Postpartum Hemorrhage and the Likelihood of Exclusive Breastfeeding Through 6 Months Postpartum: A Case-Control Study.
Stefanie L Boyles, Sarah R Weinstein, Aleeca F Bell and 1 others
PMID 40579779WHAT IT FOUND
People who had postpartum hemorrhage were less likely to exclusively breastfeed at 4 and 6 months and stopped about 5 weeks earlier.
The study shows an association, not that hemorrhage caused lower breastfeeding.
Key findings
01Exclusive breastfeeding was less common after PPH at 6 to 10 weeks (64.1% vs 82.5%), at 4 months (55% vs 77.5%), and at 6 months (49.1% vs 70.3%).
02Mean exclusive breastfeeding duration was 14.4 weeks after PPH and 19.5 weeks after typical bleeding, a mean of 5 weeks earlier.
03At 6 to 10 weeks, insufficient milk production was reported by 37.3% of PPH participants and 13.9% of controls.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a secondary analysis of a case-control study that was not originally powered to detect differences in exclusive breastfeeding. Post hoc power for the 4-month comparison was 64%, so the study may have missed smaller differences. The sample was selected for PPH from uterine atony after vaginal birth, and people with coagulation disorders, severe pregnancy complications, magnesium sulfate or tocolysis, and certain placental or genital tract abnormalities were excluded, so results may not apply to all births or all causes of PPH. Ten participants who did not plan to breastfeed were excluded, which limits generalizability to all postpartum people. Exclusive breastfeeding was based on participant report, and any formula use at any time was classified as nonexclusive, which may miss timing or cultural nuances. Ferritin was measured in 85 participants, and the ferritin association appeared only after excluding participants who had received iron supplements or blood transfusions. The study is observational, so it shows an association, not that PPH caused lower breastfeeding.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that postpartum hemorrhage causes lower exclusive breastfeeding or that ferritin or iron treatment will fix it. This was an observational case-control study, and the ferritin difference appeared only after excluding participants who had received iron supplements or blood transfusions.