Caesarean birth is associated with suboptimal breastfeeding outcomes such as delayed initiation, a higher incidence of difficulties and shorter duration when compared to vaginal birth. Contributing factors may include post-operative pain and reduced mobility as well as higher rates of maternal and infant health complications. Breastfeeding experiences may also differ between women that have elective and non-elective caesarean births as well as between primiparous and multiparous women. Exploration of women’s experiences of establishing breastfeeding after caesarean birth is needed to better understand their needs.
A mixed-methods descriptive study was conducted using an anonymous online questionnaire to determine Australian women’s experiences of establishing breastfeeding in hospital and during the first 2 weeks at home after caesarean birth. Thematic analysis of qualitative data was used to identify themes relating to breastfeeding establishment. Inclusion criteria were birth at ≥37 weeks gestation within the previous 12 months, and age ≥ 18 years.
Questionnaires were completed by n = 961 women that were 33.0 ± 6.2 years of age, n = 480 (50%) primiparous, and 6.1 ± 4.3 months postpartum. Reported caesarean birth types were non-elective, 42.9%; elective for medical indications, 39.5%; and elective by maternal request, 17.6%. Initiation of breastfeeding occurred within an hour of birth for n = 675 women (70.2%), and n = 771 (80.2%) breastfed their infant during the postnatal ward stay. One third of women (n = 275, 32%) reported it was easy to pick up their baby to breastfeed and half (n = 418, 49%) received conflicting information from hospital staff. Qualitative themes relating to breastfeeding establishment included experiences of clinical care, maternal expectations and difficulty in picking up the baby. Aspects of care found to be helpful included midwives spending time with women to show and explain breastfeeding, consistent advice and recognition of multiparous women that needed breastfeeding support. Physical and emotional support of the partner was highly valued.
In the days following caesarean birth, women benefit from physical support in accessing the baby for breastfeeding, while availability and consistency of clinical lactation support is vital. As the current global midwifery shortage poses challenges to staffing, inclusion of the partner in breastfeeding education and extension of their ‘visiting hours’ may improve breastfeeding support, while re-examination of the education of all postpartum health care providers is needed to ensure consistent evidence-based lactation care.
Author Contributions
Conceptualization, S.L.P., S.A.P. and D.T.G.; methodology, S.L.P., S.G.A. and J.L.M.; data collection, J.L.M.; formal analysis, S.G.A., S.L.P. and P.V.; investigation, S.L.P. and S.G.A.; resources, D.T.G.; data curation, J.L.M.; writing—original draft preparation, S.L.P.; writing—review and editing, S.A.P. and D.T.G.; supervision, S.L.P. and D.T.G.; project administration, J.L.M.; funding acquisition, D.T.G. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by unrestricted research grant from Medela AG (Switzerland).
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Human Research Ethics Committee at The University of Western Australia (2022/ET000174) and conducted in accordance with the relevant guidelines and regulations.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Restrictions apply to the availability of some, or all data generated or analyzed during this study. The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.
Acknowledgments
We thank all our participants for their time and help with this research.
Conflicts of Interest
D.T.G. declares participation in the Scientific Advisory Board of Medela AG. S.L.P. and D.T.G. are supported by an unrestricted research grant from Medela AG, administered by The University of Western Australia. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. All other authors declare no conflicts of interest.
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