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Birth Interventions & Breastfeeding: Can Your Birth Experience be a Booby Trap?
Correlation does not equal causation.
Any statistician or researcher worth his (or her) salt knows that studies can provide links, not causal relationships. The age old post hoc ergo propter hoc fallacy, Latin for "after this, therefore because of this," is a fallacy of fear I have seen countless times on pregnancy, birth, and breastfeeding blogs. Sometimes, birth interventions and medical technologies are necessary for the health and safety of mothers and babies. No one will ever be able to prove that a birth intervention was the cause of unsuccessful breastfeeding.
Where did the fallacy of fear originate?
Like most myths that travel by word of mouth, their origins are shrouded in folklore- or bad data. Many will cite retrospective studies to try and draw conclusions from correlational or bias research.
While the limitations of statistics cannot prove causality, the current data collected in researching this controversy does not even prove correlation.
According to a recent study published by Current Opinion in Anaesthesiology, "Alarming messages were sent out following a retrospective study indicating that epidural analgesia caused more breastfeeding failures. The limitations of this study were reviewed as well as the critical importance of good lactation support. There is no good evidence that epidural analgesia causes reduced breastfeeding success. Good lactation support is critical."
Most people believe that c-sections will have a negative correlation to breastfeeding success. The data regarding this belief comes from cross sectional, retrospective analysis from studies conducted in other countries. The most recent study to follow this trend comes from Brazil: "Determinants of breastfeeding initiation within the first hour of life...47.1% of the mothers initiated breastfeeding within the first hour after birth." Notice in the title, "the first hour of life." Most women who have given birth via c-section are being sewn up and transported to recovery during the first hour of their baby's life; some are able to nurse in the recovery room, others with babies who require immediate attention in the nursery typically wait until after recovery. This study says nothing about the successful breastfeeding rates of c-sectioned mothers. Also, this data comes from another country with a different model/culture of care.
Breastfeeding Initiation & Continued Success
Currently, America has reached its Healthy People goal of breastfeeding initiation. 75% of mothers (regardless of birthing methods) initiate breastfeeding. In my state, 80% of mothers initiate nursing in the hospital, slightly above the national average.
However, the data of Exclusive Breastfeeding Success dips down when measured at 3 and 6 months. At 3 months, 33% of mothers are still exclusively nursing and at 6 months, only 13% of mothers are still exclusively nursing. Exclusive nursing is defined as nothing other than breastmilk- no solids, no formula, no juice, and no water.
There are many unmeasurable lurking variables that could possibly explain such a dip in "success." Personality, desire to breastfeed, nursing support, environment, legislation, work, physical and mental health, nutrition, stress, as well as early implementation of solid foods, juice, or water.
One of the common mistakes when interpreting observational data is assigning quantative principles to the outcomes of qualitative data. In terms of breastfeeding, technology has become the scapegoat of not only the limitations of statistics, but of unmeasurable lurking variables that can affect the outcome of breastfeeding rates.
Birth cannot be controlled, as much as we plan, hope, and manifest labor during the months of pregnancy. You have every right to be as comfortable as you want during your labor, without fear or guilt that it will negatively affect a future breastfeeding relationship. Whether you have a natural delivery or a planned c-section, your experience is not setting you up for breastfeeding failure.
Current Opinion in Anaesthesiology: Obstetric and gynecological anesthesia: Edited by Marc Van de Velde. June 2009 - Volume 22 - Issue 3 - p 327.
Determinants of breastfeeding initiation within the first hour of life in a Brazilian population: cross-sectional study. http://www.biomedcentral.com/1471-2458/10/760. Accessed July 1, 2011.