Exclusive breastfeeding and cesarean delivery on maternal request: A population-based study in Ontario, Canada

Objectives It is well established that delivery by caesarean section is associated with lower rates of breastfeeding initiation; however, little is known about breastfeeding among women who plan to have a cesarean delivery on maternal request (CDMR). Our objective is to compare the rate of exclusive breastfeeding at discharge between a planned CDMR group and a planned vaginal birth (VD) group using an “intent-to-treat” approach. Methods This was a population-based retrospective cohort study of singleton pregnancies using data from the BORN Ontario registry (Apr ‘12-Mar ’17). Generalized estimating equation models with log link function were used to estimate the adjusted risk ratio (aRR) of exclusive breastfeeding at discharge between planned CDMR and planned VD. A sensitivity analysis comparing planned cesarean section for medical indication with planned VD was conducted. Results Out of 668,468 pregnancies in our study, 0.72% (4,821) had planned CDMR and 85.2% (569,212) had planned VD. The exclusive breastfeeding rate was 42.3% for planned CDMR and 55.4% for planned VD. Women who planned CDMR were less likely to exclusively breastfeed at discharge than those in the planned VD group (aRR: 0.72; 95% CI 0.70-0.75). Women with planned cesarean section with medical indication were also less likely to exclusively breastfeed at discharge than those in the planned VD group (aRR: 0.75; 95% CI 0.75-0.76). Conclusions Planned CDMR is associated with a decreased rate of exclusive breastfeeding compared to planned VD. Additional work to determine the factors influencing breastfeeding is needed to inform on improvements to breastfeeding supports for this population.