Does Caesarean Section Affect Breastfeeding Practices in China? A Systematic Review and Meta-Analysis

Objectives To ascertain the association between caesarean delivery and breastfeeding practices in China. Methods We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Electronic databases of CNKI, Medline, EMBASE, CINAHL, ProQuest and Science Direct were searched and screened to identify relevant articles from January 1990 to June 2015. Both fixed and random effect meta-analysis techniques were used to estimate the pooled effect size between caesarean delivery and breastfeeding outcomes at different time points. Sensitivity analysis and publication bias test were also conducted. Results Forty six studies were eligible for the qualitative synthesis of systematic review; among them, 27 studies were included for the meta-analysis. At the early postpartum period, the odds of exclusive breastfeeding after caesarean section was 47% (pooled OR 0.53, 95% CI 0.41, 0.68) lower than that after vaginal delivery. At 4 months postpartum, the odds of breastfeeding was similarly lower (pooled OR 0.61, 95% CI 0.53, 0.71) for caesarean mothers. Substantial heterogeneity among studies was detected for both breastfeeding outcomes. Subgroup analyses stratified by study design, time points of breastfeeding outcomes and definitions of breastfeeding all confirmed the negative association between caesarean section and breastfeeding prevalence. Conclusions In China, breastfeeding practices were affected adversely by caesarean delivery. Therefore, health policy to improve breastfeeding outcomes should take this into consideration.