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The Effect of Delivery Method on Breastfeeding Initiation from the The Ontario Mother and Infant Study (TOMIS) III


  • Disclosure: The authors report no conflict of interest or relevant financial relationships.


Susan Watt, DSW, RSW, School of Social Work, McMaster University, KTH-3091280 Main Street, West Hamilton, ON L8S 4M4, Canada.



To report on the relationship between delivery method (cesarean vs. vaginal) and type (planned vs. unplanned) and breastfeeding initiation in hospital and continuation to 6 weeks postpartum as self-reported by study participants.


Quantitative sequential mixed methods design.


Women were recruited from 11 hospital sites in Ontario, Canada.


Participants included 2,560 women age 16 years or older who delivered live, full-term, singleton infants.


Data were collected from an in-hospital questionnaire, hospital records, and a 6-week postpartum interview.


Ninety-two percent of women reported initiating breastfeeding, and 74% continued to 6 weeks. The method of delivery, when defined as cesarean versus vaginal, was not a determining factor in breastfeeding initiation in hospital or in the early postdischarge period. An unexpected delivery method (i.e., unplanned cesarean or instrument-assisted vaginal deliveries) was associated, at a statistically significant level, with an increased likelihood of initiating breastfeeding and continuation to 6 weeks postdischarge.


Breastfeeding can be considered a coping strategy that serves to normalize an abnormal experience and allows the individual to once again assume control. These unexpected results warrant further investigation to understand why women make the decision to initiate breastfeeding, why they choose to continue breastfeeding, and how they can be supported to achieve exclusive breastfeeding as recommended for infants in the first 6 months.

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