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

Abstract

BackgroundPostpartum 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.MethodsThis 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).ResultsAmong 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.ConclusionsFollowing 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.

Information-hungry and disempowered: A qualitative study of women and their partners' experiences of severe postpartum haemorrhage

“…birthtraumaassociation.org.uk/birth_stories.htm#pph and The Third Stage of Labour Website; www.thirdstageoflabour.org/ womenexperiences.html, www.thirdstageoflabour.org/mans_ex perience.html) and two qualitative studies offer some insights. One study considers effects of PPH on breast feeding, but does not specifically explore experiences of PPH (Thompson et al, 2010). The most relevant research involves women who underwent hysterectomy following PPH, and describes dramatic and stressful circumstances, as well as women's concern for their partners during the crisis (Elmir et al, 2011).…”

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

“…39 Medically complicated pregnancies can also impact negatively on breastfeeding rates. 35,40 Women may be discharged from hospital having had major surgery and emergency treatment or time in intensive care, and follow-up is variable. Some may have lost their baby as a result of their illness.…”

“…[34][35][36][37][38] In addition to their physical recovery, women can experience anxiety, isolation and flashbacks in the aftermath. Birth trauma can have lasting consequences that impact negatively on maternal, infant and family well-being.…”

Traditional Unani perspective of perceived insufficient milk (Qillatul Laban) and Galactogogues: A literary research with recent studies

“…In addition, elevated cortisol levels following such a stressful labour and delivery may also adversely affect lactogenesis Stage II. Delayed early contact between mother and baby following a complicated birth with PPH may also impact on a mother's ability to successfully establish and maintain breast feeding (Thompson et al, 2010) Clinicians also need to consider the possibility of retained placental fragments that can be responsible for maintaining maternal progesterone levels sufficient to delay or inhibit secretory activation (lactogenesis II) (Kent et al, 2012). Moreover, it is an established fact that poor nutrition of the mother can lead to poor growth and development of the foetus, and to an insufficient quantity of milk (Parr, 1983).…”