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. 2010 May 27:5:5.
doi: 10.1186/1746-4358-5-5.

Women's breastfeeding experiences following a significant primary postpartum haemorrhage: A multicentre cohort study

Jane F Thompson  1 , Laura J Heal, Christine L Roberts, David A Ellwood
Affiliations

Women's breastfeeding experiences following a significant primary postpartum haemorrhage: A multicentre cohort study

Jane F Thompson et al. Int Breastfeed J. .

Abstract

Background: Postpartum haemorrhage (PPH) is a significant and increasing contributor to maternal mortality and morbidity. Following a PPH, women may have difficulties initiating and sustaining breastfeeding, although little has been published on this issue. The aim of this study was to describe breastfeeding experiences in a cohort of women following a significant PPH.

Methods: This is a descriptive study based on quantitative and qualitative data collected via questionnaires completed in the first week postpartum and at two and four months postpartum, by 206 women participating in a multicentre study of women's experiences of a significant primary postpartum haemorrhage (blood loss of 1500 mL or more in the 24 hours following childbirth, and/or a peripartum fall in haemoglobin (Hb) concentration to 7g/dL or less, or of >/= 4g/dL).

Results: Among women with a significant PPH, 63% fully breastfed their babies from birth, whereas 85% said they had hoped to do so (p < 0.001). Only 52% of mothers who intended to either fully or partially breastfeed were able to give their baby the opportunity to suckle within an hour of the birth. Delays were longer in women with greater estimated blood loss and women with the longest delays in breastfeeding were less likely to initiate full breastfeeding. 70% of women with PPH of < 2000 mL were fully breastfeeding in the first postpartum week, whereas less than 50% of those with blood loss >/= 3000 mL were able to do so. Overall, 58% of women with significant PPH were fully breastfeeding at two and 45% at four months postpartum.In qualitative data, three major themes were identified: 1) Difficulty initiating or sustaining breastfeeding, 2) Need for education and support; and 3) Emotional sequelae.

Conclusions: Following a significant PPH, women with greater blood loss are less likely to initiate and sustain full breastfeeding and this may be related, in part, to delays in initial contact with their baby as a consequence of the PPH. These findings have implications for postnatal care as these women may require greater support, education and assistance in initiating and sustaining breastfeeding. In particular, enabling the opportunity for the newborn to suckle as soon as is practicable should be encouraged.

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Figures

Figure 1
Figure 1
Timing of first opportunity to suckle among mothers with significant PPH who intended to breastfeed, by estimated blood loss (EBL).
Figure 2
Figure 2
Breastfeeding status in first postpartum week among mothers with significant PPH who intended to breastfeed, by timing of first opportunity to suckle.
Figure 3
Figure 3
Breastfeeding status in first postpartum week among mothers with significant PPH who intended to breastfeed, by estimated blood loss.
Figure 4
Figure 4
Breastfeeding status in first postpartum week, at two and at four months postpartum among women with significant PPH.
Figure 5
Figure 5
Percentage of women with significant PPH fully breastfeeding in the first postpartum week and at 2 and 4 months postpartum, by estimated blood loss.
See this image and copyright information in PMC

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