1. Christine Rubertsson Associate professor Uppsala University Sweden
Risk factors for Shorter Exclusive Breastfeeding Identifying Women in Need of Targeted Support
Thank you forgiving me this opportunity to present our research for you
Risk factors for Exclusive Breastfeeding Lasting Less than Two Months: Identifying Women in Need of Targeted Breastfeeding Support
Christine Rubertsson
Associate professor
Uppsala University
Sweden

2. Background Sweden 9 million people 110 000 births per year
Midwives assist normal birth
Cesarean section rate 20 %
Mean age for primiparous women 29 years
Welcome to Sweden a small country up north in Europe with 9 million people.
We have around births per year almost all women give birth in hospital swith a midwife assisting
The national Cesaren section rate is around 20 %
Mean age for primiparous women is 29 years

3. Parental leave 480 paid days for mothers and partners to share
1.85 fertility rate
The Swedish national welfare system gives parents the possibility to have paid parental leave with 480 days per child
The total fertility rate is children per woman

4. Background Breastfeeding
98 % Initiation rate
15 % EBF for six months
Breastfeeding initiation rates in Sweden is 98 %. Although the World Health Organization recommends exclusively breastfeeding for six months 11 % of Swedish women achieve this goal. Breastfeeding rates in Sweden are declining, and it is important to identify women at risk for early cessation of exclusive breastfeeding.

5. Aim
The aim of this study was to investigate factors associated with exclusive breastfeeding lasting less than two months postpartum.

6. Data collection Amningsenkäten The questionnaire included statements
Yes, agree
No, disagree
At the first breastfeeding session the health care professionals helped me breastfed by using their hands to attach my breast with the baby’s mouth. Hands-on x
The first breastfeeding session was a positive experience to me
Amningsenkäten
The questionnaire to the women included statements such as “At the first breastfeeding session the health care professionals helped me breastfed by using their hands to attach my breast with the baby’s mouth” and “The first breastfeeding session was a positive experience to me” with yes/no alternative answers.

7. < two months postpartum
Multivariable logistic regression model
Variable
Adjusted OR for EBF
< two months postpartum
(95% CI)
BMI (kg/m2)
<25
>25 1
1.45 ( )
Parity
Multipara
Primipara
2.15 ( )
Emotional distress during pregnancy No
Yes
2.21 ( )
Cesarean section
2.63 ( )
EDA during delivery
1.55 ( )
Hands-on approach
1.34 ( )
Place/setting during first breastfeeding
Delivery ward
Maternity wardd
1.75 ( )
Variables included in the model were BMI, parity, subjective emotional distress during pregnancy, giving birth by cesarean section, use of epidural anesthesia, the hands-on approach during the first breastfeeding session and postponed first breastfeeding session. Adjusted OR and 95 % CI were estimated.

8. Association with exclusive breastfeeding lasting less than two months postpartum
77 % EBF at 2 months postpartum
Primiparous OR 2.15 ( )
Emotional distress during pregnancy OR 2.21 ( )
Cesarean section OR 2.63 ( )
77percent of the women reported exclusive breastfeeding at two months postpartum.
The following variables in the multivariate regression analysis were independently associated with exclusive breastfeeding lasting less than two months postpartum:
being a first time mother (OR 2.15, 95 % CI ),
reporting emotional distress during pregnancy (OR 2.21, 95 % CI ) and
giving birth by cesarean section (OR 2.63, 95 % CI ).

9. Conclusion
Reporting emotional distress during pregnancy, giving birth by cesarean section and being a first time mother all independently influenced the risk of exclusive breastfeeding lasting less than two months post partum.
Reporting emotional distress during pregnancy, giving birth by cesarean section and being a first time mother all independently influenced the risk of exclusive breastfeeding lasting less than two months post partum.

10. Clinical implication
Special attention at initiation of breastfeeding to women experiencing emotional distress during pregnancy as well as care giving routines around cesarean sectio needs to be addressed in order to give individual breastfeeding support

11. No separation Skin to skin care
Lessons learnt is to work with more skin to skin care and to not separate the newborn from parents.

12. Acknowlegement Karin Cato, doctoral student Sara Sylvén, PhD
Alkistis Skalkidou, Associate Professor
Uppsala University
All participating women