Does the mode of delivery affect breastfeeding?

Objective: To assess the relationship between method of delivery and breastfeeding initiation and duration. Methods: This analysis, of the longitudinal Infant Feeding Practices Study II, examined method of delivery and breastfeeding (n=3026). The outcomes included breastfeeding initiation, breastfeeding at 4 weeks and mean breastfeeding duration. Delivery method was categorized into: vaginal delivery/not induced, vaginal delivery/induced, unplanned/emergency cesarean delivery, and planned/cesarean. SAS software was used for analysis and several confounders, including pre-delivery breastfeeding intentions and attitude, were assessed. Tukey-Kramer method was used to adjust for multiple comparisons. Results: After adjustment for maternal pre-delivery attitude and infant feeding intentions, there was not a significant association between delivery mode and breastfeeding initiation. Multivariable model assessing breastfeeding at 4 weeks postpartum, however, showed that compared to women who delivered vaginally, those who delivered vaginally-induced (adjusted OR (AOR)=0.55; 95%CI: 0-39-0.78) were less likely to breastfeed; and the association was not significant for those who had a planned/cesarean (AOR=0.96; 95%CI:0.58-1.56 ) or emergency/cesarean (AOR=0.72; 95%CI: 0.46-1.14). Duration was longest for those who delivered vaginally/not induced (adjusted mean=36.9 weeks), it was 33.6 weeks for those with planned/cesareans, 30.4 weeks for those with unplanned/emergency cesarean and it was 28.9 weeks for vaginally/induced deliveries. Comparison of means indicated significant differences between those who delivered vaginally without induction (p<0.0001) and those with vaginally/induced deliveries and those who with unplanned/cesareans (p=0.03). Conclusion: Mode of delivery may not influence breastfeeding initiation; however, it does appear to impact duration, perhaps indicating a need for additional breast-feeding support for women with assisted deliveries.