title: Elective cesarean delivery: does it have a negative effect on breastfeeding?
abstract: BACKGROUND
  Cesarean delivery has negative effects on breastfeeding. The objective of this study was to evaluate breastfeeding rates, defined in accordance with World Health Organization guidelines, from delivery to 6 months postpartum in infants born by elective and emergency cesarean section and in infants born vaginally.
  
  
  METHODS
  Delivery modalities were assessed in relation to breastfeeding patterns in 2,137 term infants delivered at a tertiary center, the Padua University School of Medicine in northeastern Italy, from January to December 2007. The study population included 677 (31.1%) newborns delivered by cesarean section, 398 (18.3%) by elective cesarean, 279 (12.8%) by emergency cesarean section, and 1,496 (68.8%) delivered vaginally.
  
  
  RESULTS
  Breastfeeding prevalence in the delivery room was significantly higher after vaginal delivery compared with that after cesarean delivery (71.5% vs 3.5%, p < 0.001), and a longer interval occurred between birth and first breastfeeding in the newborns delivered by cesarean section (mean ± SD, hours, 3.1 ± 5 vs 10.4 ± 9, p < 0.05). No difference was found in breastfeeding rates between the elective and emergency cesarean groups. Compared with elective cesarean delivery, vaginal delivery was associated with a higher breastfeeding rate at discharge and at the subsequent follow-up steps (7 days, 3 mo, and 6 mo of life).
  
  
  CONCLUSIONS
  Emergency and elective cesarean deliveries are similarly associated with a decreased rate of exclusive breastfeeding compared with vaginal delivery. The inability of women who have undergone a cesarean section to breastfeed comfortably in the delivery room and in the immediate postpartum period seems to be the most likely explanation for this association.
authors.affiliation: Department of Pediatrics, Padua University School of Medicine, Via Giustiniani, 3 35128 Padua, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Zanardo
authors.forename: Giorgia
authors.initials: G
authors.lastname: Svegliado
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.forename: Arturo
authors.initials: A
authors.lastname: Giustardi
authors.forename: Erich
authors.initials: E
authors.lastname: Cosmi
authors.forename: Pietro
authors.initials: P
authors.lastname: Litta
authors.forename: Daniele
authors.initials: D
authors.lastname: Trevisanuto
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000523:psychology / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D017558:Elective Surgical Procedures / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D009730:Nursing Assessment / Q000379:methods; D015403:Nursing Evaluation Research; D009769:Object Attachment; D016017:Odds Ratio; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D012944:Social Support; D055815:Young Adult