Maternal health
Does having a caesarean make breastfeeding harder or shorter?
Open access · cc by · source: Europe PMC
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.
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.
Key findings
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.
Methodology
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.
Limitations
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.
How this study connects
Role on claims
Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.
Complicated or emergency births leave women with poorer experiences and more early breastfeeding difficulty.
How birth unfolds affects women's experience and early feeding: in 920 Swedish first-time mothers, operative births, oxytocin augmentation and long labours were linked to lower childbirth-experience scores, and in a Calgary cohort of 3,021 women almost 40% after emergency caesarean could not breastfeed on the first try versus about 25% after other births.
Evidence for the claim as stated.
The Calgary cohort found that emergency caesarean caused the most early breastfeeding problems, but after adjustment it was planned caesarean that was linked to stopping by 12 weeks (odds ratio 1.61), largely because planned-caesarean mothers had usually given birth before. Crude and adjusted comparisons of birth mode can point in different directions.
Evidence for the claim as stated.
The African studies measure access (whether care is reached at all), while the Swedish and Canadian studies, in well-resourced systems where nearly all women receive care, measure experience and outcomes of that care; findings from one setting should not be transferred directly to the other.
Evidence for the claim as stated.
Open questions
Tensions this paper is part of
From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.
The Calgary cohort found that emergency caesarean caused the most early breastfeeding problems, but after adjustment it was planned caesarean that was linked to stopping by 12 weeks (odds ratio 1.61), largely because planned-caesarean mothers had usually given birth before. Crude and adjusted comparisons of birth mode can point in different directions.
The African studies measure access (whether care is reached at all), while the Swedish and Canadian studies, in well-resourced systems where nearly all women receive care, measure experience and outcomes of that care; findings from one setting should not be transferred directly to the other.
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