In Ireland, breastfeeding rates (either exclusive or complimentary breastfeeding) on discharge from hospital/within the first 48 hours after birth, increased from 48% to 54% between 2005 and 2010 (McAvoy et al., 2014). Analysis of nationally representative data from the
Growing Up in Ireland (GUI) survey has provided a snapshot of breastfeeding duration for infants born in Ireland in 2007/2008. Of those women who initiated breastfeeding (both EBF and partial breastfeeding n= 6,580), half were still breastfeeding at three months and one in four were still breastfeeding at 6 months, with a sharp decline at the 6 month point. Among mothers who practiced partial breastfeeding soon after birth, a sharp decline in breastfeeding was observed within the first three months. Thus, breastfeeding duration in Ireland fell considerably below the WHO recommendations on EBF for the first six months of life. Around 97% of mothers of 9 month olds reported that their infant had received an infant formula product at some stage (McAvoy et al., 2014).
143
7.0.2.1 High pre-pregnancy and postpartum BMI and breastfeeding practices
Pre-pregnancy overweight and obesity has been shown to be associated with early termination of breastfeeding (Oddy et al., 2006; Mok et al., 2008; Liu et al., 2010; Guelinckx et
al., 2012). As pre-pregnancy BMI increases, there is a progressively higher risk of terminating
full or partial breastfeeding earlier (Baker et al., 2007; Liu et al., 2010; Krause et al., 2011). Correspondingly, high maternal BMI is negatively associated with breastfeeding duration and intensity (Krause et al., 2011).
7.0.2.2 Pregnancy and labour complications and breastfeeding practices
Obese and overweight women are at increased risk of pregnancy related complications (Ramachenderan et al., 2008). Kitsantas & Pawloski (2010) found that women with medical complications during pregnancy and/or labour complications who were overweight or obese pre- pregnancy were less likely to initiate breastfeeding than their ideal weight counterparts. Also, women in this group who did initiate breastfeeding were more likely to cease breastfeeding earlier than their ideal weight counterparts. Interestingly, no difference in breastfeeding initiation was detected between overweight and obese women with no medical or labour complications, and their ideal weight counterparts. However these overweight and obese women ceased breastfeeding earlier than their ideal weight peers, showing that while overweight and obese women with no medical or labour complications may be able to initiate breastfeeding, they may need additional continued support to maintain breastfeeding.
7.0.2.3 Socio-demographic variables and breastfeeding practices
Significant risk factors for early cessation of breastfeeding include young maternal age (Lande et al., 2003; Kehler et al., 2009), lower maternal education (Baker et al., 2007; Kehler et
144
al., 2009), lower SES (Donath & Amir, 2007; Amir & Donath, 2008), and not being married
(Lande et al., 2003). In the US, black women are observed to have lower breastfeeding initiation rates and shorter breastfeeding durations than white women suggesting psychosocial and cultural barriers to breastfeeding among black women (Liu et al., 2010). Conversely, being born in an Asian country is associated with a longer duration of breastfeeding (Forster et al., 2006). It has also been consistently shown in studies that smoking is negatively associated with breastfeeding duration (Lande et al., 2003; Giglia et al., 2006; Baker et al., 2007; Kehler et al., 2009).
7.0.2.4 Biological variables and breastfeeding practices
Overweight and obesity is associated with delayed lactogenesis (Dewey et al., 2003; Hilson et al., 2004). Rasmussen & Kjolhede (2004) found that overweight and obese women have a lower prolactin response to suckling at 48 hours postpartum than women of ideal bodyweight. During this early stage of lactogenesis, prolactin response is more important for milk production than later on in lactation, thus a lower prolactin production in overweight and obese women may be a reason for early cessation of full breastfeeding.
Mok et al. (2008) found that a greater proportion of obese women who breastfed reported difficulties e.g. cracked nipples, fatigue, and difficulty initiating breastfeeding; versus ideal weight breastfeeding mothers. Fewer obese mothers perceived milk supply as adequate and a greater proportion of obese mothers reported feeling uncomfortable breastfeeding in the presence of others compared to their ideal weight peers.
Caesarean section rates are higher among obese mothers (Oddy et al., 2006; Kitsantas & Pawloski, 2010). This is relevant because caesarean sections are associated with delayed onset of lactation and poor breastfeeding performance (Dewey et al., 2003; Baker et al., 2007). They also
145
result in longer recovery periods and often in increased complications which can compromise the mother’s ability to breastfed by increasing mother child separation and forcing the mother to
concentrate more on her own recovery than on breastfeeding (Perez-Rios et al., 2008).
Numerous studies have investigated the effect of parity on breastfeeding duration. Some studies show a longer duration of breastfeeding with increased parity (Lande et al., 2003; Simard
et al., 2005). For example, Kronborg & Vaeth (2004) found that among multiparous women,
previous experience of extended breastfeeding had a significant positive impact on the duration of the current breastfeeding period. Relative to mothers who breastfed the previous child for more than 17 weeks, mothers who breastfed the previous child for less than 5 weeks had an earlier cessation rate. The cessation rate was almost 8 times higher among women who breastfed their previous child for a shorter duration. They also found that higher breastfeeding knowledge among primiparous women was associated with longer breastfeeding duration.
7.0.2.5 Psychosocial variables and breastfeeding practices
Krause et al., (2011) found that in a 12 month postpartum follow-up of women who had ever or were still breastfeeding their infant, reasons for doing so included weight loss for the mother, improved infant health, bonding with the infant, lower feeding costs and convenience. Although women stated that one of the reasons for breastfeeding was weight loss, this belief did not affect women’s breastfeeding initiation and intensity (combining the duration and exclusivity of breastfeeding). Expectations regarding weight loss decreased from 6 weeks to 12 months postpartum. A higher expectation of weight loss over time and at 12 months postpartum was associated with lower breastfeeding intensity. Krause et al., (2011) hypothesized that this may be
146
because women with persistently high, unrealistic expectations of achieving better weight loss with breastfeeding gave up on breastfeeding earlier.
Low maternal self-efficacy (a mother’s confidence in her ability to carry out
breastfeeding) has also been negatively associated with breastfeeding duration (Kronborg & Vaeth, 2004). A history of depression and/or anxiety during pregnancy has been shown to negatively affect breastfeeding duration (Taveras et al., 2003; Forster et al., 2006; Kehler et al., 2009); however some studies show no association with depression and/or anxiety and
breastfeeding duration in overweight and obese women (Mehta et al., 2012).
Women who return to work or education early have also been shown to have shorter breastfeeding durations (Kehler et al., 2009; Ogbuanu et al., 2011), while women who breastfeed female infants, have been shown to have longer breastfeeding durations than those who
breastfeed male infants (Lande et al., 2003; Baker et al., 2007).