Labour pain, complications drive early breastfeeding cessation

Among breastfeeding mums in Singapore, those who had obstetric complications and experienced more pain during labour tend to stop sooner than the recommended 6 months, according to a study.

In a multiethnic cohort of women in labour with a term, singleton pregnancy, several factors showed independent associations with cessation of breastfeeding at postpartum weeks 6–10. These included diabetes (adjusted odds ratio [aOR], 2.57, 95 percent confidence interval [CI], 1.21–5.44; p=0.0141), presence of obstetric complications (aOR, 1.57, 95 percent CI, 1.00–2.46; p=0.0494), artificial rupture of membrane and oxytocin induction (aOR, 2.07, 95 percent CI, 1.22–3.50, p=0.0068), and higher A-LPQ birth pain score (aOR, 1.02, 95 percent CI, 1.01–1.04; p=0.0064). Other factors were lower education level (aOR, 3.88, 95 percent CI, 2.57–5.85; p<0.0001) and lower age (aOR, 0.92, 95 percent CI, 0.88–0.97; p=0.0010). [Sci Rep 2024;14:31361]

A model based on the six factors had an area under the curve of 0.72 (95 percent CI, 0.68–0.77) for predicting breastfeeding cessation at postpartum weeks 6–10.

The findings are consistent with previous research, which have shown that birth complications may increase the risk of difficulties with breastfeeding. [Mædica 2022;17:955; Dev Psychobiol 2019;61:979-987; Breastfeed Med 2017;12:98-102; Anaesthesia 2021;76:1526-1537; Adv Nurs 2013;69:828-839]

Inadequate pain management during labour may lead to a cascade of events that subsequently impact the successful initiation and establishment of breastfeeding, as the investigators pointed out. Furthermore, while synthetic oxytocin can help with labour, it might have an unintended consequence of reducing the body’s natural ability to produce the hormone needed for successful breastfeeding, they said.

The presence of complications in childbirth may also result in increased need for medical care of the newborn, limiting skin-to-skin contact between mums and their newborns in the immediate postpartum period, according to the investigators. Studies indicate that separation of the newborn from the mother is associated with reduced breastfeeding initiation and continuation. [Matern Child Nutr 2023;19:e13449; J Pediatr 2018;203:190-196]

The study was conducted in KK Women’s and Children’s Hospital and included 813 participants who responded to an online survey. Of these, 624 (76.8 percent) women were still breastfeeding at postpartum weeks 6–10, while 189 (23.2 percent) had discontinued breastfeeding. Women who continued vs ceased breastfeeding differed in terms of age (mean, 31.3 vs 30.1 years), ethnicities (Chinese: 57.7 percent vs 43.9 percent; Malay: 26.0 percent vs 34.2 percent; Indian: 5.0 ;percent vs 7.5 percent), occupation (employed professionally: 41.9 percent vs 26.7 percent), and education level (university: 70.6 percent vs 54.0 percent), among others.

Breastfeeding support

In a recent study, the exclusive breastfeeding rate in Singapore was found to be 38.2 percent at 6 months postpartum. This figure falls short of the WHO and UNICEF recommendation of exclusive breastfeeding for infants in the first 6 months of life and continued breastfeeding for up to 2 years of age and beyond, with introduction of complementary solid foods after 6 months. [Midwifery 2019;79:102532; https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding]

KK Women’s and Children’s Hospital offers several support initiatives to encourage mothers to breastfeed. In the present study, women who used the support services from Lactation Consultant and Breastfeeding Mothers Support Group helpline were more likely to be still breastfeeding at postpartum 6–10 weeks. This finding aligns with previous reports suggesting that breastfeeding education and support can effectively increase breastfeeding rates. [Int J Nurs Stud 2018;80:94-105; Lancet 2016;387:491-504] 

“Lactation Consultants receive extensive education and training and are a source of support for women who are preparing, commencing, or sustaining breastfeeding in the postpartum period. Similarly, breastfeeding support helplines managed by breastfeeding counsellors provide an alternative source of support for mothers,” the investigators said.

“The findings of this study suggest the need to identify and provide closer monitoring to women [who are at] risk of early cessation of breastfeeding… More support [may be provided to these women] to optimize breastfeeding outcomes in the postpartum period,” they added.