Breastfeeding following caesarean section in Zhejiang Province: public health implications

This paper describes the influence of caesarean section on breastfeeding rates in Zhejiang Province, People's Republic of China. A longitudinal cohort study of infant feeding was conducted in Zhejiang Province, in city, suburban and rural areas. Mothers were recruited and interviewed while in hospital and then followed for six months. The sample size was 638 in the city, 347 in the suburban area and 532 in the remote mountainous rural area. In this study the highest caesarean section rate was in the city (76%), a similar rate in the suburbs (74%) and the lowest in the rural area (53%). The overall the breastfeeding initiation rate was 94%. Mothers who had a caesarean section were less likely to be exclusively breastfeeding on discharge (35.8% in city, 59.6% in the suburbs) compared to vaginal delivery where the rates were 45% and 74.4% respectively. The adjusted odds ratio for exclusive breastfeeding in caesarean section deliveries in the city and suburban mothers was 0.64 (95% CI 0.46, 0.88). Caesarean section is increasingly being used for routine deliveries in China and other countries in the region. Mothers who have an operative delivery have lower rates of exclusive breastfeeding on hospital discharge. These mothers will need extra support and encouragement to commence and maintain breastfeeding.