title: The influence of mode of delivery on breastfeeding initiation in women with a prior cesarean delivery: a population-based study.
abstract: OBJECTIVE
  This study compared breastfeeding initiation following repeat cesarean delivery, successful vaginal birth after cesarean (VBAC), and unsuccessful trial of labor.
  
  
  METHODS
  We performed a population-based retrospective cohort study of Ohio births (2006-2007) with a previous cesarean delivery. The primary outcomes were breastfeeding initiation rates among women with a previous cesarean delivery. Breastfeeding initiation rates were compared among three different delivery types: repeat cesarean delivery, successful VBAC, and unsuccessful trial of labor. Sociodemographic factors, medical risk factors, and pregnancy-related risk factors were also compared to assess influence on breastfeeding initiation rates.
  
  
  RESULTS
  Women delivered by successful VBAC were 47% more likely to initiate breastfeeding than women delivered by scheduled repeat cesarean (adjusted relative risk 1.47; 95% confidence interval 1.35, 1.60). Women who ultimately delivered by cesarean section with unsuccessful trial of labor were also more likely to breastfeed than women with a scheduled repeat cesarean section (61% vs. 58.7%, respectively) (adjusted relative risk 1.17; 95% confidence interval 1.04, 1.33).
  
  
  CONCLUSIONS
  Patients who undergo a scheduled repeat cesarean delivery are less likely to initiate breastfeeding. Women who attempt and succeed in achieving vaginal birth after a previous cesarean section are more likely to breastfeed than are women who deliver by repeat cesarean section. Also, those women who ultimately deliver by cesarean section after an unsuccessful trial of labor were also more likely to breastfeed than those women with a scheduled repeat cesarean section. This suggests there are influences on patient choice for delivery that also may influence the patient's decision to breastfeed.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, and Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267-0526, USA. reganji@ucmail.uc.edu
authors.forename: Jodi
authors.initials: J
authors.lastname: Regan
authors.forename: Amy
authors.initials: A
authors.lastname: Thompson
authors.forename: Emily
authors.initials: E
authors.lastname: DeFranco
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000523:psychology / Q000706:statistics & numerical data*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008425:Maternal Behavior / Q000523:psychology; D009035:Mothers / Q000523:psychology; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000523:psychology / Q000706:statistics & numerical data*