by Anne Eglash MD, IBCLC, FABM

It is well documented that breastfeeding initiation and duration rates are lower for women who undergo a cesarean birth. There are many factors that might contribute to these lower rates, such as post-operative pain, delay in lactation, infant health complications and separation of the mother and infant. Women who have a planned cesarean birth are less likely to intend to breastfeed as compared to women who have an unplanned cesarean birth.

A 2016 systematic review evaluated studies of interventions that might increase breastfeeding rates among women who undergo cesarean births. Postnatal interventions have included immediate or early skin-to-skin contact, education and breastfeeding support, the use of sidecar bassinets, and use of breast pumps.

What do you think are true statements about Cesarean births and interventions to increase breastfeeding rates? (choose more than 1)

• A. There is weak evidence that targeted prenatal education and postpartum support can increase breastfeeding initiation and duration for dyads undergoing a cesarean birth.
• B. Use of sidecar bassinets increases the frequency of breastfeeding postpartum.
• C. Mothers with cesarean births who pump three times a day from 24 hours to 72 hours postpartum have higher milk supplies and transfer more milk to their babies as compared to women with cesarean births who just breastfeed.
• D. There is weak evidence to show that skin to skin immediately after a cesarean birth can increase breastfeeding initiation.

  See the Answer

   
  Answer – A and D

  See Abstract

  Interventions for women who have a cesarean birth to increase update and duration of breastfeeding: a systematic review

  Sarah Beake, Debra Bick, Cath Narracott, Yan-Shing Chan, Mat Child Nutr 2016 1-13

  Rates of breastfeeding uptake are lower after a caesarean birth than vaginal birth, despite caesarean rates increasing globally over the past 30 years, and many high-income countries reporting overall caesarean rates of above 25%. A number of factors are likely to be associated with women’s infant feeding decisions following a caesarean birth such as limited postoperative mobility, postoperative pain, and ongoing management of medical complications that may have triggered the need for a caesarean birth. The aim of this systematic review was to evaluate evidence of interventions on the initiation and duration of any and exclusive breastfeeding among women who had a planned or unplanned caesarean birth. Seven studies, presenting quantitative and qualitative evidence, published in the English language from January 1994 to February 2016 were included. A limited number of interventions were identified relevant to women who had had a caesarean birth. These included immediate or early skin-to-skin contact, parent education, the provision of sidecar bassinets when rooming-in, and use of breast pumps. Only one study, an intervention that included parent education and targeted breastfeeding support, increased initiation and continuation of breastfeeding, but due to methodological limitations, findings should be considered with caution. There is a need to better understand the impact of caesarean birth on maternal physiological, psychological, and physical recovery, the physiology of lactation and breastfeeding and infant feeding behaviors if effective interventions are to be implemented.

  Milk Mob Comment by Anne Eglash MD, IBCLC, FABM

  The authors point out that Cesarean births have increased in frequency in the vast majority of countries in the last 10 years. In England, for example, the Cesarean rate increased from 12% in 1990 to 26% during 2013-2014. The rate of cesarean births in the USA in 2014 was 32.2%.

  It is alarming that we do not have strong evidence for strategies to optimize breastfeeding initiation and duration rates for dyads who under cesarean births. Like most clinical breastfeeding studies, the trials are small, often not adequately controlled, methodology is poor, and the follow-up duration is short.
  Until we have more robust research, it would be reasonable to individualize prenatal counseling for mothers who are planning a cesarean birth, addressing their breastfeeding barriers and opportunities. In addition, it seems reasonable to consider providing all mothers with cesarean birth special attention and support from a breastfeeding specialist postpartum.