Impact of mode of delivery on early initiation and sustained exclusive breastfeeding in infants: a prospective cohort study

Aditi Chawla; Mukesh Kumar Singh; Sandeep Kumar Kanwal; Sarita Singh; Bindu Bajaj

doi:10.18203/2349-3291.ijcp20263305

Authors

Aditi Chawla Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
Mukesh Kumar Singh Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
Sandeep Kumar Kanwal Department of Paediatrics, VMMC and Safdarjung Hospital, New Delhi, India
Sarita Singh Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
Bindu Bajaj Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263305

Keywords:

Breastfeeding, Exclusive, EBF, EIBF, Caesarean delivery

Abstract

Background: Early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) are critical determinants of neonatal and infant health. Caesarean section (CS) has been consistently associated with delayed initiation and early discontinuation of breastfeeding, but prospective evidence from institutional settings in India remains limited. Objectives were to evaluate the association between mode of delivery and EIBF; to assess the impact of early versus late initiation on EBF at day 3, 6 weeks, and 3 months postpartum; and to identify maternal and neonatal factors independently associated with failure of EBF.

Methods: This prospective observational cohort study was conducted in a self-declared baby-friendly tertiary hospital in North India between July and September 2023. Women with singleton pregnancies beyond 34 weeks’ gestation were enrolled and followed until 3 months postpartum. Breastfeeding outcomes in infants were assessed at predefined intervals. Multivariable logistic regression was used to adjust for potential confounders.

Results: Among 585 women, 52% delivered vaginally and 48% by CS. EIBF occurred in 45% overall and was significantly lower following CS (15% vs 73%, p<0.001). EBF rates at day 3, 6 weeks, and 3 months were consistently lower in the CS group (79%, 55%, and 58.4%) compared to vaginal delivery (VD) (90%, 74.3%, and 71.6%). Caesarean delivery remained independently associated with failure of EBF at 6 weeks and 3 months. EIBF was a strong independent predictor of sustained EBF.

Conclusions: Despite a baby-friendly institutional environment, caesarean delivery remains a significant barrier to early initiation and sustained EBF in infants. Targeted, post-caesarean breastfeeding support strategies are urgently required.

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