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Maternal and pediatric nutrition

The association between caesarean delivery and the initiation and duration of breastfeeding: a prospective cohort study in China

European Journal of Clinical Nutritionvolume 72pages16441654 (2018) | Download Citation



Breastfeeding is of great benefit to infants and their mothers. Caesarean delivery (CD) have increased worldwide in recent years and emerging evidence has implied that CD may influence the initiation and duration of breastfeeding. However, the findings are inconsistent and intricate. The aim of this study is to illuminate the association between the CD and the initiation and duration of breastfeeding in the first 6 months postpartum.


A total of 2058 mother–infant pairs were studied in this prospective study. Delivery information was obtained from birth records. Feeding information in the first 6 months postpartum were collected from face-to-face interviews. Logistic regression was used to explore the association between CD and the initiation and duration of breastfeeding.


After adjustment for potential confounders, CD was significantly associated with the unsuccessful initiation of breastfeeding [odds ratio (OR): 1.943, 95% confidence interval (CI): 1.050–3.597] and delayed initiation of breastfeeding [OR: 1.450, (95% CI: 1.041–2.019)], when compared with vaginal delivery (VD). More importantly, for mothers who had initiated breastfeeding, CD was associated with significantly higher risks of an inability to sustain full breastfeeding (OR: 1.369, 95% CI: 1.128–1.662), any breastfeeding at 3 months postpartum (OR: 1.715, 95% CI: 1.265–2.325) and any breastfeeding at 6-month postpartum (OR: 1.462, 95% CI: 1.174–1.820).


CD is an independent risk factor for the inability to initiate and sustain breastfeeding. It is desirable to reduce the CD rate and provide specific breastfeeding support during early postpartum period to CD mothers.

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We would like to acknowledge all participants who participated in this study. We are sincerely grateful to the staff at Jiangan Maternal and Child Health Hospital of Wuhan for their support of this project. We would also like to thank all members of the TMCHC Study Group.


This study was supported by the National Program on Basic Research Project of China (No. 2013FY114200).

Author information


  1. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    • Yuanjue Wu
    • , Yan Wang
    • , Junmei Huang
    • , Zhen Zhang
    • , Liping Hao
    • , Nianhong Yang
    •  & Xuefeng Yang
  2. Jiangan Maternal and Child Health Hospital, Wuhan, 430014, Hubei, China

    • Jing Wang
    • , Li Zhou
    •  & Zemin Ni
  3. Jiangan Centers for Disease Control and Prevention, Wuhan, 430014, Hubei, China

    • Jing Wang


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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding authors

Correspondence to Nianhong Yang or Xuefeng Yang.

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