Effect of operative delivery in the second stage of labor on breastfeeding success.
BACKGROUND
Operative delivery rates are currently rising in many countries, but the effects of this factor on the initiation and duration of breastfeeding are unclear. The purpose of this study was to evaluate breastfeeding success after instrumental vaginal delivery or cesarean section at full dilatation, and to investigate whether timing of discharge after operative delivery affects breastfeeding rates.


METHODS
A prospective cohort study was conducted of 393 women with term, singleton, live, cephalic pregnancies who required delivery in theater during the second stage of labor between February 1999 and February 2000. Postal questionnaires were mailed to participants at 6 weeks and 1 year. Logistic regression models were used to explore the relationships between infant feeding and mode of delivery, controlling for factors previously correlated with breastfeeding success.


RESULTS
Rates of exclusive breastfeeding at discharge and 6 weeks postpartum were 70 and 44 percent, respectively. No significant differences occurred when instrumental vaginal delivery was compared with cesarean section, adjusted OR 0.84 (95% CI 0.50, 1.41) and 1.15 (95% CI 0.69, 1.93) respectively. Breastfeeding rates after failed instrumental delivery were similar to those after immediate cesarean section, adjusted OR 0.99 (95% CI 0.72, 1.38) and 1.28 (95% CI 0.91, 1.78). Women who had a longer in-patient stay after cesarean section were more likely to achieve exclusive breastfeeding at hospital discharge (78% vs 66%, p = 0.03).


CONCLUSIONS
Method of operative delivery in the second stage of labor does not appear to influence initiation or duration of exclusive breastfeeding. A longer inpatient stay may help cesarean-delivered women to initiate breastfeeding.
Division of Obstetrics and Gynaecology, St. Michael's Hospital, University of Bristol, Bristol, United Kingdom.
Roshni R
RR
Patel
Rachel E
RE
Liebling
Deirdre J
DJ
Murphy
D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000523:psychology / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005113:Extraction, Obstetrical / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D007902:Length of Stay; D016015:Logistic Models; D010351:Patient Discharge; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires