The use of nipple shields by breastfeeding women

The use of nipple shields when breastfeeding has given rise to concerns about possible harmful effects. A study was carried out to examine this issue. A lactation consultant's (LC) patients using nipple shields were compared with her other patients who were not using nipple shields, and an incidental sample of all postnatal breastfeeding women. The three groups were compared on discharge from hospital and at 3 months. Breastfeeding rates and problems (nipple trauma and mastitis) were studied: on discharge from hospital the LC patients who were not using nipple shields were significantly less likely to be breastfeeding than either of the other two groups. At 3 months, both LC groups were less likely to be breastfeeding than the postnatal group; there was no significant differences between the women using nipple shields and those who were not. There were no significant difference in reported problems in the 3 groups. It is concluded that women with breastfeeding problems are more likely to give up breastfeeding than those women who do not have major problems, and that the use of nipple shields is not a contributing factor and does not appear to compromise lactation.     

Baby Friendly Hospital Initiative practices and breast feeding duration in a cohort of first-time mothers in Adelaide, Australia

OBJECTIVE: to investigate the relationship between adherence to six of the Baby Friendly Hospital Initiative (BFHI) Ten steps to successful breast feeding and the duration of breast feeding in first-time mothers. DESIGN: a prospective study to assess the duration of breast feeding up to 6 months postpartum. Survival analysis techniques (Kaplan-Meier curves and Cox proportional hazard models) were used to interpret the data. PARTICIPANTS: 317 women who had given birth to their first baby (at term) in a large teaching maternity hospital in Adelaide, South Australia, during the period March to November 2003. FINDINGS: ignoring all other factors, we found that women whose babies received a bottle feed, used a pacifier or dummy, or who used a nipple shield during their postnatal stay, were at significantly greater risk of weaning (p0.05). After adjusting for socio-demographic variables, self-efficacy, intended duration of breast feeding, and method of delivery, the results unexpectedly showed that the only significant predictor of early weaning was breast feeding on demand. However, a composite variable indicating use of one or more of nipple shields, a dummy or bottle feeds while in hospital resulted in a significantly greater risk of weaning (p=0.05). IMPLICATIONS FOR PRACTICE: socio-demographic and cultural factors may be more important determinants of the duration of breast feeding than some of the very specific hospital practices targeted in the Ten steps to successful breast feeding. From a public health perspective, we may influence the duration of breast feeding through better post-discharge support services, or through interventions that improve attitudes to breast feeding in specific socio-cultural and economic groups.     

Preparing for breast feeding: treatment of inverted and non-protractile nipples in pregnancy

Objective: to determine the effectiveness of recommending Hoffman's nipple stretching exercises or breast shells (or both) to pregnant women with inverted or non-protractile nipples who intend to breast feed.Design: randomised controlled trial with a two treatment by two level factorial design.Setting: in the UK, antenatal clinics in hospital and community settings in 10 centres and the antenatal network of the National Childbirth Trust; in Ontario, Canada, antenatal clinics in six hospital centres and one public health unit.Participants: 463 women with at least one inverted or non-protractile nipple and a singleton pregnancy, recruited between 25 completed and 35 completed weeks of pregnancy.Primary outcome measure: rate of breast feeding as reported by postal questionnaire six weeks postnatally.Findings: 107 out of 234 (46%) women allocated to use Hoffman's exercises compared with (44%) women not allocated to use exercises were breast feeding at six weeks after delivery (difference 2%, 95% confidence interval −7% to 11%). One hundred and three out of 230 (45%) women allocated to use shells compared with (45%) women not allocated to use breast shells were breast feeding at six weeks after delivery (difference 0%, 95% confidence interval −9% to 9%).Conclusions: in the light of the findings from this and a previous single centre trial, there is no basis for recommending the use of either Hoffman's nipple stretching exercises or breast shells as antenatal preparation for women with inverted and non-protractile nipples who wish to breast feed. Given the lack of evidence to support these and other antenatal preparations there are no grounds for midwives to continue routine breast examination in pregnancy for this purpose.     

Inflammation of the breast

The primary care physician usually is the first person to see patients complaining of breast pain or nipple discharge. The diagnosis of lactational mastitis is evident because of the history The major consideration is prompt and effective treatment and close follow-up evaluation. Failure to respond to appropriate therapy should suggest abscess formation, and prompt intervention is required. Any diagnosis of mastitis in a patient who is not lactating should be viewed with suspicion. Although several benign and non-life-threatening conditions have been discussed herein, inflammatory breast cancer must always be considered.     

The physician as a factor in outpatient medical care after laparoscopically assisted vaginal hysterectomy: a multivariate analysis

OBJECTIVE: To evaluate whether physician experience affects outpatient medical care utilization after laparoscopically assisted vaginal hysterectomy (LAVH). STUDY DESIGN: A total of 120 patients who underwent LAVH were included in the study; 84 underwent LAVH by 2 senior physicians, who had performed an average of 3 LAVHs per month for >6 years; 36 patients underwent LAVH by 3 junior physicians, who had performed an average of 1 case per month for < 3 years. Data were analyzed by the multiple linear regression model. The dependent variable was the number of outpatient visits within 3 months after discharge. The independent variables were patient age, parity, pelvic adhesions, chronic disease and physicians performing LAVH > 6 years. RESULTS: The patients in the 2 groups did not differ in age, parity, chronic disease or pelvic adhesions. The level of physician experience significantly influenced the mean number of outpatient visits after LAVH within 3 months. After controlling for patient characteristics, the mean number of outpatient visits after discharge within 3 months of LAVH performed by senior physicians with 6 years of experience was reduced (-1.98). CONCLUSION: LAVH performed by experienced physicians reduces the need for patients to seek postoperative outpatient medical care, thereby controlling medical costs incurred under the hospital global budget payment system. However, adding more variables to the multiple regression model, such as the socioeconomic status of patients, habits of seeking medical help, distance between home and hospital and relationship between patient and physician, may further explain the factors affecting outpatient medical care utilization.     

Epidural analgesia: breast-feeding success and related factors

Objective

to compare the early breast-feeding behaviours of full-term newborns whose mothers had received epidural analgesia (EDA) during an uncomplicated labour, with a group of newborns whose mothers had not received EDA.

Design and setting

a retrospective comparative study design was used and the study was carried out in a labour ward in Stockholm, Sweden between January 2000 and April 2000. The ward has about 5500 deliveries per year.

Participants

all maternity records of women who had received EDA during labour (n=585) were included in the study. For each EDA record, a control record was selected, matched for parity, age and gestational age at birth. Women with emergency caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation or an intra-uterine death, as well as neonates with an Apgar score <7 at 5 mins were excluded. After exclusion, the study population consisted of 351 healthy women and babies in each group.

Method

logistic regression was performed. The dependent variables: (1) initiation of breast feeding after birth; (2) artificial milk given during hospital stay; and (3) breast feeding at discharge were studied in response to: (a) parity; (b) gestational age at birth; (c) length of first and second stage of labour; (d) administration of oxytocin; (e) administration of EDA; and (f) neonatal weight, as independent variables.

Findings

significantly fewer babies of mothers with EDA during labour suckled the breast within the first 4 hours of life [odds ratio (OR) 3.79]. These babies were also more often given artificial milk during their hospital stay (OR 2.19) and fewer were fully breast fed at discharge (OR 1.79). Delayed initiation of breast feeding was also associated with a prolonged first (OR 2.81) and second stage (OR 2.49) and with the administration of oxytocin (OR 3.28). Fewer newborns of multiparae received artificial milk during their hospital stay (OR 0.58). It was also, but to a lesser extent, associated with oxytocin administration (OR 2.15). Full breast feeding at discharge was also positively associated with multiparity (OR 0.44) and birth weight between 3 and 4 kg (OR 0.42).

Key conclusions

the study shows that EDA is associated with impaired spontaneous breast feeding including breast feeding at discharge from the hospital. Further studies are needed on the effects of EDA on short- and long-term breast-feeding outcomes.     

What influences the uptake and early cessation of breast feeding?

OBJECTIVE: To examine obstetric, maternal and social factors associated with the uptake and early cessation of breast feeding and women's reasons for altering from breast to bottle feeding. DESIGN: Women who responded to a postal questionnaire on long-term postpartum health were contacted and asked to participate in a home-based interview. In addition to health problems, the interview obtained information on baby feeding and a number of social factors. Women were also asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and maternal data were obtained from maternity records. SETTING: Deliveries from a large maternity hospital in Birmingham. PARTICIPANTS: 906 women were interviewed at a mean of 45 weeks after delivery. FINDINGS: 63% of the women said they had breast fed, but 40% of these stopped within three months of delivery. Many of the women gave physical problems with lactation as reasons for stopping. The factors found to be predictors of early cessation were: return to work within three months of birth; regular childcare support from other female relatives, and a high EPDS score. Non-initiation of breast feeding was predicted by a different set of factors: multiparity; general anaesthetic (GA); and unmarried status. DISCUSSION AND CONCLUSION: Despite evidence of the benefits of breast feeding, this remains an unacceptable long-term option for many women, and for over one-third it is never attempted. Factors within the woman's social environment were found to influence early cessation. Women who had a GA during or immediately following labour and delivery were less likely to initiate breast feeding. IMPLICATIONS FOR PRACTICE: If breast-feeding incidence and duration are to increase, more attention should be paid to establishing early, successful breast feeding and countering the negative influences of factors within the social environment.     

Trans-perineal versus endo-anal ultrasound in the detection of anal sphincter tears

Reduction mammaplasty (RM) can be performed during adolescence if the functional capacity of the breast is preserved. Future breast feeding must be carefully considered in the therapeutic decision making process. PURPOSE OF THE STUDY: Breast feeding after reduction mammaplasty performed during adolescence was assessed to determine surgical factors influencing outcome and patient reception of information concerning breast feeding. METHODS: A questionnaire was sent to 109 women who had undergone reduction mammaplasty between 1981 and 1997 when they were 15-17 years old to ascertain their reasons for having surgery, their satisfaction, and their attitude towards breast feeding. RESULTS: Sixty-five questionnaires (60%) could be analyzed. Mean delay since surgery was 8.1 years. Seventeen women (26%) had delivered 25 infants (mean 1.5). Mean delay after surgery to first delivery was 7.68 years. Five women (29%) nursed their first infant for a mean 11.3 days. None of the women interrupted breast feeding for a reason related to a nipple anomaly or difficult sucking. Twelve women (71%) did not nurse their first infant, because of the prior breast surgery for six of them. Among the 48 nulliparous women, 24 (50%) stated they would nurse their future infant. Although information on breast feeding was systematically delivered, 41 women (63%) stated they had not been informed. There was no statistical relationship between breast feeding and degree of satisfaction, patient-assessed scar quality, or nipple disorders. CONCLUSION: Adolescents who undergo reduction mammaplasty can nurse their future infants with a complication rate similar to that in the general population. Special attention must be given to delivery of information on breast feeding.     

Postpartum concerns of breastfeeding mothers

Increased mobility of families and shorter hospital stays have added to the adjustment difficulties of new mothers, and lack of an adequate support system may cause the mother to end breast feeding. The purpose of this study was to identify the postpartum concerns of breast feeding mothers from time of discharge through the 1st postpartum month. The sample consisted of 32 women, aged 20-38, who had uncomplicated vaginal deliveries, were released from hospital by the 3rd day, and were breast feeding for the 1st time. They were telephoned daily during the 1st 2 weeks and twice a week for the 3rd and 4th week. 78% were primigravidas. 97% of the women reported a total of 210 concerns about the infant; 81% reported 237 concerns about themselves; and 19% reported 15 concerns about interactions with family or friends. Feeding-related concerns were most frequent in the 1st and 2nd weeks and included frequency of feeding (64%), formula and/or water supplementation, and duration of nursing time. Concerns about the infants' sleeping and crying behavior were also most frequent (76%) during the 1st 2 weeks. Sleeping concerns included the effects of long periods of wakefulness and sleeping during the day rather than at night. Crying or fussy behavior following feeding and during family dinner was reported by 53% of the mothers during the 1st week and 41% during the 2nd week. Concerns about the physical state of the infant included wellness and growth, temperature, cord care, bilirubin level, infection, and bowel movements. 81% of the mothers expressed concerns about themselves. Physical concerns included breast soreness, nipple pain and blisters, uterine bleeding and cramps, episiotomy pain, muscle pain, and hemorrhoids. 18 mothers reported emotional concerns, particularly fatigue. Only 6 mothers reported concern over interactions with family and friends, including lack of help from the father and pressure from visits by friends and relatives. The greatest number of concerns expressed in this study were related to the infant, whereas other studies have reported more maternal concerns. However, these women were all breast feeding, which may imply that they were more infant-oriented to begin with.     

Factors associated with low immunity to rubella infection on antenatal screening

BACKGROUND: Rubella infection during the first trimester results in congenital rubella syndrome. There has been little recent published evidence identifying those at-risk of infection in the first trimester of pregnancy. This study examined the level of rubella immunity in pregnant women in a part of Sydney and risk factors for non-immunity. METHODS: We looked at data on all confinements at two maternity hospitals in Sydney in the 2-year period between July 1999 and June 2001. Variables included in our data set included mother's country of birth, mother's date of birth, hospital status (public or private patient), parity, rubella status and postpartum rubella vaccination. RESULTS: Of the 8096 confinements, the mother was documented as being non-immune to rubella in 567 cases (7%) of cases. Of the 567 confinements where rubella status was documented as non-immune, Asian-born women comprised of 65% (366) of non-immune women while 13% (73) were Australian-born. Country of birth remained a strong predictor of immunity, even after controlling for age, parity and hospital status. Maternal age > 35 years and nulliparity were also significant risk factors for non-immunity. CONCLUSION: Programs targeting underimmunised populations for rubella vaccination should focus on overseas-born women, particularly those born in Asia, nulliparous women and also women > 35 years of age.     

Community-acquired methicillin-resistant Staphylococcus aureus among patients with puerperal mastitis requiring hospitalization

OBJECTIVE: To estimate the incidence of puerperal mastitis requiring hospital admission and to describe demographic and obstetric risk factors for this condition. We also sought to identify trends in bacteriology among isolates obtained from breast abscesses and breast-milk aspirates, with a focus on treatment strategies used for community-acquired methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Patients with puerperal mastitis who were admitted to a county-based teaching hospital between January 1997 and December 2005 were identified by International Classification of Diseases, 9th Revision, codes (675.1, 675.2). Data collected included demographic characteristics, clinical presentation, treatment, duration of admission, premorbid antibiotic exposure, and bacteriology. Demographic variables and obstetric outcomes were compared with all other pregnant women delivered at our hospital. RESULTS: One hundred twenty-seven of 136,459 women delivered at our teaching hospital were admitted for puerperal mastitis (9.3 [95% confidence interval (CI) 7.8-11.1] per 10,000 deliveries). The incidence of mastitis only during the study period was 6.7 (95% CI 5.4-8.3) per 10,000 deliveries, and the incidence of mastitis with breast abscess was 2.6 (95% CI 1.8-3.6) per 10,000 deliveries. Puerperal mastitis was significantly associated with younger women (23.4 years compared with 25.1 years, P<.001) and decreased parity (P=.02). Clinically significant breast abscess (n=35, 28%) was seen most commonly with community-acquired MRSA (n=18, 67%) during the data-collection period. The majority (15 [56%]) of women with culture-proven MRSA did not receive antibiotic therapy to which this organism was sensitive. They were discharged without complication, and there were no treatment failures. CONCLUSION: Community-acquired MRSA was most commonly associated with breast abscess. The empiric use of antibiotics ineffective against community-acquired MRSA did not adversely affect the outcomes in this study.     

Benign breast disease

Benign breast disease includes all nonmalignant conditions of the breast, including benign tumors, trauma, mastalgia, mastitis, and nipple discharge. Benign tumors include pathologic changes that do not increase a patient's risk for developing cancer, lesions that confer a slightly increase risk, and lesions that are associated with an up to 50% risk of developing breast cancer. Both benign and malignant breast disorders can present with a palpable mass; skin dimpling, thickening, or erythema; pain; nipple discharge and inversion or distortion; or an abnormal screening mammogram with no clinical findings. Tools available to investigate breast problems include clinical breast examination, mammogram, and ultrasound. This article discusses the gynecologist's role in maintaining breast health, the clinical evaluation of breast problems, and management of benign breast disease.     

Factors associated with newborn in-hospital weight loss: comparisons by feeding method, demographics, and birthing procedures.

Full-term newborn normative weight loss and factors influencing this were determined through chart audits (n = 812) at 6 hospitals in Manitoba, Canada. The effects of parity, gestational age, birth weight, sex, length of stay, type of delivery (cesarean vs vaginal), epidural use, and type of infant feeding (exclusively breastfed, partially breastfed, exclusively formula-fed) on percentage weight loss in hospital were analyzed using multiple regression analysis. In-hospital weight loss was 5.09% +/- 2.89% (95% CI, 4.89-5.29), varying by feeding category: exclusively breastfed 5.49% +/- 2.60% (95% CI, 5.23-5.74), partially breastfed 5.52% +/- 3.02% (95% CI, 5.16-5.88), and formula-fed 2.43% +/- 2.12% (95% CI, 2.02-2.85). Factors significantly increasing the percentage weight loss included higher birth weight, female sex, epidural use, and longer hospital stay. Lower percentage weight loss was associated with greater gestational age and exclusive formula feeding. Parity and type of delivery were not significant. Controlling for demographic and delivery-related variables, exclusive formula feeding had the largest impact, with 3.1% less weight loss than exclusive breastfeeding.     

Factors influencing the duration of exclusive breastfeeding in a group of Turkish women.

This study was conducted to evaluate the influence of demographic characteristics, hospital practices, maternal psychosocial factors, and knowledge about infant feeding and breast milk on duration of breastfeeding. The mothers of 91 healthy, term infants delivered at a university hospital between June 1998 and December 1998, and first seen in the well-child unit within 10 days of delivery, participated in the study. Forty-nine (54%) infants were exclusively breastfed at 4 months of age. Cox regression analysis showed a negative association between formula supplementation during the hospital stay and duration of exclusive breastfeeding. The median age for starting non-breast milk liquids was 1 month for those who received formula in the hospital and 3 months for those who did not (P = .001). The hospital practices were more predictive of the duration of exclusive breastfeeding in this study group than mothers' knowledge of infant feeding or psychosocial factors. Thus, hospital practices should be reevaluated.     

Mammary ductoscopy for the evaluation of nipple discharge and comparison with standard diagnostic techniques

STUDY OBJECTIVE: To describe performance of breast duct endoscopy and compare the method with conventional diagnostic techniques. DESIGN: Canadian Task Force classification III. SETTING: Interdisciplinary Breast Unit of a university hospital. PATIENTS: Consecutive and unselected series of 15 female patients including 20 breasts with nipple discharge. INTERVENTIONS: Prospective data assessment on all patients with ductoscopy for nipple discharge between April 2003 to April 2004. All preoperative (mammography, ultrasonography, nipple smear) and minimally invasive (galactography, fine needle aspiration cytologic study) diagnostics were evaluated and compared with ductoscopy. MEASUREMENTS AND MAIN RESULTS: Mammography on 20 breasts showed BI-RADS-I (5%), BI-RADS-II (50%), and BI-RADS-III (45%). Breast ultrasound scanning showed abnormalities, classified as BI-RADS-III equivalent lesions in all cases. Nipple smear showed in 69.2% a normal cytology and in most cases revealed a papilloma later (n=8/9). Unilateral galactography was performed in 46.7% who had spontaneous nipple discharge. Two galactography results were unremarkable, and open biopsy demonstrated 1 atypical ductal hyperplasia and papilloma. On 20 breasts of 15 women, 19 ductoscopies were successfully performed (95%). In 17 cases open biopsy followed ductoscopy, and 1 ductal carcinoma in situ (DCIS), 3 atypical ductal hyperplasia (ADH), 1 ductal hyperplasia without atypias, and 12 ductal papillomas were found. CONCLUSION: Compared to nipple smear, the diagnostic value of ductoscopy in this study is superior but marginally inferior to galactography and highly specialized breast ultrasound scanning. Therefore ductoscopy needs to be evaluated on a larger scale, preferably in multicenter trials to further determine its potential and indications.     

Incorrect advice: the most significant negative determinant on breast feeding in Malta

Objective

this study reviewed breast-feeding rates in Malta for the first six months of life and identified reasons why mothers discontinue breast feeding in this small island state.

Design and participants

a random sample of 405 new mothers who chose to breast feed in the only major state hospital were contacted by phone one week postnatally and again each month up to six months, and presented with a questionnaire relating to their feeding experience.

Findings

breast-feeding attrition rates were high with just 152 (38%) of 403 analysable babies still breast feeding at six months. The reasons for stopping breast feeding were categorised by: maternal choice; medical reasons; lack of information; social reasons, incorrect advice and no reason provided. 200 (50%) of the total cohort stopped breast feeding following incorrect advice from health professionals. Just 14 (3.5%) and 17 (4.2%) mothers stopped as a result of their own choice or a medical problem, respectively. Of the total of 403, 77 (19%) mothers introduced supplementary bottle feeds in hospital; of these, 70 (91%) stopped breast feeding altogether soon afterwards. This compared with just 180 (55%) of 326 women who did not introduce bottle feeds in hospital yet subsequently discontinued breast feeding (p<0.001).

Key conclusions

many health professionals in Malta are not sufficiently committed to supporting breast-feeding mothers, and artificial feeds are widely recommended without any scientific-based rationale. Incorrect advice on breast feeding is often given early prior to discharge from hospital. As a result, many Maltese mothers introduce supplementary artificial milk feeds in hospital, and this is significantly associated with subsequent cessation of breast feeding within six months of discharge.

Implications for practice

the introduction of a clear hospital breast-feeding policy and appropriate education for all health professionals involved in maternity care is strongly recommended.     

Changes in uterine size after vaginal delivery and cesarean section determined by vaginal sonography in the puerperium

There have been few reports on postpartum changes in the uterus during the three months after delivery. The aim of this study was to evaluate uterine morphological changes in women after vaginal delivery (n=262–351) and in women after cesarean section (n=64–82) and to evaluate the relation between breast-feeding and parity, and uterine involution at 1 and 3 months postpartum measured by vaginal ultrasonography. There were no significant differences in parity between the vaginal delivery group and the cesarean section group. The length of the uterus at one month (7.93±1.16 cm, mean±SD) and, three months (7.03± 1.19 cm) and the width of the uterus at three months (3.83±0.94 cm) after delivery in the cesarean section group were greater than in the transvaginal group (7.64±1.03 cm, 6.65±0.99 cm, 3.57±0.62 cm, respectively). Increasing maternal parity was associated slightly with larger uterine size at one month post partum. The length of the uterus of women with a breast-feeding rate of 80% or more per day was 6.35±0.85 cm, and shorter than in women with a rate of 20% or less 7.03±1.04 cm, at three months after delivery. The width of the uterine body of women with a breast-feeding rate of 80% or more per day was 3.32±0.45 cm, and shorter than in women with a rate of 20% or less 3.87±0.66 cm, at 3 months after delivery. Stepwise regression and multiple regression analysis among parity, the history of cesarean section, the breast-feeding rate at one and three months after the delivery, and the restoration of the menses at three months after the delivery showed that the uterine size at one month after the delivery was related to the cesarean section and that the uterine size at three months after delivery was mostly related to the rate of breast-feeding. These results indicated that uterine involution was related to delivery mode at one and three months postpartum, feeding mode at three months postpartum, the menses restoration, and parity. The rate of breast-feeding was mostly related to the uterine size at three months postpartum. Received: April 1998 / Accepted: 26 March 1999     

Predictive factors of early cessation of breastfeeding. A prospective study in a university hospital

OBJECTIVE: To emphasize the factors involved in early cessation of breastfeeding among patients who have given birth in a high-tech maternity hospital, both during the stay on the maternity ward and before their infants reach the age of 4 months. STUDY DESIGN: Prospective study involving all patients who gave birth during the first 2 months of 2002 in the maternity department of Tours University Hospital, France. Exclusion criteria were preterm delivery before 35 weeks of pregnancy, twin birth and any condition in the newborns that required intensive or long-term hospitalization. The methodology suggested by the World Health Organization in the report "Indicators for Assessing Breastfeeding Practices" was strictly followed, and the breastfeeding status was assessed on the day of discharge from hospital and then in personal telephone conversations with each patient held 1, 2, 3, and 4 months after the date of delivery. The data were analyzed with the Chi-square test or Fisher's Exact Test for the dichotomous variables, and the populations were compared for the continuous variables with the Student test. RESULTS: We studied 115 breastfeeding patients (=57% of the patients who gave birth in the study period). At the time of discharge from hospital, 95% of the 115 were still breastfeeding; the corresponding proportions 1, 2, 3, and 4 months after the birth were 78, 66, 44, and 17%. For patients who were breastfeeding exclusively, the corresponding proportions were: 95, 69, 47, 17, and 6% at discharge from hospital and 1, 2, 3, and 4 months after the birth. We found differences between multiparous and primiparous women only in the timing of the first breastfeeding session and the use of formula supplement while on the maternity ward. There were no differences between the group whose babies were born by cesarean section and those who had vaginal deliveries. The only factor found to be linked with early cessation of breastfeeding during the hospital stay was the lack of previous experience in a multipara who decided to breastfeed for the first time (OR=35.33; 95% CI=2.4531 < OR < 508.925). CONCLUSION: Among the women discharged from the maternity ward with a healthy baby, for a multipara the lack of any previous experience of breastfeeding with earlier babies is the greatest risk factor in early definitive cessation of breastfeeding. Targeting such women would make it possible to provide more support for them when they start breastfeeding and thus hopefully to avoid early cessation.