Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD, United States
Objective: While it is a goal to aid in early breastfeeding (BF) of postpartum persons, no study has investigated if there are racial, ethnic, or other disparities in achieving this after cesarean delivery. Our objective was to identify demographic and clinical characteristics associated with BF initiation in the first hour of life as recommended by the World Health Organization. We hypothesized that those who are non-White, Hispanic, and with public insurance would be less likely to initiate early BF.
Study Design: In this secondary analysis of participants in a randomized trial of tranexamic acid during cesarean delivery, patients who breastfed were included.Those who experienced maternal or neonatal death prior to 24 hours after birth, delivery < 34 weeks, or had a multifetal gestation were excluded. Demographic and obstetric factors were analyzed in relation to BF initiation within the first hour. Adjusted ORs (95% CIs) were calculated using characteristics that may be associated with BF.
Results: A total of 10,993 participants were enrolled in the study of whom 5,514 (50.2%) breastfed and had data regarding timing of BF initiation. Of these, 889 (16.1%) initiated BF in the first hour. Patients with private insurance (aOR 1.57, 95% CI 1.30-1.91) were more likely to achieve this outcome whereas Hispanic patients were less likely (aOR 0.74, 95% CI 0.60-0.92). There were no significant differences with regard to race or obesity. Those undergoing scheduled cesarean (versus unscheduled) were more likely to initiate BF within the first hour (aOR 1.53, 95% CI 1.28-1.83) and those who delivered prematurely were less likely to do so (aOR 0.45, 95% CI 0.31-0.64).
Conclusion: Public insurance and Hispanic ethnicity, which have both been associated with adverse health outcomes, were associated with delayed BF initiation. Initiation of BF is a modifiable outcome with appropriate operating room staff training. Inequities with breastfeeding in the first hour of life demonstrate the need for further evaluation and action to mitigate these disparities.
