Hopsital breastfeeding experiences after Cesarean among WIC mothers

Introduction: Healthy People 2020 objectives include reducing low-risk mothers' primary Cesarean rate, minimizing formula use, and increasing breastfeeding exclusivity and duration. Currently, one third of U.S. mothers birth by Cesarean, and these mothers have lower breastfeeding rates. Though WIC supports breastfeeding, women enrolled in the program have lower breastfeeding rates than those not eligible. We report on Maryland WIC mothers' experiences of breastfeeding in the hospital after Cesarean. Design: Qualitative interviews were conducted with a convenience sample of 80 WIC clients with infants and 8 Breastfeeding Peer Counselors at 3 representative WIC agencies. Mothers reported birth experiences and subsequent feeding experiences and practices. PCs reported what mothers related and their own observations. Results: 34% of mothers had a Cesarean birth. Mothers reported not being allowed to hold their babies; that babies were supplemented without consent before the mother attempted breastfeeding; and that they experienced fatigue and pain after surgery, leading to breastfeeding concerns resulting in supplementation or termination. Mothers did not report being informed of risks of Cesarean birth, including risks to breastfeeding. Practices for mother-infant contact and breastfeeding support were not consistent among hospitals or providers. Discussion: Mothers who had Cesareans frequently faced inadequate post-operative breastfeeding support and hospital practices that thwarted breastfeeding. Implementing the Surgeon General's Call to Action to adopt Baby Friendly practices and implement peer counseling may be particularly important regarding Cesarean birth. Healthy People 2020 objectives should consider how goals for reducing Cesareans and increasing breastfeeding rates can be coordinated.