Breastfeeding initation after Postpartum Haemorrhage: Associated factors and potential implications

BACKGROUND: Breastfeeding has been recognised as a significant driver of neonatal and infant outcomes, particularly in LMIC settings. Postpartum haemorrhage (PPH) is an increasingly common complication of childbirth, with multiple effects on mothers and their babies. This study aimed to explore the association between aspects of PPH care and outcomes and the rates of breastfeeding among this cohort of women. METHODS: This was a secondary analysis of data from the WOMAN trial, an international, randomised, double-blind, placebo-controlled trial, investigating the effect of tranexamic acid in women who have experienced PPH. A binary logistic regression model was developed to examine the associations between the rates of any breastfeeding during the study period and the occurrence of specific factors within the peripartum period. RESULTS: 16,285 mothers of healthy singleton babies were included in the current study. Factors that may result in maternal-infant separation in the immediate postpartum period were significantly associated with lower rates of breastfeeding. These included: the mother requiring transfer between hospitals following PPH (Odds Ratio 0.47 [95%CI 0.41-0.54]) and the mother being admitted to ICU postpartum (OR 0.65 [95%CI 0.54-0.78]). Transfusion of any blood product was associated with a lower rate of breastfeeding (OR 0.82 [95%CI 0.73-0.93]), as was the use of Ergometrine (OR 0.69 [95%CI 0.62-0.77]). Maternal pain (OR 0.65 [95%CI 0.58-0.75]) and maternal anxiety or depression (OR 0.63 [95% CI 0.53-0.75]) were also associated with lower rates of breastfeeding. CONCLUSIONS: Identifying women at higher risk of experiencing difficulties in initiating or sustaining breastfeeding following a PPH may allow for targeted information and support to be provided to those women. Specific prospective research should be carried out to ascertain the true implications of the identified associations. KEY MESSAGES: • Identifying women at higher risk of experiencing difficulties in initiating or sustaining breastfeeding following a PPH may allow for targeted information and support to be provided to those women. • Certain environments, interventions and aspects associated with PPH care are associated with lower rates of breastfeeding initiation prior to hospital discharge.