Download PDF
Am J Perinatol 2024; 41(16): 2252-2257
DOI: 10.1055/s-0044-1786750
Original Article

Postpartum Hemorrhage after Vaginal Delivery Is Associated with a Decrease in Immediate Breastfeeding Success

Jacqueline Roig
1   Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Patricia Rekawek 
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital—Long Island, Mineola, New York
,
Tahera Doctor
3   Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York
,
Mackenzie N. Naert 
3   Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York
,
Julie Cadet
3   Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York
,
Johanna Monro
3   Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York
,
Joanne L. Stone
3   Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York
,
Lilly Y. Liu
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study aimed to identify the impact of postpartum hemorrhage (PPH) after vaginal delivery on immediate breastfeeding success.

Study Design This is a retrospective cohort study examining the impact of PPH on breastfeeding for nulliparous patients after term, singleton, vaginal deliveries at a large academic institution from 2017 to 2018. Indicators of successful breastfeeding in the immediate postpartum period were measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life.

Results A total of 1,904 women met inclusion criteria during the study period, 262 (13.8%) of whom experienced PPH, defined as an estimated blood loss of 500 mL or greater after vaginal delivery. Women who had a PPH had significantly fewer breastfeeding sessions on average (β = −0.06, p-value 0.01) and required more time at each breastfeeding session (β = 0.08, p-value <0.002). Neonates of women with PPH had a larger percentage in weight loss over the first 2 to 3 days of life compared with those without PPH (β = 0.06, p = 0.008).

Conclusion Women who experience PPH after vaginal delivery have a decreased number of breastfeeding sessions despite spending more time trying to breastfeed, and an increased percentage in neonatal weight loss over the first 2 to 3 days of life. Further work is needed to elicit the mechanism behind this association; however, it is possible that PPH results in decreased secretion of endogenous oxytocin from the hypothalamic–pituitary axis as a result of hypovolemia. These women may therefore require additional breastfeeding support for successful breastfeeding initiation in the immediate postpartum period.

Key Points

  • Women who experience PPH after vaginal delivery have decreased breastfeeding success.

  • Further work is needed to elicit the mechanism behind this association.

  • These women may require additional support for successful breastfeeding initiation postpartum.

Keywords

breastfeeding - postpartum hemorrhage - vaginal delivery

Note

This abstract was accepted as an oral presentation at the SRI 67th Annual Scientific Meeting, in Vancouver, British Columbia, which was ultimately cancelled due to the coronavirus disease 2019 pandemic in March 2020.




Publication History

Received: 03 January 2024

Accepted: 05 April 2024

Article published online:
27 May 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kilpatrick SK, Ecker JL. American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Severe maternal morbidity: screening and review. Am J Obstet Gynecol 2016; 215 (03) B17-B22
    CrossrefPubMedSearch in Google Scholar
  • 2 Mehrabadi A, Liu S, Bartholomew S. et al; Maternal Health Study Group of the Canadian Perinatal Surveillance System (Public Health Agency of Canada). Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010. J Obstet Gynaecol Can 2014; 36 (01) 21-33
    CrossrefPubMedSearch in Google Scholar
  • 3 Lutomski JE, Byrne BM, Devane D, Greene RA. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG 2012; 119 (03) 306-314
    CrossrefPubMedSearch in Google Scholar
  • 4 Nguyen B, Jin K, Ding D. Breastfeeding and maternal cardiovascular risk factors and outcomes: A systematic review. PLoS One 2017; 12 (11) e0187923
    CrossrefPubMedSearch in Google Scholar
  • 5 Martens PJ, Shafer LA, Dean HJ. et al. Breastfeeding initiation associated with reduced incidence of diabetes in mothers and offspring. Obstet Gynecol 2016; 128 (05) 1095-1104
    CrossrefPubMedSearch in Google Scholar
  • 6 Chowdhury R, Sinha B, Sankar MJ. et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104 (467) 96-113
    CrossrefPubMedSearch in Google Scholar
  • 7 Fituch CC, Palkowetz KH, Goldman AS, Schanler RJ. Concentrations of IL-10 in preterm human milk and in milk from mothers of infants with necrotizing enterocolitis. Acta Paediatr 2004; 93 (11) 1496-1500
    CrossrefPubMedSearch in Google Scholar
  • 8 Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev 2019; 7 (07) CD002971
    CrossrefPubMedSearch in Google Scholar
  • 9 Quigley MA, Carson C, Sacker A, Kelly Y. Exclusive breastfeeding duration and infant infection. Eur J Clin Nutr 2016; 70 (12) 1420-1427
    CrossrefPubMedSearch in Google Scholar
  • 10 Frank NM, Lynch KF, Uusitalo U. et al; TEDDY Study Group. The relationship between breastfeeding and reported respiratory and gastrointestinal infection rates in young children. BMC Pediatr 2019; 19 (01) 339
    CrossrefPubMedSearch in Google Scholar
  • 11 Victora CG, Bahl R, Barros AJ. et al; Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387 (10017): 475-490
    CrossrefPubMedSearch in Google Scholar
  • 12 Xu L, Lochhead P, Ko Y, Claggett B, Leong RW, Ananthakrishnan AN. Systematic review with meta-analysis: breastfeeding and the risk of Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther 2017; 46 (09) 780-789
    CrossrefPubMedSearch in Google Scholar
  • 13 Chua S, Arulkumaran S, Lim I, Selamat N, Ratnam SS. Influence of breastfeeding and nipple stimulation on postpartum uterine activity. Br J Obstet Gynaecol 1994; 101 (09) 804-805
    CrossrefPubMedSearch in Google Scholar
  • 14 Dordević G, Jovanović B, Dordević M. [An early contact with the baby–benefit for the mother]. Med Pregl 2008; 61 (11–12): 576-579
    CrossrefPubMedSearch in Google Scholar
  • 15 Matthiesen AS, Ransjö-Arvidson AB, Nissen E, Uvnäs-Moberg K. Postpartum maternal oxytocin release by newborns: effects of infant hand massage and sucking. Birth 2001; 28 (01) 13-19
    CrossrefPubMedSearch in Google Scholar
  • 16 Saxton A, Fahy K, Rolfe M, Skinner V, Hastie C. Does skin-to-skin contact and breast feeding at birth affect the rate of primary postpartum haemorrhage: results of a cohort study. Midwifery 2015; 31 (11) 1110-1117
    CrossrefPubMedSearch in Google Scholar
  • 17 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006; 108 (04) 1039-1047
    CrossrefPubMedSearch in Google Scholar
  • 18 Lewallen LP. A review of instruments used to predict early breastfeeding attrition. J Perinat Educ 2006; 15 (01) 26-41
    CrossrefPubMedSearch in Google Scholar
  • 19 Tuthill EL, McGrath JM, Graber M, Cusson RM, Young SL. Breastfeeding self-efficacy: a critical review of available instruments. J Hum Lact 2016; 32 (01) 35-45
    CrossrefPubMedSearch in Google Scholar
  • 20 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum hemorrhage. Obstet Gynecol 2017; 130 (04) e168-e186
    CrossrefPubMedSearch in Google Scholar
  • 21 Taylor K, Noel E, Chapple AG, Buzhardt S, Sutton E. Risk factors for postpartum hemorrhage in a tertiary hospital in South-Central Louisiana. J Matern Fetal Neonatal Med 2022; 35 (25) 7353-7359
    CrossrefPubMedSearch in Google Scholar
  • 22 Dabrowska J, Hazra R, Ahern TH. et al. Neuroanatomical evidence for reciprocal regulation of the corticotrophin-releasing factor and oxytocin systems in the hypothalamus and the bed nucleus of the stria terminalis of the rat: Implications for balancing stress and affect. Psychoneuroendocrinology 2011; 36 (09) 1312-1326
    CrossrefPubMedSearch in Google Scholar
  • 23 Thompson JF, Heal LJ, Roberts CL, Ellwood DA. Women's breastfeeding experiences following a significant primary postpartum haemorrhage: a multicentre cohort study. Int Breastfeed J 2010; 5: 5
    CrossrefPubMedSearch in Google Scholar
  • 24 Menard MK, Main EK, Currigan SM. Executive summary of the reVITALize initiative: standardizing obstetric data definitions. Obstet Gynecol 2014; 124 (01) 150-153
    CrossrefPubMedSearch in Google Scholar