Relationships between work and breastfeeding in women employed in the Paris region

Abstract Background Socioeconomic and cultural factors like maternal age, education level or country of origin are well known to influence breastfeeding practices. For employed mothers, returning to work (RTW) represents a key moment often cited as a reason for breastfeeding cessation. Even though French regulations allow for breastfeeding to continue after maternity leave, through workplace provisions, the impact of work-related factors on infant-feeding practices is not well circumscribed. The aim of this exploratory study was to determine which maternal employment characteristics are associated with breastfeeding initiation, cessation, or continuation after RTW, and what factors influence its total duration. Methods Questionnaires distributed through the occupational health centers of the Paris area were used to collect data at two time-points: at the occupational health reinstatement visit when RTW after childbirth, and at 3 months after RTW. Multiple logistic regressions were used to assess binary outcomes, and survival analyses were used to study breastfeeding duration. Results For breastfeeding initiation, a positive association was observed with early or late shift-work during pregnancy (OR 1.72, [1.04, 2.91]), whereas a negative association was observed with seniority in the current job (OR 0.94, [0.90, 0.97]). Split-shift work - shorter shifts intersected by a break ≥ 2 h - was associated with continued breastfeeding after RTW (OR 3.18, [1.47, 6.98]). Night work was associated with a shorter total breastfeeding duration after RTW (HR 3.12, [1.33, 7.29]), whereas working from home was associated with a longer duration (HR 0.63, [0.41, 0.99]). Breastfeeding cessation because of work and a shorter total breastfeeding duration were significantly linked to not having the possibility to express milk in the workplace (risk ratios about 2). Conclusion Among women RTW after post-natal leave, non-standard schedules seem to have contrasting effects on breastfeeding practices. Although early or late shifts appear to favour breastfeeding initiation, night work seems to limit breastfeeding duration. In contrast, split-shifts could favour continued breastfeeding after RTW. To sustain breastfeeding, it must be possible to express milk in the workplace. The option to work from home could be addressed in future studies as it seems to favour breastfeeding for a longer duration.