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The early cessation of exclusive or any level of breastfeeding is often attributed to low milk supply [...]

Caesarean section birth (CS) accounts for 38% of Australian births and is known to negatively impact breastfeeding exclusivity and duration. Comparison of breastfeeding outcomes between elective (ELUSCS) and non-elective lower uterine segment caesarean section (NELUSCS) births is needed to inform clinical care. Secondary analysis was performed on data from Australian women who had birthed by CS within the previous 12 months and completed an anonymous online questionnaire. Women responded to items relating to CS birth type and feeding methods immediately post birth, during the hospital stay and in the first 2 weeks at home. Self-reported pain at those time points was rated using a scale of 0–10 with 0 indicating no pain and 10 indicating severe pain. Associations between CS birth type, pain scores and feeding methods were determined, and breastfeeding prevalence at the time of survey completion examined. Our sample consisted of 851 women at 5 ± 3.5 months postpartum, of which 435 (51.1%) were primiparous and 362 (42%) had a NELUSCS birth. Infants born by NELUSCS were more likely to receive formula (37.1% vs. 28.8% ELUSCS, p = 0.024) and less likely to be breastfed (78.6% vs. 85.9% ELUSCS, p = 0.022) during the hospital stay. During the 2 weeks after discharge, women who birthed by NELUSCS had higher mean pain scores (6.5 vs. 4.6 ELUSCS, p < 0.001). Few women expressed and fed their milk in the weeks after discharge, with higher rates seen after NELUSCS (7.7% vs. 3.5%, p = 0.017). Breastfeeding status at study completion was not associated with CS birth type (19.6% ELUSCS vs. 19% NELUSCS, p = 0.99). The study findings indicate that Australian women who give birth by NELUSCS are more likely to experience breastfeeding challenges, with higher rates of infant formula supplementation and a more painful recovery in the days and weeks after birth. In light of the higher postpartum pain scores and lower rates of exclusive breastfeeding, women who birth by NELUSCS need additional postpartum support.

Caesarean birth is associated with suboptimal breastfeeding outcomes such as delayed initiation, a higher incidence of difficulties and shorter duration when compared to vaginal birth [...]

Abstract Background Gestational diabetes mellitus (GDM) is major pregnancy complication that is associated with short- and long-term consequences for both mother and infant, including increased risk of diabetes later in life. A longer breastfeeding duration has been associated with a reduced risk of diabetes, however, women with GDM are less likely to exclusively breastfeed and have shorter breastfeeding duration. While the timing of breastfeeding initiation and milk removal frequency affects subsequent breastfeeding outcomes, little is known about early infant feeding practices and milk production in women with GDM. This case series offers detailed prospective breastfeeding initiation data, as well as the first report of objective measures of milk production in women with GDM. Case presentation In this case series, we present the early infant feeding practices of eight women with GDM that gave birth at term gestation. Women recorded the timing of initiation of breastfeeding and secretory activation, as well as their breastfeeding, expression and formula feeding frequencies on postpartum days 1, 7 and 21. Measurement of 24 h milk production volume was performed at 3 weeks postpartum using the test weight method. We observed a delayed first breastfeed (> 1 h) in 6 (75%) cases, formula use in hospital in 5 (63%) cases and delayed secretory activation in 3 (38%) cases. At 3 weeks postpartum, 2 cases had measured milk productions that were insufficient to sustain adequate infant weight gain. Conclusions Our data suggest that despite early and frequent milk removal, women with GDM are at greater risk of delayed secretory activation and low milk supply. Cohort studies that consider co-morbidities such as obesity are needed to determine the lactation outcomes of women with GDM.

Numerous factors not consistently identified in pregnancy are linked with decreased breastfeeding exclusivity and durations. These factors may be considered in three domains: the anatomical, metabolic, and psychosocial domains. As fundamental research into lactation has increased, it is now often possible to identify or speculate the mechanisms by which these factors potentially reduce milk production. The first domain describes the anatomical characteristics of the breast, including intrinsic factors such as hypoplasia (underdevelopment), which may have a genetic component and can be masked by breast augmentation surgery. Hypoplasia has long been associated with the inability to make a full milk production that satisfyies the infant’s needs, although it is not possible to predict a woman’s 24-h milk production so that appropriate complementary feeds can be advised. Extrinsic causes such as breast reduction surgery impact the volume of glandular tissue, thereby reducing the synthetic capacity of the breast. Whereas nipple piercings may damage milk ducts, obstructing milk flow from the breast and thereby reducing milk supply via the autocrine pathway. Various maternal metabolic disorders (intrinsic) comprise the second domain, which includes conditions such as gestational diabetes mellitus, type 1 and 2 diabetes, polycystic ovarian syndrome (often undiagnosed), and hypothyroidism. The aberrant levels of hormones associated with these disorders, such as insulin, are also implicated in breast development, raising the possibility of reduced mammary growth in pregnancy and, consequently, milk production. Much more research is needed in this area, not only to understand mechanisms by which lactation is impacted but also to identify the women at risk of reduced lactation capacity. The third and final domain includes psychosocial issues such as short intended breastfeeding durations, a lack of breastfeeding support, and maternal anxiety and depression. With respect to anxiety and depression, their association with reduced breastfeeding is likely multifaceted, encompassing mood and the potential biochemical changes associated with these states, such as lower levels of circulating oxytocin and higher cortisol levels. Possessing a knowledge of the negative impacts of the intrinsic and extrinsic factors within the maternal anatomical, metabolic, and psychosocial domains provides the impetus for antenatal lactation screening. The antenatal identification of risk factors enables anticipatory guidance and education during pregnancy, as well as early postpartum intervention should breastfeeding issues occur.

Continued breastfeeding attenuates maternal and infant risks associated with gestational diabetes mellitus (GDM), which may be more difficult after a GDM pregnancy, with reports of delayed secretory activation and reduced milk production. The total 24 h milk production cycle is not routinely measured; therefore, it is unclear whether reported low milk production is actual or perceived. We aimed to describe early lactation outcomes and 24 h milk production in women with GDM. Women with GDM-complicated pregnancies recorded early feeding practices. The 24 h cycle of milk production was measured at 3 weeks by weighing infants pre- and post-breastfeeds, as well as breast expression volumes. Electronic scales sensitive to 2 g were used. Low 24 h milk production was classified as n = 40), the median time to the initiation of breastfeeding was 55 min, and delayed secretory activation (n = 24, 60%) was common. Most women achieved frequent milk removal (≥8 × 24 h) in the first 24 h after birth (n = 27, 68%) was at one week (n = 38, 95%) and three weeks postpartum (n = 36, 90%). However, median 24 h milk production was 639 mL (range 100–1220 mL), with low milk production measured in n = 16 (40%, range 100–592 mL). Conclusions: Delayed secretory activation and low milk production are more common in women with GDM despite regular milk removal from the breast, suggesting that altered endocrine pathways inherent to GDM may be implicated.

In response to the need for affordable and comprehensive maternity care, a multidisciplinary team-based maternity care service led by general practitioners with obstetric training (GPOs) and midwives was established for women of low obstetric risk. We evaluated maternal satisfaction with this model of care. All women that attended the service and gave birth in 2020 were approached. Participants used an online survey to rate their satisfaction with aspects of their pregnancy, hospital stay and postpartum care and were invited to provide additional written feedback. Fifty percent (81/162) of women (33 ± 3.9 years) responded, with 59% primiparous. Proportions of participants that were very satisfied with their overall pregnancy, hospital stay, and postpartum care were 91%,