césarienne planifiée ou non planifiée. Les difficultés d’allaitement ont été mesurées à l’aide d’une échelle de l’expérience d’allaitement (Breastfeeding Experiences Scale) et opérationnalisées avec des variables binaires pour détecter la présence de divers types de difficultés éprouvées par les mères (c.-à-d. physiques, sociales, de production de lait) et par les nourrissons (c.-à-d. prise du sein, comportement/santé) déclarées par les mères comme étant de modérées à insupportables. Une analyse de régression logistique multivariée a servi à estimer les rapports de cotes ajustés (RCa) et les intervalles de confiance de 95 % (IC).
Résultats
Dans l’ensemble, 37,1 % des femmes avaient accouché par césarienne, et 80,9 % avaient éprouvé une difficulté d’allaitement durant leur hospitalisation après l’accouchement. De toutes les difficultés étudiées, l’accouchement par césarienne présentait une corrélation significative avec la faible production de lait (RCa = 1,62, IC de 95 % = 1,16-2,28) et avec les difficultés de comportement/de santé du nourrisson (RCa = 1,33, IC de 95 % = 1,01-1,75). L’association avec la faible production de lait est demeurée lorsque nous avons examiné les accouchements par césarienne planifiés (RCa = 2,42, IC de 95 % = 1,19-4,92) et non planifiés (RCa = 2,21, IC de 95 % = 1,16-4,22).
Conclusion
Chez les mères ayant accouché par césarienne, la probabilité de déclarer une faible production de lait et des difficultés de comportement/de santé du nourrisson est plus élevée que chez les femmes ayant accouché par voie vaginale.
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Data availability
Requests for data from the Happy Baby Study can be directed to the principal investigator, Kathleen Chaput, at khchaput@ucalgary.ca.
Code availability
Not applicable.
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Acknowledgements
We are grateful to the Happy Baby Study research team and participants.
Funding
The Happy Baby Study was funded by the Women and Children’s Health Research Institute at the University of Alberta and the Alberta Children’s Hospital Research Institute. NVS is supported by a Canadian Institutes of Health Research Doctoral Award.
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JS completed this project for her undergraduate thesis with supervision from NVS and KHC. All authors contributed to the study conception and design. Data analysis was conducted by JS with mentorship from NVS. The first draft of the manuscript was written by JS; NVS and KHC provided critical feedback to the manuscript. All authors read and approved the final manuscript.
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The Happy Baby Study was approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB #21754).
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Informed consent was obtained from all individual participants included in the Happy Baby Study.
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The authors declare no competing interests.
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Singh, J., Scime, N.V. & Chaput, K.H. Association of Caesarean delivery and breastfeeding difficulties during the delivery hospitalization: a community-based cohort of women and full-term infants in Alberta, Canada. Can J Public Health 114, 104–112 (2023). https://doi.org/10.17269/s41997-022-00666-0
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DOI: https://doi.org/10.17269/s41997-022-00666-0