The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum.
The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum.
复制标题
剖腹产对产后最初四个月的母乳喂养开始，持续时间和困难的影响。
DOI：
10.1186/s12884-016-0876-1
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发表时间：
2016-04-26
影响因子：
3.1
通讯作者：
Tough SC
中科院分区：
文献类型：
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作者：
Hobbs AJ;Mannion CA;McDonald SW;Brockway M;Tough SC
加拿大的剖腹产率为27.1%，远高于世界卫生组织2009年建议的5- 15%的分娩率。与阴道分娩相比，紧急和计划的剖腹产可能会对母乳喂养的开始、母乳供应和婴儿母乳喂养的接受性产生不利影响。我们的研究探讨了分娩方式和母乳喂养的开始，持续时间和困难的母亲在产后4个月。我们所有的婴儿研究是一个前瞻性的怀孕队列在卡尔加里，阿尔伯塔，开始于2008年。参与者在妊娠<25周和34-36周以及产后约4个月时完成问卷。获得了人口统计学、心理健康、生活方式和卫生服务数据。纳入了产单胎婴儿的女性（n = 3021）。使用交叉表和卡方检验比较了不同分娩方式（阴道分娩、计划剖腹产和紧急剖腹产）的母乳喂养率和困难程度。建立多变量logistic回归模型，以研究分娩方式对母乳喂养持续时间至产后12周之间的关系。与阴道分娩（分别为3.4%和1.8%）和紧急剖腹产（分别为2.7%和2.5%）相比，计划剖腹产分娩的妇女不打算母乳喂养或不开始母乳喂养（分别为7.4%和4.3%）。与阴道分娩（分别为29%、40%和52%）或计划剖腹产（分别为33%、49%和41%）相比，通过紧急剖腹产分娩的妇女母乳喂养困难的比例更高（41%），在出院前（67%）和出院后（58%）使用更多资源。与阴道分娩的妇女相比，计划剖腹产的妇女更有可能（OR = 1.61; 95% CI：1.14，2.26; p = 0.014）在产后12周前停止母乳喂养，控制收入，教育，产次，早产，产妇身心健康，种族和母乳喂养困难。我们发现，当控制社会人口统计学和劳动和交付的特点，计划剖腹产与早期停止母乳喂养。可以为考虑计划剖腹产的妇女提供有关母乳喂养的预期指导。此外，还可以在产后24小时内和整个产后早期为紧急剖腹产的哺乳期妇女提供额外的支持性护理。本文的在线版本（doi：10.1186/s12884-016-0876-1）包含补充材料，可供授权用户使用。
The caesarean section (c-section) rate in Canada is 27.1 %, well above the 5–15 % of deliveries suggested by the World Health Organization in 2009. Emergency and planned c-sections may adversely affect breastfeeding initiation, milk supply and infant breastfeeding receptivity compared to vaginal deliveries. Our study examined mode of delivery and breastfeeding initiation, duration, and difficulties reported by mothers at 4 months postpartum. The All Our Babies study is a prospective pregnancy cohort in Calgary, Alberta, that began in 2008. Participants completed questionnaires at <25 and 34–36 weeks gestation and approximately 4 months postpartum. Demographic, mental health, lifestyle, and health services data were obtained. Women giving birth to singleton infants were included (n = 3021). Breastfeeding rates and difficulties according to mode of birth (vaginal, planned c-section and emergency c-section) were compared using cross-tabulations and chi-square tests. A multivariable logistic regression model was created to examine the association between mode of birth on breastfeeding duration to 12 weeks postpartum. More women who delivered by planned c-section had no intention to breastfeed or did not initiate breastfeeding (7.4 % and 4.3 % respectively), when compared to women with vaginal births (3.4 % and 1.8 %, respectively) and emergency c-section (2.7 % and 2.5 %, respectively). Women who delivered by emergency c-section were found to have a higher proportion of breastfeeding difficulties (41 %), and used more resources before (67 %) and after (58 %) leaving the hospital, when compared to vaginal delivery (29 %, 40 %, and 52 %, respectively) or planned c-sections (33 %, 49 %, and 41 %, respectively). Women who delivered with a planned c-section were more likely (OR = 1.61; 95 % CI: 1.14, 2.26; p = 0.014) to discontinue breastfeeding before 12 weeks postpartum compared to those who delivered vaginally, controlling for income, education, parity, preterm birth, maternal physical and mental health, ethnicity and breastfeeding difficulties. We found that when controlling for socio-demographic and labor and delivery characteristics, planned c-section is associated with early breastfeeding cessation. Anticipatory guidance around breastfeeding could be provided to women considering a planned c-section. As well, additional supportive care could be made available to lactating women with emergency c-sections, within the first 24 hours post birth and throughout the early postpartum period. The online version of this article (doi:10.1186/s12884-016-0876-1) contains supplementary material, which is available to authorized users.