Does having a caesarean make breastfeeding harder or shorter?
Women who had a caesarean had more trouble breastfeeding, and after accounting for other factors those with a planned caesarean were more likely to stop breastfeeding by about three months.
Source
The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum
Study at a glance
- Design
- Cohort — Prospective community pregnancy cohort (All Our Babies, Calgary) with questionnaires in pregnancy and at 12-16 weeks postpartum; logistic regression of mode of birth on breastfeeding cessation.
- N
- N=3021 · 3021 women with singleton births; 2954 of them initiated breastfeeding and form the denominator for breastfeeding-difficulty analyses.
- Population
- Pregnant women in urban Calgary, Canada, enrolled from 2008; mostly married, highly educated, Caucasian and Canadian-born.
- Outcome
- Self-reported breastfeeding intention, initiation, early success, difficulties, support use, and any breastfeeding beyond 12 weeks postpartum.
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
The researchers used a Calgary pregnancy cohort that surveyed women during pregnancy and again around four months after birth. They compared women who gave birth vaginally, by emergency caesarean, or by planned caesarean on whether they intended to breastfeed, started breastfeeding, had early problems, sought help, and were still breastfeeding past 12 weeks. A logistic regression adjusted for income, education, previous births, preterm birth, maternal health, ethnicity and number of breastfeeding difficulties.
What they found
Almost all women (98%) started breastfeeding, and 83% were still breastfeeding after 12 weeks. Emergency caesarean was linked to the most early problems: almost 40% could not breastfeed successfully on the first try, compared with about 25% after vaginal or planned caesarean births, and more of them used lactation consultants. After adjustment, planned caesarean was associated with higher odds of stopping by 12 weeks (odds ratio 1.61), whereas emergency caesarean was no longer significantly different from vaginal birth, largely because most planned-caesarean mothers had given birth before.
The limits
What it doesn't show
The study is observational, so it cannot show that the surgery itself causes earlier weaning; reasons for the planned caesarean, labour complications and previous breastfeeding experiences were not measured and may confound the link. The sample was mostly affluent, educated, Caucasian urban women, limiting generalisability. Breastfeeding was self-reported as any breastfeeding at a single four-month questionnaire, so exclusive breastfeeding and changes over time could not be assessed, and all types of vaginal birth were grouped together.
Key terms
- Planned vs emergency caesarean
- A planned caesarean is scheduled before labour; an emergency caesarean is decided on because of complications, before or during labour.
- Parity
- The number of times a woman has previously given birth; nulliparous women have not given birth before, multiparous women have.
- Confounding
- When a third factor is linked to both the exposure and the outcome, distorting their apparent relationship.
- Odds ratio
- A measure comparing the odds of an outcome in one group with the odds in a reference group; above 1 means higher odds.
- Lactogenesis
- The hormonal process by which milk production begins after birth, which may be delayed by stress or surgery.
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Quiz yourself
What kind of study design was used?
Common questions
Why did the emergency caesarean result change after adjustment?
Emergency caesareans happened mostly to first-time mothers, while planned caesareans happened mostly to women who had given birth before. Parity is strongly related to breastfeeding duration, so once it was accounted for the apparent effects shifted, with planned rather than emergency caesarean predicting earlier stopping.
Does this mean caesareans physically prevent breastfeeding?
Not necessarily. The authors suggest possible biological routes such as delayed milk production after surgery or earlier-term babies with weaker sucking, but they also note that women having planned caesareans were less likely to intend to breastfeed in the first place, which the study cannot separate.
What practical recommendation comes from this study?
Women having an emergency caesarean may need extra lactation support right after birth, and women considering a planned caesarean could benefit from breastfeeding counselling during pregnancy.
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