Determinants of Non-Exclusive Breastfeeding Practice During the First 6 Months After an Elective Caesarean Birth: A Prospective Cohort Study

Background: Caesarean birth is associated with higher rate of non-exclusive breastfeeding (NEBF) than vaginal birth. NEBF refers to the provision of food or fluid besides breast milk, excluding drugs and vitamins, to infants before 6 months of age. This study determined the prevalence and factors associated with NEBF practice during the first 6 months after an elective caesarean birth.Methods: This prospective cohort study recruited 171 mothers who underwent an elective caesarean birth at two tertiary hospitals in Kelantan, Malaysia. Face-to-face interviews were conducted 2 days after the caesarean birth to obtain information on the variables of interest. Follow-up phone calls were made at 1, 3 and 6 months after birth to determine the prevalence of NEBF. Simple and multiple logistic regressions were used for data analysis.Results: The prevalence of NEBF was 19.9%, 40.4% and 57.9% at 1 month, 3 months and 6 months, respectively. Factors found to be associated with NEBF practice at 1 month were age of the last child, last child breastfeeding practice, and confidence with adequacy of breast milk. Last child breastfeeding practice was also found to be associated with NEBF practice at 3 months, as well as perception of insufficient of breast milk supply. At 6 months, perception of insufficient breast milk supply remains as one of factors associated with NEBF practice, together with experience of breast pain as baby suckled.Conclusion: The prevalence of NEBF increased as the child grew older. Perceived breast milk insufficiency was the only factor associated with NEBF at all months.