248568 Caesarian Delivery and breastfeeding rates in a WIC population

Tuesday, November 1, 2011: 3:15 PM

Joy P. Nanda, DSc, MS, MHS, MBA , Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Marycatherine Augustyn, PhD , Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Susan Gross, PhD, MPH, RD , Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Amy Resnik, MS, RD, CSP, LDN , Maryland WIC Program, Maryland State Department of Health and Mental Hygiene, Balitmore, MD
David M. Paige, MD MPH , Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Introduction: Improving breastfeeding initiation, exclusivity, and duration is a priority for the Maryland WIC program. However, WIC participants' breastfeeding rates consistently fall below those of non-participants. Of the numerous factors that influence breastfeeding decision making, undergoing C-section delivery has been found to be an important barrier to breastfeeding.

Design: We analyzed a year of data (ending Sep. 2010) on demographics, timing of program enrollment, delivery type, including C-sections and infant feeding status for 34,409 Maryland WIC infants.

Results At enrollment, infants' mean age was 26 days. 22.1% were White; 49.3% African American, 24.6% Hispanic, and 4% other. 10.5% were pre-term and 9.2% LBW. 60% of mothers initiated breastfeeding, and 12.2% breastfed exclusively. 11% reported C-sections.

Approximately 25% of mothers who reported C-section delivery initiated breastfeeding compared to 63% of mothers who did not report a C-section delivery (p<0.001). Additionally, at program enrollment, significantly fewer mothers who reported C-sections were exclusively breastfeeding than mothers who did not report a C-section (0.5% vs. 13.6%, p<0.001). Controlling for health, social, demographic, and obstetric variables did not change the relationships.

Discussion: Breastfeeding rates for Maryland WIC participants who reported having a C-section was significantly lower than rates for women who had a vaginal delivery. Healthy People 2020 Objectives call for decreased number of C-Sections for both primaparous and women who previously underwent a C-section and increased rates of breastfeeding initiation, exclusivity and duration. Prenatal breastfeeding education should include information and discussion of strategies to initiate and continue breastfeeding in the event of a C-Section.

Learning Areas:
Assessment of individual and community needs for health education
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. Explain the relationship between breastfeeding initiation, exclusivity, and duration and C-section delivery in a WIC population. 2. Discuss barriers to breastfeeding among women who have C-section deliveries.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I formulated study question and performed data analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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