Breast-feeding and its relation to smoking and mode of delivery.
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.
Leung
Gabriel M
GM
Department of Community Medicine, The University of Hong Kong Medical Center, Hong Kong, China. gmleung@hku.hk
Lam
Tai Hing
TH
Ho
Lai Ming
LM
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