title: Breastfeeding outcome comparison by parity.
abstract: OBJECTIVE
  Anecdotally, breastfeeding experiences differ between those who have previously nursed an infant and those who are primiparous. This analysis contrasted breastfeeding outcomes between primiparous women and those with previous experience spanning from maternity stay through 6 months postpartum.
  
  
  METHODS
  A secondary analysis was conducted of data collected in a randomized, controlled trial with mothers and "well" newborns ≥34 weeks of gestation comparing two post-hospital discharge care models. Mothers completed an in-person interview during the postpartum stay and phone surveys at 2 weeks, 2 months, and 6 months where questionnaires related to breastfeeding were completed. All participants intended to breastfeed. Chi-squared and Wilcoxon rank sum tests were used to test for differences between parity groups. Breastfeeding duration by parity group was compared using a Kaplan-Meier plot and a logrank test. A Cox proportional hazards model was used to evaluate the relationship between breastfeeding duration and parity after adjusting for covariates.
  
  
  RESULTS
  Among 1,099 mothers available for analysis, 542 (49%) were primiparous. Multiparous mothers had a longer intended breastfeeding duration (median, 9 vs. 6 months; p<0.001). Following delivery, primiparous mothers had a longer median time to first breastfeeding attempt (119 vs. 96 minutes; p<0.001) and were more likely to have eight or fewer feeding attempts in the first 24 hours (33% vs. 44%; p<0.001)). More primiparous women reported early breastfeeding problems (35% vs. 20%; p<0.001) and mixed feeding at hospital discharge (39% vs. 23%; p<0.001) despite reporting less breastfeeding-associated pain during the first week (p=0.04). Multiparous women were more likely to breastfeed through 6 months (p<0.001). In a multivariable Cox model for breastfeeding duration, an interaction existed between intended breastfeeding duration and parity (p=0.006); among those intending to breastfeed for 12 months, multiparous mothers had a significantly lower hazard of stopping breastfeeding (hazard ratio=0.66; p=0.03) than primiparous mothers.
  
  
  CONCLUSIONS
  Women who have breastfed previously have significantly different breastfeeding experiences than primiparous women. Pre- and postdelivery breastfeeding support should differentially target primiparous women to improve breastfeeding outcomes.
authors.affiliation: 1 Department of Pediatrics, Penn State College of Medicine , Hershey, Pennsylvania.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Hackman
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schaefer
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Beiler
authors.forename: Chelsea M
authors.initials: CM
authors.lastname: Rose
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paul
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D037001:Directive Counseling; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008425:Maternal Behavior / Q000523:psychology*; D009035:Mothers / Q000523:psychology*; D010298:Parity; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology