Literature review for - Flourish Paediatrics

Impact of delivery method on breastfeeding outcomes
Search results
Data were extracted from 15 studies, including 12 prospective cohort studies, 1 retrospective
cohort study and 2 cross-sectional studies. For obvious ethical reasons there were no
randomised controlled trials. Data from 14 publications were used to form the final body of
evidence statement, which included 5 studies of Australian women, 7 studies of Chinese
women, 1 study from New Zealand and 1 study from the UK. Sufficient evidence was found
to make statements on the relationship between delivery method and breastfeeding outcomes.
Breastfeeding outcomes investigated included breastfeeding initiation/ at discharge (any or
exclusive) and breastfeeding duration (any or exclusive).
What is the effect of delivering by caesarean section on breastfeeding outcomes?
Draft Evidence statement
Delivery by caesarean section may be negatively associated
with the initiation of breastfeeding, particularly exclusive
breastfeeding, and to a lesser extent breastfeeding duration.
Draft Grade
D
Component Rating Notes
Evidence Base Good 13 cohort studies (11P, 2 O), 1 cross-sectional study (O)
Consistency Poor Approximately half of the studies found no effect for one or
more breastfeeding outcomes, whilst the remainder found no
effect
Clinical impact Poor There was an inconsistent association
Generalisability Excellent All studies involved either Australian women or women
from relevant population sub-groups
Applicability Satisfactory Studies of Chinese women not directly relevant to the
Australian healthcare context
Studies of women from Australia, New Zealand or the UK were considered separate to those
of Chinese women. Two studies reported that women who delivered by caesarean section
were significantly less likely to have initiated breastfeeding or be breastfeeding at discharge,
while another two studies reported that the women who delivered by caesarean section were
significantly less likely to be discharged from hospital exclusively breastfeeding. Two studies
reported no association between delivery method and (any) breastfeeding at discharge and
one study reported no association between delivery method and exclusive breastfeeding at
discharge. One study reported that women who delivered by caesarean section were less
likely to be fully breastfeeding at 1 month but the negative association did not persist beyond
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