Association between intrapartum interventions and breastfeeding duration

J Midwifery Womens Health. 2013 Jan-Feb;58(1):25-32. doi: 10.1111/j.1542-2011.2012.00254.x. Epub 2013 Jan 14.


Introduction: Few women who reside in Hong Kong exclusively breastfeed, and one-half stop breastfeeding within the first few months. There is little research in this population on the association between intrapartum interventions and breastfeeding duration.

Methods: A sample of 1280 mother-infant pairs were recruited from the obstetric units of 4 public hospitals in Hong Kong and followed prospectively for 12 months or until the infant was weaned. The outcome variables for this analysis were the duration of any and exclusive breastfeeding. Predictor variables were 4 intrapartum interventions: receipt of opioid pain medication, induction versus spontaneous labor, epidural administration, and mode of birth. We used Cox proportional hazards modeling to assess the impact of intrapartum interventions on the duration of any and exclusive breastfeeding, and we constructed Kaplan-Meier survival curves to evaluate the cumulative impact of multiple intrapartum interventions on breastfeeding outcomes.

Results: Bivariate analysis showed that induction of labor (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.09-1.41), opioid pain medication (HR, 1.21; 95% CI, 1.06-1.37), and having an emergency cesarean birth (HR, 1.22; 95% CI, 1.01-1.48) were associated with a shorter duration of any breastfeeding. Induction of labor (HR, 1.23; 95% CI, 1.08-1.39) and having an emergency cesarean birth (HR, 1.25; 95% CI, 1.05-1.51) were associated with a shorter duration of exclusive breastfeeding. After controlling for known confounding variables, there was no longer any association between individual intrapartum interventions and the duration of any or exclusive breastfeeding. The median duration of breastfeeding for participants who experienced a natural birth with no intrapartum interventions was 9 weeks compared with 5 weeks for participants who experienced at least 3 intrapartum interventions.

Discussion: Clinicians working with new breastfeeding mothers should focus on providing additional support to mothers who experience a difficult labor and birth with multiple interventions to improve their breastfeeding experiences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesia, Epidural
  • Analgesics, Opioid / administration & dosage*
  • Breast Feeding*
  • Cesarean Section*
  • Confounding Factors, Epidemiologic
  • Delivery, Obstetric
  • Emergencies
  • Female
  • Hong Kong
  • Humans
  • Infant
  • Kaplan-Meier Estimate
  • Labor, Induced*
  • Multivariate Analysis
  • Obstetric Labor Complications*
  • Pregnancy
  • Proportional Hazards Models
  • Prospective Studies
  • Weaning


  • Analgesics, Opioid