title: Breast-feeding and its relation to smoking and mode of delivery.
abstract: OBJECTIVE
  To examine the effects of cesarean and forceps or vacuum delivery and parental smoking habits on the initiation and duration of breast-feeding.
  
  
  METHODS
  We conducted a prospective, population-based birth cohort study in 1997. Data were collected on breast-feeding history, household smoking habits, method of delivery, and other demographic, obstetric, behavioral, and potential confounding variables via a standardized self-administered questionnaire. Multivariable logistic regression was used to examine the association between method of birth (cesarean versus forceps or vacuum delivery versus normal vaginal birth) and either not initiating breast-feeding or doing so for less than 1 month. Among women who breast-fed for 1 month or more, multivariable survival analysis was employed to study the relationship between method of delivery and breast-feeding duration. We repeated these analyses to examine the link between parental smoking habits and breast-feeding initiation and duration.
  
  
  RESULTS
  A total of 7825 mother-infant pairs were followed up for 9 months. Cesarean delivery was a risk factor for not initiating breast-feeding, for breast-feeding less than 1 month, and remained a significant hazard against breast-feeding duration. Assisted delivery with forceps or vacuum, although not associated with breast-feeding initiation, was a significant risk against breast-feeding duration. Conversely, current parental smoking habits only affected breast-feeding initiation but were unrelated to breast-feeding duration.
  
  
  CONCLUSIONS
  This study indicates a possible effect of forceps or vacuum delivery on breast-feeding and of cesarean on long-term breast-feeding duration. The findings provide additional evidence in support of the avoidance of unnecessary obstetric interventions.
authors.affiliation: Department of Community Medicine, The University of Hong Kong Medical Center, Hong Kong, China. gmleung@hku.hk
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
authors.forename: Lai Ming
authors.initials: LM
authors.lastname: Ho
mesh_terms: D001942:Breast Feeding / Q000523:psychology*; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005113:Extraction, Obstetrical / Q000379:methods; D005260:Female; D006801:Humans; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D012044:Regression Analysis; D012907:Smoking; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors