Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Winthrop Hospital, Mineola, New York.
Am J Perinatol. 2024 Jul;41(10):1329-1336. doi: 10.1055/a-1906-8642. Epub 2022 Jul 21.
This article identifies how mode of delivery and the presence of labor affect the initiation and effectiveness of breastfeeding.
This is a retrospective cohort study of breastfeeding success after vaginal delivery, cesarean section after labor, and scheduled cesarean section in term, singleton deliveries in nulliparous patients at a large academic institution from 2017 to 2018. Exclusion criteria included major postpartum complications requiring admission to the surgical intensive care unit or neonatal intensive care unit, general anesthesia, and major fetal anomalies. Breastfeeding success in the immediate postpartum period, defined as the first 2 to 3 days postpartum prior to hospital discharge, was measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life. Multivariable linear and logistic regression were used to assess the association between mode of delivery and markers of breastfeeding success after adjusting for potential confounders. A Tukey's post hoc analysis with pairwise comparisons was performed to assess differences in breastfeeding outcomes between vaginal delivery, scheduled cesarean section, and cesarean section after labor.
A total of 2,966 women met inclusion criteria during the study period, 1,936 (65.3%) of whom underwent spontaneous vaginal delivery, 415 (14.0%) of whom delivered by scheduled cesarean section, and 615 (20.7%) of whom underwent cesarean section after labor. There were significant differences in maternal age, obesity, race/ethnicity, insurance status, gestational age at delivery, birth weight, and 1-minute Apgar's score less than 7 between vaginal delivery, scheduled cesarean section, and cesarean section after labor. There were also significant differences between indication for oxytocin, type of anesthesia, and postpartum hemorrhage between the three groups. After controlling for these factors, women who underwent vaginal delivery were more likely to have infants with decreased need for formula supplementation (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.52-1.93) and were less likely to switch from breast to formula feeding (aOR = 1.71, 95% CI: 1.04-1.31) in comparison to women who delivered via cesarean section in labor or scheduled cesarean section. The infants of these women also had an increased number of breastfeeding sessions on average ( = 0.06, = 0.002), required fewer number of daily formula feedings ( = 0.14, < 0.001), and experienced a smaller percentage in neonatal weight loss over the first 2 to 3 days of life ( = 0.18, < 0.001) compared to those born after cesarean section and cesarean section after labor. These women comparatively required less time at each breastfeeding session ( = 0.06, = 0.005), and produced fewer wet diapers and stools on average ( = 0.12, < 0.001 and = 0.12, < 0.001, respectively). On post hoc analysis with pairwise comparisons, and on separate sensitivity analysis of only women who underwent cesarean delivery, there was no difference in breastfeeding outcome measures between scheduled cesarean section and cesarean section in labor.
Women who deliver by cesarean section, despite the presence or absence of labor, are less likely to maintain exclusive breastfeeding postpartum and are more likely to require formula supplementation. These women may need more support with breastfeeding after surgery in order to experience similar benefits for neonatal growth and weight gain.
· Women who deliver by cesarean section are less likely to maintain exclusive breastfeeding.. · Women who deliver by cesarean section are more likely to require formula supplementation.. · Women may need more support with breastfeeding after cesarean delivery..
本文旨在探讨分娩方式和产程对母乳喂养启动和效果的影响。
这是一项回顾性队列研究，纳入了 2017 年至 2018 年在一家大型学术机构分娩的初产妇、单胎足月分娩的阴道分娩、产时剖宫产和择期剖宫产患者。排除标准包括需要入住外科重症监护病房或新生儿重症监护病房、全身麻醉以及主要胎儿异常等严重产后并发症。在产后最初 2-3 天（出院前）的即刻母乳喂养成功率通过母乳喂养、配方奶补充、每日母乳喂养次数、每次母乳喂养时间、新生儿每日粪便和尿液量以及新生儿头 2-3 天内体重减轻百分比来衡量。采用多元线性和逻辑回归分析，在校正潜在混杂因素后，评估分娩方式与母乳喂养成功率标志物之间的关联。采用 Tukey 事后分析进行两两比较，评估阴道分娩、择期剖宫产和产时剖宫产之间的母乳喂养结局差异。
研究期间共有 2966 名女性符合纳入标准，其中 1936 名（65.3%）接受了自然阴道分娩，415 名（14.0%）接受了择期剖宫产，615 名（20.7%）接受了产时剖宫产。阴道分娩、择期剖宫产和产时剖宫产三组之间的母亲年龄、肥胖、种族/民族、保险状况、分娩时的胎龄、出生体重和 1 分钟 Apgar's 评分<7 均存在显著差异。三组之间的催产素指征、麻醉类型和产后出血也存在显著差异。在控制这些因素后，与产时剖宫产或择期剖宫产的女性相比，阴道分娩的女性婴儿更有可能减少对配方奶的需求（调整后的优势比[aOR] = 1.71，95%置信区间[CI]：1.52-1.93），更不可能从母乳喂养转为配方奶喂养（aOR = 1.71，95%CI：1.04-1.31）。这些女性的婴儿平均母乳喂养次数也更多（= 0.06，= 0.002），每日配方奶喂养次数更少（= 0.14，<0.001），新生儿头 2-3 天内体重减轻百分比更小（= 0.18，<0.001），与产时剖宫产和剖宫产的婴儿相比。这些女性每次母乳喂养所需时间也较短（= 0.06，= 0.005），平均每天产生的湿尿布和粪便较少（= 0.12，<0.001 和= 0.12，<0.001）。在两两比较的事后分析和仅对接受剖宫产的女性的单独敏感性分析中，择期剖宫产和产时剖宫产的母乳喂养结局指标无差异。
尽管有或没有产程，剖宫产分娩的女性更不可能在产后维持纯母乳喂养，更有可能需要配方奶补充。这些女性在手术后可能需要更多的母乳喂养支持，以便在新生儿生长和体重增加方面获得类似的益处。
· 剖宫产分娩的女性更不可能维持纯母乳喂养。· 剖宫产分娩的女性更有可能需要配方奶补充。· 剖宫产女性可能需要更多的母乳喂养支持。
