Women in Australia who conceive using assisted reproductive technology, such as IVF – and who have a caesarean birth before going in to labour – are less likely to breastfeed. This is despite the majority of pregnant women stating that they want to breastfeed their baby for at least six months.
A study published this week in the journal Acta Paediatrica highlights the complexity of the relationship between a mother's age, method of conception, type of birth and breast feeding.
Lead author Professor Jane Fisher, Jean Hailes Professor of Women's Health at Monash University, emphasised the importance of health professionals helping to build confidence in women to breast feed, particularly in women who have had an assisted conception and caesarean birth prior to labour.
"We hope this new data will encourage midwives, lactation consultants and doctors to provide women in this situation with additional assistance to help them establish breastfeeding," Professor Fisher said.
"These are important findings and show that women using assisted reproductive technology (ART) to become pregnant need to be aware that they may find breastfeeding difficult, and so ask for support and help quickly after their babies are born," Associate Professor John McBain said, Senior Fertility Specialist at Melbourne IVF and a co-author of the paper.
The Parental Age and Transition to Parenthood Australia (PATPA) study was undertaken in collaboration with Macquarie University, Melbourne IVF and IVF Australia. It involved 619 women who became pregnant using ART or naturally.
Overall, 37.2 per cent of women had caesarean births. Women who conceived through ART had twice the number of caesareans prior to labour compared to women who became pregnant spontaneously.
When asked in pregnancy, more than 95 per cent of women wanted to breastfeed for at least six months. However, on discharge from hospital, 63.6 per cent of women who had used ART were exclusively breastfeeding, compared to 76.5 per cent of women who conceived spontaneously.
Four months after their baby's birth, 53.8 per cent of women who conceived naturally were exclusively breastfeeding. This compared to only 41.3 per cent of women who conceived using ART.
"We think there is something about going into labour that assists the onset of lactation – people speculate that it is to do with the release of the chemical, oxytocin," Professor Fisher said.
"If you don't have labour the onset of lactation might be delayed and that can be very anxiety-arousing. We think it's especially so for women who conceived with ART because they might already have experienced loss and be especially concerned about their baby's health and wellbeing.
"So even though women in these circumstances intend to breastfeed, when lactation is delayed they may worry about their baby being hungry and then introduce formula very early. After that, it becomes difficult to establish breastfeeding."
Professor Fisher said the study findings were particularly important in light of the World Health Organisation/UNICEF Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding that emphasises the importance of strategies to 'increase women's confidence in their ability to breastfeed' and that this requires not only sensitivity to their needs, but also the 'removal of obstacles to breastfeeding within the health system'.
"Assisted conception followed by caesarean prior to labour has significant negative effects on breastfeeding, which has not been reported before," Professor Fisher said.
"Given that breastfeeding is so strongly advocated by health authorities, women need to be aware of these adverse effects and speak to their IVF clinician and their obstetrician.
"They should also be aware that if they conceive with assisted reproductive technologies and have a caesarean without going in to labour then they could find breastfeeding harder and so should ask for extra support to help them in those early days after their baby is born."