ABSTRACT
OBJECTIVE: To determine the demographic, behavioral, and clinical factors associated with breastfeeding termination in the first 12 weeks postpartum. STUDY DESIGN: This was a prospective cohort study. POPULATION: Breastfeeding women in Michigan and Nebraska were interviewed by telephone at 3, 6, 9, and 12 weeks postpartum or until breastfeeding termination. OUTCOMES MEASURED: We measured associations of demographic, clinical, and breastfeeding variables with weaning during the first 12 weeks postpartum. RESULTS: A total of 946 women participated; 75% breastfed until 12 weeks. Women older than 30 years and women with at least a bachelor's degree were more likely to continue breastfeeding in any given week. Mastitis, breast or nipple pain, bottle use, and milk expression in the first 3 weeks were all associated with termination. Beyond 3 weeks, women who expressed breast milk were 75% less likely to discontinue breastfeeding than women who did not. Women who used a bottle for some feedings during weeks 4 to 12 were 98% less likely to discontinue breastfeeding than women who did not use a bottle. "Not enough milk" was the most common reason given for termination in weeks 1 through 3 (37%) and weeks 4 through 6 (35%); "return to work" was the most common reason given in weeks 7 through 9 (53%) and weeks 10 through 12 (58%). CONCLUSIONS: Younger women and less educated women need additional support in their breastfeeding efforts. Counseling and assistance should be provided to women with pain and mastitis. Exclusive breastfeeding for the first 3 weeks should be recommended. After the first 3 weeks, bottles and manual expression are not associated with weaning and may improve the likelihood of continuing breastfeeding, at least until 12 weeks.
