Comments on Evaluation of Two Midwife-Supported Breastfeeding Positions after Cesarean Section: A Pilot Randomized Controlled Study

Dear Editor:

We read with great interest the study by Oguz and Bolsoy comparing two midwife-supported breastfeeding positions during the first breastfeeding session after a cesarean section. ¹ This study provides important clinical insights into breastfeeding support during a period of significant maternal physical burden.

We offer several considerations that may deepen the interpretation of our findings.

First, although both groups received midwife support, the nature of the support differed between interventions. In the modified football hold group, the midwife actively stabilized the infant’s head and trunk and guided latching, whereas that in the cradle hold group was more supplementary and mother-led. Therefore, it may be valuable to distinguish the effect of breastfeeding position itself from the effect of the intensity of hands-on midwifery support. This distinction would clarify whether improved IBFAT scores and maternal satisfaction are primarily associated with positioning or the degree of professional physical assistance provided during feeding.

Second, breastfeeding is a dynamic process that evolves over time. Since outcomes were evaluated immediately after the first breastfeeding session, additional longitudinal outcomes, such as breastfeeding exclusivity or continuation at discharge or 1 month postpartum, may clarify the clinical significance of the intervention.

Third, although maternal comfort and satisfaction are important outcomes following a cesarean section, infant positioning and safety may warrant consideration. In the modified football hold, the infant was positioned longitudinally along the mother’s body, while the midwife actively supported the infant’s head and trunk. This positioning requires advanced midwifery skills to continuously assess the airway alignment, postural stability, and infant responsiveness during feeding. Newborns undergo physiological adaptation during the immediate postnatal period, and feeding posture may influence vomiting, respiratory stability, and feeding comfort. Additionally, infant comfort and physiological stability during feeding may affect sucking behavior and breastfeeding effectiveness. Therefore, future studies examining breastfeeding position and observational and safety-related components of midwifery support may provide a more comprehensive understanding of the clinical applicability of this intervention. ²

Finally, this study highlights an important perspective on breastfeeding support after cesarean delivery. Mothers recovering from a cesarean section often experience incisional pain and limited mobility, making independent positioning difficult. ³ The findings suggest that effective breastfeeding support involves selecting an appropriate position and providing skilled hands-on assistance that compensates for maternal physical limitations.

This study offers a valuable contribution to postcesarean breastfeeding care, and we look forward to further research in this field.

Authors’ Contributions

Y.S. conceived the idea and drafted the article. Y.K. and A.I. contributed to the interpretation and critically revised the article. All authors approved the final version.

Ethical Statement

This article does not contain any studies with human participants or animals performed by the author. Ethical approval was not required.