Maternal and Child Health Journal

, Volume 16, Supplement 2, pp 231–237 | Cite as

Breastfeeding Practices: Does Method of Delivery Matter?



Objective of this study was to assess the relationship between method of delivery and breastfeeding. Using data (2005–2006) from the longitudinal Infant Feeding Practices Study II (n = 3,026) we assessed the relationship between delivery method (spontaneous vaginal, induced vaginal, emergency cesarean, and planned cesarean) and breastfeeding: initiation, any breastfeeding at 4 weeks, any breastfeeding at 6 months, and overall duration. We used SAS software to analyze data using multivariable analyses adjusting for several confounders, including selected demographic characteristics, participants’ pre-delivery breastfeeding intentions and attitude, and used event-history analysis to estimate breastfeeding duration by delivery method. We found no significant association between delivery method and breastfeeding initiation. In the fully adjusted models examining breastfeeding duration to 4 weeks with spontaneous vaginal delivery group as the reference, those with induced vaginal deliveries were significantly less likely to breastfeed [adjusted odds ratio (AOR) = 0.53; 95 % CI = 0.38–0.71]; and no significant relationship was observed for those who had planned or emergency cesarean deliveries. Again, compared with spontaneous vaginal delivery group, those with induced vaginal [AOR = 0.60; 96 % CI = 0.47–0.78] and emergency cesarean [AOR = 0.68; 96 % CI = 0.48–0.95] deliveries were significantly less likely to breastfeed at 6 months. Median breastfeeding duration was 45.2 weeks among women with spontaneous vaginal, 38.7 weeks among planned cesarean, 25.8 weeks among induced vaginal and 21.5 weeks among emergency cesarean deliveries. While no significant association was observed between delivery method and breastfeeding initiation; breastfeeding duration varied substantially with method of delivery, perhaps indicating a need for additional support for women with assisted deliveries.


Breastfeeding Initiation Duration Delivery method 


  1. 1.
    Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O’Hare, D., Schanler, R. J., et al. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496–506.PubMedCrossRefGoogle Scholar
  2. 2.
    Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D. et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment No. 153. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  3. 3.
    Rubin, D. H., Leventhal, J. M., Krasilnikoff, P. A., Kuo, H. S., Jekel, J. F., Weile, B., et al. (1990). Relationship between infant feeding and infectious illness: A prospective study of infants during the first year of life. Pediatrics, 85, 464–471.PubMedGoogle Scholar
  4. 4.
    Kramer, M. S., Chalmers, B., Hodnett, E. D., Sevkovaskaya, Z., Dzikovich, I., Shapiro, S., et al. (2001). Promotion of breastfeeding intervention trial (PROBIT): A randomized trial in the Republic of Belarus. JAMA, 285(4), 413–420.PubMedCrossRefGoogle Scholar
  5. 5.
    Duncan, B., Ey, J., Holberg, C., Wright, A., Martinez, F., & Taussig, L. (1993). Exclusive breastfeeding for at least 4 months protects against otitis media. Pediatrics, 91, 867–872.PubMedGoogle Scholar
  6. 6.
    Raisler, J., Alexander, C., & O’Campo, P. (1999). Breastfeeding and infant illness: A dose-response relationship. American Journal of Public Health, 89, 25–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Ball, T. M., & Wright, A. L. (1999). Health care costs of formula-feeding in the first year of life. Pediatrics, 103, 870–876.PubMedGoogle Scholar
  8. 8.
    Bartick, M., Reinhold, A. (2010). The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics. doi:10.1542/peds.2009-1616.
  9. 9.
    Harder, T., Bergmann, R., Kallischnigg, G., & Plagemann, A. (2005). Duration of breastfeeding and risk of overweight: A meta-analysis. American Journal of Epidemiology, 162(5), 397–403.PubMedCrossRefGoogle Scholar
  10. 10.
    Arnez, S., Ruckerl, R., Kolestzko, B., & Von Kries, R. (2004). Breastfeeding and childhood obesity—A systematic review. International Journal of Obesity, 28(10), 1247–1256.CrossRefGoogle Scholar
  11. 11.
    Anderson, J. W., Johnstone, B. M., & Remley, D. T. (1999). Breastfeeding and cognitive development: A meta-analysis. American Journal of Clinical Nutrition, 70(4), 525–535.PubMedGoogle Scholar
  12. 12.
    Angelsen, N. K., Vik, T., Jacobson, G., & Bakketeig, L. S. (2001). Breastfeeding and cognitive development at age 1 and 5 years. Archives of Disease in Childhood, 85(3), 183–188.PubMedCrossRefGoogle Scholar
  13. 13.
    Kramer, M. S., Aboud, F., Mironova, E., Vanilovich, I., Platt, R. W., Matush, L., et al. (2008). Breastfeeding and child cognitive development: New evidence from a large randomized trial. Archives of General Psychiatry, 65(5), 578–584.PubMedCrossRefGoogle Scholar
  14. 14.
    Oddy, W. H., Kendell, G. E., Li, J., Jacoby, P., Robinson, M., de Klerk, N. H., et al. (2010). The long-term effects of breastfeeding on child and adolescent mental health: A pregnancy cohort study followed for 14 years. Journal of Pediatrics, 156(4), 568–574.PubMedCrossRefGoogle Scholar
  15. 15.
    Collaborative Group on Hormonal Factors in Breast Cancer. (2002). Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet, 360(9328), 187–195.CrossRefGoogle Scholar
  16. 16.
    Schwarz, E. B., Ray, R. M., Stuebe, A. M., Allison, M. A., Ness, R. B., Freiberg, M. S., et al. (2009). Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics and Gynecology, 113(5), 974–982.PubMedGoogle Scholar
  17. 17.
    Centers for Disease Control and Prevention. (2010). Breastfeeding Report Card—United States, 2010. Available at:]. Accessed Mar 18, 2011.
  18. 18.
    US Department of Health and Human Services. (2011). The surgeon general’s call to action to support breastfeeding. Washington, DC; US Department of Health and Human Services, Office of the Surgeon General; 2011. Available at:
  19. 19.
    Zanardo, V., Svegaliado, G., Cavallin, F., Giustardi, A., Cosmi, E., Litta, P., et al. (2010). Elective cesarean delivery: Does it have a negative effect on breastfeeding? Birth, 4, 275–279.CrossRefGoogle Scholar
  20. 20.
    Perez-Escamilla, R., Maulen-Radovan, I., & Dewey, K. G. (1996). The Association between cesarean delivery and breast-feeding outcomes among Mexican women. American Journal of Public Health, 86, 832–836.PubMedCrossRefGoogle Scholar
  21. 21.
    Rowe-Murray, H. J., & Fisher, J. R. W. (2001). Operative intervention in delivery is associated with compromised early mother-infant interaction. British Journal of Obstetrics and Gynaecology, 108, 1068–1075.PubMedCrossRefGoogle Scholar
  22. 22.
    Rowe-Murray, H. J., & Fisher, J. R. W. (2002). Baby-friendly hospital practices: Cesarean section is a persistent barrier to early initiation of breastfeeding. Birth, 29, 124–131.PubMedCrossRefGoogle Scholar
  23. 23.
    Patel, R. R., Liebling, R. E., & Murphy, D. J. (2003). Effect of operative delivery in the second stage of labor on breastfeeding success. Birth, 30, 255–260.PubMedCrossRefGoogle Scholar
  24. 24.
    Menacker, F., Hamilton, B. E. (2010). Recent trends in cesarean delivery in the United States. NCHS data brief, no 35. Hyattsville, MD; National Center for Health Statistics, 2010.Google Scholar
  25. 25.
    Dewey, K. G. (2001). Maternal and fetal stress are associated with impaired lactogenesis in humans. Journal of Nutrition, 131, 3012–3015.Google Scholar
  26. 26.
    Dewey, K. G., Nommsen-Rivers, L. A., Heinig, M. J., & Cohen, R. J. (2003). Risk factors for suboptimal infant breastfeeding behaviors, delayed onset of lactation, and excess weight loss. Pediatrics, 112, 607–819.PubMedCrossRefGoogle Scholar
  27. 27.
    McGovern, P., Dowd, B., Gjerdingen, D., Gross, C. R., Kenney, S., Ukestad, L., et al. (2006). Postpartum health of employed mothers 5 weeks after childbirth. Annals of Family Medicine, 4(2), 159–167.PubMedCrossRefGoogle Scholar
  28. 28.
    Fein, S. B., Labiner-Wolfe, J., Shealy, K. R., Li, R., Chen, J., Grummer-Strawn, L. M. (2008). Infant Feeding Practices Study II: Study methods. Pediatrics, 122, S28–S35. doi:10.1542/peds.2008-1315c; Available at:
  29. 29.
    Li, R., Jewell, S., & Grummer-Strawn, L. M. (2003). Maternal obesity and breastfeeding practices. American Journal of Clinical Nutrition, 77, 931–936.PubMedGoogle Scholar
  30. 30.
    Liu, J., Smith, M. G., Dobre, M. A., & Ferguson, J. E. (2010). Maternal obesity and breast-feeding practices among white and black women. Obesity, 18(1), 175–182.PubMedCrossRefGoogle Scholar
  31. 31.
    Donath, S. M., & Amir, L. H. (2003). Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: A cohort study. Acta Paediatrica, 92(3), 352–356.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2012

Authors and Affiliations

  1. 1.Division of Reproductive Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations