Breastfeeding exclusivity and duration rates are lower after caesarean birth, yet the factors contributing to these are not well understood. This mixed-methods study used an anonymous online questionnaire to examine the facilitators and barriers to establishing breastfeeding as identified by Australian women after a caesarean birth. Quantitative data were reported using descriptive statistics, and multivariable models were used to determine the factors associated with breastfeeding outcomes including the timing of breastfeeding initiation, birth experience, and commercial infant formula use. Qualitative data were analysed using an inductive thematic analysis. Data were obtained for N = 961 women, of which <50% reported skin-to-skin contact during breastfeeding initiation. The barriers to breastfeeding included aspects of clinical care and reduced mobility, while unrushed care, partner support, and physical help with picking up the baby were helpful. Following a non-elective caesarean birth, women had half the odds of early breastfeeding initiation (OR = 0.50; 95% CI: 0.36, 0.68; p ≤ 0.001) and 10 times the odds to report a negative birth experience (OR = 10.2; 95% CI: 6.88, 15.43; p < 0.001). Commercial milk formula use was higher in primiparous women (OR = 2.16; 95% CI: 1.60, 2.91; p < 0.001) and in those that birthed in a private hospital (OR = 1.67; 95% CI: 1.25, 2.32; p = 0.001). Pain and reduced mobility, as well as conflicting and rushed care, negatively impacted breastfeeding after a caesarean birth, while delayed breastfeeding initiation, higher pain ratings, and negative birth experiences were more common for women that birthed by non-elective caesarean. This study adds valuable insights into the physical, emotional, and clinical care needs of women in establishing breastfeeding after a surgical birth. Clinical staffing and care should be modified to include full access to partner support to meet the specific needs of breastfeeding women after a caesarean birth.

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

Caesarean section (CS) birth is associated with higher rates of breastfeeding difficulty and has an increasing prevalence in Australia and globally

Caesarean section (CS) birth is associated with pain and reduced mobility that impacts a woman’s ability to breastfeed and care for her newborn infant

Background/Objectives: Breast pumps are essential tools when breastfeeding dyads are separated or there are breastfeeding challenges that prevent or reduce effective milk removal. Hospital-grade and personal-use pumps offer different features and performance characteristics. Direct comparative studies evaluating pump efficacy and maternal satisfaction are limited in this area, hampering healthcare professionals in their support of lactating women. We compared the efficacy and maternal perceptions of a hospital-grade breast pump (Symphony; Medela AG) and an electric personal-use pump (Pump in Style Pro; Medela AG). Methods: In total, 28 lactating mothers with healthy-term infants participated in an unblinded randomised crossover trial. Participants attended two pumping sessions using either the hospital-grade pump or personal-use pump. Effectiveness of milk removal and maternal perception were measured. Participants completed a 24 h milk profile to enable calculation of the percentage of available milk removed from the breast. Results: There were no significant differences for milk removal efficacy parameters after accounting for pre-expression degree of fullness of the breast between pumps. Similarly, there was no difference in comfort ratings. However, mothers perceived the hospital-grade breast pump vacuum as smoother than the personal-use pump (p = 0.003) and rated the hospital-grade breast pump as having a more pleasant sound (p < 0.001). Both findings remained significant after adjustment for pre-expression degree of fullness (p < 0.001 and p = 0.030, respectively). Conclusions: The hospital-grade pump and the personal-use pump did not differ with respect to milk removal efficacy and comfort. However, participants did perceive differences in vacuum application.