Breastfeeding Initiation and Birth Setting Practices: A Review of the Literature

Della A. Forster, RN, RM, PhD; Helen L. McLachlan, RN, RM, PhD


J Midwifery Womens Health. 2007;52(3):273-280. 

In This Article

Second Stage of Labour and Birth

There is inconsistent evidence regarding the impact of second-stage factors, such as type of birth, on the initiation of breastfeeding.

Caesarean section has been associated with decreased duration of breastfeeding,[31,46] suboptimal breastfeeding behaviour on the day of birth as well as with delayed onset of lactation,[25,47] and lower exclusive breastfeeding rates at discharge.[48] However, other studies have found no association between birth type and breastfeeding outcome,[49] including no difference between women who had an instrumental vaginal birth and those who had a caesarean birth in the second stage of labour.[50]

Given the importance of early breastfeeding initiation, the increase in the proportion of babies born by caesarean section, and the inconsistency of the evidence on the effects of caesarean section on breastfeeding, new mothers and their infants should be given the opportunity to have contact in the operating theatre (clothed or unclothed) as well as the opportunity to have skin-to-skin contact, and to breastfeed in the recovery room.

Although the evidence is not strong, postpartum hemorrhage may be associated with a delay in lactogenesis.[51] A prolonged second stage has also been associated with delayed lactogenesis in some studies.[28,47] Other obstetric procedures that have been reported to be associated with poorer breastfeeding outcomes include a very short or very long second stage and having an instrumental delivery.[31] Rajan[31] suggests that in addition to identifying these women for extra breastfeeding support, attention could be given to some of the factors that may be amenable to change; for example, that women are only induced for a medical indication.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.