title: Early lactation failure and formula adoption after elective caesarean delivery: cohort study.
abstract: OBJECTIVE
  To investigate the effects of elective primary and elective repeat caesarean deliveries on lactation at hospital discharge.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Four Italian teaching hospitals - Padua, Brescia, L'Aquila and Udine.
  
  
  METHODS
  Deliveries were classified as vaginal, elective caesarean (primary and repeat) or emergency caesarean. A total of 2296 (24.7%) infants born by caesarean section (CS), 816 of which (35.5%) classified as primary elective CS and 796 (34.7%) as repeat elective CS, were studied. Moreover, 30.2% of the elective CS deliveries took place before 39 weeks.
  
  
  METHODS
  Feeding modalities at discharge: formula, complementary and breastfeeding.
  
  
  RESULTS
  At discharge, 6.9% of the vaginal delivery mothers, 8.3% of the emergency CS mothers, 18.6% of the elective CS mothers, 23.3% of the primary CS mothers and 13.9% of the repeat CS mothers were using infant formula exclusively. Multivariate analysis (OR; 95% CI) identified primary elective delivery (3.74; 3.0 to 4.60), lower gestational age (1.16; 1.10 to 1.23), and place L'Aquila versus Udine (1.42; 1.01 to 2.09) and of Brescia versus Udine hospitals (6.16; 4.53 to 8.37) as independent predictors of formula feeding at discharge.
  
  
  CONCLUSIONS
  These findings provide new information about the risks of breastfeeding failure connected to elective CS delivery, particularly if primary and scheduled before 39 weeks of gestation.
authors.affiliation: Padua University, Pediatric Department, Via Giustiniani 3 Padua, 35128, Italy. zanardo@pediatria.unipd.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Zanardo
authors.forename: Anna
authors.initials: A
authors.lastname: Pigozzo
authors.forename: Gary
authors.initials: G
authors.lastname: Wainer
authors.forename: Diego
authors.initials: D
authors.lastname: Marchesoni
authors.forename: Antonella
authors.initials: A
authors.lastname: Gasparoni
authors.forename: Sandra
authors.initials: S
authors.lastname: Di Fabio
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.forename: Arturo
authors.initials: A
authors.lastname: Giustardi
authors.forename: Daniele
authors.initials: D
authors.lastname: Trevisanuto
mesh_terms: D000328:Adult; D001942:Breast Feeding; D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D041943:Infant Formula; D007231:Infant, Newborn; D007774:Lactation / Q000502:physiology; D011247:Pregnancy