1126 Breastfeeding rates in women that attempt trial of labor after cesarean vs. repeat cesarean delivery

Abstract

Cesarean delivery(CD) is associated with decreased breastfeeding rates. Our objective was to examine breastfeeding rates in the hospital and at the postpartum visit in women who attempted trial of labor after CD(TOLAC) compared to women who declined TOLAC. This is was a retrospective cohort study of women admitted for delivery at an urban, academic hospital between 1/1/2017 and 12/31/2018 with a history of 1 prior CD. Exclusion criteria were contraindication to breastfeeding, gestational age < 24 weeks, fetal chromosomal anomalies, IUFD, and multiple gestation. Patients were identified by departmental statistics and medical records were reviewed. Patients were grouped by intended delivery plan at time of admission: attempted TOLAC and scheduled repeat CD. Postpartum visits were scheduled at 3-6 weeks from discharge. Breastfeeding rates at time of discharge and at the postpartum visit were compared. 283 women met inclusion criteria, 195(69%) attempted TOLAC. Age, body mass index(BMI), and parity were similar in the two groups. 91% of patients of the TOLAC group were breastfeeding during their hospitalization compared to 87% in the group that declined TOLAC(P= 0.28). 227(80%) patients presented for their postpartum visit. Of the women who returned for their postpartum visit, 82% of patients who attempted TOLAC were breastfeeding compared to 65% in the group that declined TOLAC(P= 0.005). Of those who attempted TOLAC, 153(78%) had a successful VBAC. The rate of breastfeeding during hospitalization and at the postpartum visit was similar for patients with successful VBAC or failed TOLAC(94% vs 90%, P=0.75; 85% vs 71%, P=0.09; respectively). Patients who attempt TOLAC have higher breastfeeding rates at their postpartum visits compared to those who declined TOLAC. Breastfeeding rates were similar in women who had a successful VBAC and those who failed TOLAC. Given the numerous neonatal benefits of breastfeeding, this information should be included when counseling patients regarding delivery mode in women with one prior CD.