title: Breastfeeding Initiation in Mothers with Repeat Cesarean Section: The Impact of Marital Status.
abstract: Approximately 90% of mothers with a primary C-section have a subsequent C-section. To date, research has demonstrated that primary C-sections are associated with breastfeeding noninitiation. However, it is unknown if this association persists after the primary C-section. Furthermore, literature has shown a differing relationship between breastfeeding initiations by marital status. Due to the high proportion of women who give birth while unmarried, investigating differences by marital status will add a significant contribution to breastfeeding literature. This study investigates the association between repeat C-section and breastfeeding initiation within marital status groups using a nationally representative cross-sectional survey.
  
  
  
  Data from the 2004 to 2011 Pregnancy Risk Assessment Monitoring System were analyzed. The sample was restricted to women with a previous singleton live birth who had C-section and whose infant was alive at the time of interview (N = 34,854). Multiple logistic regression analyses were conducted to obtain crude and adjusted odds ratio (AOR) and 95% confidence intervals (CIs).
  
  
  
  After adjusting for potential confounders, married women who had a repeat C-section were 2.2 times (AOR = 2.16, 95% CI = 1.69-2.77) more likely to never breastfeed compared to women with vaginal birth after caesarean section (VBAC). Similarly, the odds of breastfeeding noninitiation were 76% (AOR = 1.76, 95% CI = 1.47-2.12) higher among women with a repeat C-section compared to women with VBAC. No significant associations were exhibited among nonmarried women.
  
  
  
  Enhanced educational programs and counseling support may be needed to help families cope with delivery challenges and resulting stressors that may reduce their desire to initiate breastfeeding in the postpartum period.
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University , Richmond, Virginia.
authors.forename: Jordyn T
authors.initials: JT
authors.lastname: Wallenborn
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University , Richmond, Virginia.
authors.forename: Whitney C
authors.initials: WC
authors.lastname: Graves
authors.affiliation: Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University , Richmond, Virginia.
authors.forename: Saba W
authors.initials: SW
authors.lastname: Masho
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000523:psychology / Q000706:statistics & numerical data*; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D017533:Marital Status / Q000706:statistics & numerical data*; D008425:Maternal Behavior / Q000523:psychology*; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D016017:Odds Ratio; D011181:Postnatal Care; D018570:Risk Assessment; D012944:Social Support; D016064:Vaginal Birth after Cesarean / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: VBAC; breastfeeding initiation; cesarean section; marital status