Postpartum Hemorrhage and the Likelihood of Exclusive Breastfeeding Through 6 Months Postpartum: A Case-Control Study

The purpose of this article is to describe the relationship between postpartum hemorrhage (PPH) and exclusive breastfeeding (EBF) duration among participants who planned to breastfeed their infants. We also describe factors that were protective or prohibitive of breastfeeding.

We performed a secondary analysis of data from a case-control study examining genetic variations associated with PPH linked to uterine atony in individuals with singleton vaginal births (n = 60case, n = 40 control participants). Bivariate analyses examined the relationships between breastfeeding exclusivity and various factors, including maternal demographics, birth characteristics, and case-control status. Breastfeeding exclusivity, cessation, challenges, and formula introduction were determined from self-reported infant feeding surveys administered to participants at 6 to 10 weeks, 4 months, and 6 months postpartum. Regression models were used to describe the relationship between breastfeeding exclusivity, breastfeeding duration, and PPH, adjusting for relevant confounding variables.

EBF rates for participants with normal postpartum bleeding versus PPH were 82.5% versus 64.1% (P = .05), 77.5% versus 55% (P = .02), and 70.3% versus 49.1% (P = .04) at 6 to 10 weeks, 4 months, and 6 months, respectively. Early EBF (6-10 weeks) was more strongly associated with psychosocial factors, including higher education, lower depression scores, and higher resilience scores. Median ferritin levels at 6 to 10 weeks postpartum were higher in those who continued to exclusively breastfeed at 4 and 6 months (24.1 ng/mL; interquartile range [IQR], 14.7-46.5) compared with those who did not (17.7 ng/mL; IQR, 10.3-32.0) (P = .03 for both). Higher early breastfeeding self-efficacy emerged as the strongest predictor of EBF across all time points.

PPH significantly impacts breastfeeding initiation and duration, requiring tailored interventions to support affected individuals. Enhancing maternal self-efficacy may improve EBF outcomes. Future research is needed to elucidate the complex relationship between postpartum ferritin levels and EBF outcomes in those who experience PPH.