Breastfeeding Practices Among First-Time Mothers and Across Multiple Pregnancies
To investigate maternal characteristics associated with breastfeeding initiation and success. Women enrolled in the Mothers Outcomes After Delivery study reported breastfeeding practices 5–10 years after a first delivery. Women were classified as successful breastfeeding initiators, unsuccessful initiators, or non-initiators. For the first birth, demographic and obstetrical characteristics were compared across these three breastfeeding groups. For multiparous women, agreement in breastfeeding status between births was evaluated. Multivariate regression analysis was used to identify characteristics associated with non-initiation and unsuccessful breastfeeding across all births. Of 812 participants, 740 (91%) mothers tried to breastfeed their first child and 593 (73%) reported breastfeeding successfully. In a multivariate analysis, less educated women were less likely to initiate breastfeeding (odds ratio (OR) for non-initiation 1.97; 95% confidence interval (CI) 1.23, 3.14). There was a notable decrease in breastfeeding initiation with increasing birth order: compared to the first birth, the odds for non-initiation after a second delivery almost doubled (OR 1.83, 95% CI 1.42, 2.35) and the odds for non-initiation after a third delivery were further increased (OR 2.44, 95% CI 1.56, 3.82). Successful breastfeeding in a first pregnancy was a predictor of subsequent breastfeeding initiation and success. Specifically, women who did not attempt breastfeeding or who reported unsuccessful attempts to breastfeed at first birth were unlikely to initiate breastfeeding at later births. Cesarean delivery was not associated with breastfeeding initiation (OR 1.01; 95% CI 0.68, 1.48) or success (OR 1.33; 95% CI 0.92, 1.94). Breastfeeding practices after a first birth are a significant predictor of breastfeeding in subsequent births.
KeywordsBreastfeeding initiation Cesarean delivery Multiparity Maternal education Healthy People 2020
- MOAD Study
Mothers’ Outcomes After Delivery Study
- NHANES III
Third national health and nutrition examination survey
The MOAD study was supported by NIH grant RO1HD056275.
Conflict of interest
The authors have no conflicts to declare.
- 1.Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O’Hare, D., Schanler, R. J., et al. (1995). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496–506.Google Scholar
- 3.Kramer, M. S., & Kakuma, R. (2002). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews, 1, CD003517.Google Scholar
- 5.World Health Organization. (2002). The optimal duration of exclusive breastfeeding: Report of an expert consultation. Geneva: WHO Department of Nutrition for Health and Development.Google Scholar
- 7.US Department of Health and Human Services. (2010). Healthy people 2020 program: MICH-21: Increase the proportion of infants who are breastfed. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26. Accessed 21 December, 2010.
- 11.McDowell, M. M., Wang, C. Y., & Kennedy-Stephenson, J. (2008). Breastfeeding in the United States: Findings from the national health and nutrition examination surveys, 1999–2006. Hyattsville, MD: National Center for Health Statistics.Google Scholar
- 17.Maryland Health Care Commission. (2010). Maryland hospital performance evaluation guide. http://mhcc.maryland.gov/consumerinfo/hospitalguide/hospital_guide/reports/find_a_condition/condition_detail_b.asp?condition_cd=Moms&care_cd=D01OB. Accessed 21 December, 2010.
- 18.Centers for Disease Control and Prevention. (2010). National immunization survey methods: Wording of the breastfeeding questions. http://www.cdc.gov/breastfeeding/data/NIS_data/survey_methods.htm. Accessed 21 December, 2010.
- 19.Szldo, M., & Nieto, F. J. (2000). Epidemiology: Beyond the basics. Gaithersburg: Aspen Publishers.Google Scholar
- 20.Diggle, P., Heagerty, P., Liang, K. Y., & Zeger, S. (2002). Analysis of longitudinal data (2nd ed.). New York: New Oxford University Press.Google Scholar
- 23.Menacker, F., & Hamilton, B. E. (2010). Recent trends in cesarean delivery in the United States. Hyattsville: National Center for Health Statistics.Google Scholar
- 24.Gillespie, B., D’Arcy, H., Schwartz, K., Bobo, J. K., & Foxman, B. (2006). Recall of age of weaning and other breastfeeding variables. International Breastfeeding Journal, 1(4), 1–10.Google Scholar
- 25.Dyson, L., McCormick, F., & Renfrew, M. J. (2005). Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews, (2), CD001688.Google Scholar
- 26.Centers for Disease Control and Prevention. (2011). The CDC guide to breastfeeding interventions: Maternity care practices. http://www.cdc.gov/breastfeeding/pdf/BF_guide_1.pdf. Accessed on 25 May 2011.
- 27.Britton, C., McCormick, F. M., Renfrew, M. J., Wade, A., & King, S. E. (2007). Support for breastfeeding mothers. Cochrane Database of Systematic Reviews, (1), CD001141.Google Scholar