Exclusive Breastfeeding Rates at Hospital Discharge Across the Robson Ten-Group Classification System: A Retrospective Study

Academic Editor: Alice Monzani Received: 25 September 2025 Revised: 19 November 2025 Accepted: 25 November 2025 Published: 26 November 2025 Citation: Vila-Candel, R.; Martin-Arribas, A.; Mateu-Mollá, J.; Leon-Larios, F.; Mena-Tudela, D. Exclusive Breastfeeding Rates at Hospital Discharge Across the Robson Ten-Group Classification System: A Retrospective Study. Nutrients 2025, 17, 3708. https://doi.org/10.3390/ nu17233708 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/). Article Exclusive Breastfeeding Rates at Hospital Discharge Across the Robson Ten-Group Classification System: A Retrospective Study Rafael Vila-Candel 1,2 , Anna Martin-Arribas 3,* , Joaquín Mateu-Mollá 2, Fatima Leon-Larios 4 and Desirée Mena-Tudela 5 1La Ribera Health Department, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain; [email protected] or [email protected] 2Faculty of Health Sciences, Valencian International University (VIU), Pintor Sorolla 2, 46002 Valencia, Spain; [email protected] 3School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain 4Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Avenzoar, 6, 41009 Seville, Spain; [email protected] 5Nursing Department, Faculty of Health Sciences, Feminist Institute, Universitat Jaume I, Avda. Sos I Baynat s/n, 12071 Castellón, Spain; [email protected] *Correspondence: [email protected]; Tel.: +34-659708303 Abstract (1) Background: While the Robson Ten-Group Classification System (RTGCS) is widely used to assess and monitor caesarean section rates, its association with exclusive breastfeeding (EBF) outcomes at hospital discharge remains insufficiently explored. This study aimed to examine differences in EBF rates at hospital discharge across RTGCS groups among births attended at Hospital Universitario de la Ribera (Spain). (2) Methods: This retrospective observational study was conducted at a public hospital between 1 January 2010 and 31 December 2023. EBF at hospital discharge was analysed across Robson groups. Sociodemographic, obstetric, and neonatal variables were collected. A binomial logistic regression model was developed to identify predictors of EBF at discharge. Model fit was assessed using the Hosmer–Lemeshow goodness-of-fit test and Nagelkerke’s R 2 . (3) Results: The study analysed 23,081 births classified using the RTGCS, and 23,037 were included in the breastfeeding analysis. The overall EBF rate at discharge was 74.10%, with significant variation across Robson groups. Group 1 showed the highest EBF rate (78.339%) whereas Group 8 had the lowest (56.485%). Key factors positively associated with EBF included non-Spanish origin, nulliparity, cephalic presentation, singleton pregnancy, and term gestation. (4) Conclusions: Conclusions: Group 1 demonstrated the highest EBF rates, whereas Groups 8, 5, and 7 exhibited the lowest. These findings are essential for informing the development of targeted support strategies to improve breastfeeding outcomes in high-risk populations. Keywords: caesarean section; robson classification; perinatal outcomes; exclusive breastfeeding; cross-sectional study 1. Introduction Exclusive breastfeeding (EBF) is widely recognised as the optimal source of nutrition for newborns. Nevertheless, global EBF rates remain below the World Health Organization’s (WHO) 2025 target of 50% [ 1 ]. In Spain, only 39% of infants are exclusively breastfed at six months, according to national reports from the National Institute of Statistics [ 2 ]. Nutrients 2025,17, 3708 https://doi.org/10.3390/nu17233708 Nutrients 2025,17, 3708 2 of 16 Regional studies reveal considerable variability, with rates ranging from 81.5% at hospital discharge to 42.5% at six months [ 3 ]. These figures underscore the persistent challenges in maintaining breastfeeding beyond the immediate postpartum period. Caesarean birth is one of the key factors that may hinder both the initiation and continuation of breastfeeding [ 4 , 5 ]. Although emergency caesarean sections are particularly associated with greater initial challenges in establishing breastfeeding, the broader influence of different obstetric conditions remains inconclusive [ 3 , 5 ]. Addressing these variations requires a more comprehensive framework capable of integrating multiple obstetric factors simultaneously—such as the Robson Ten-Group Classification System (RTGCS). The RTGCS, developed in 2001, is an internationally recognised tool used to monitor and compare caesarean delivery rates across different settings [ 6 , 7 ]. The system classifies all women giving birth according to core obstetric characteristics, including parity, previous caesarean section, onset of labour, fetal presentation, and gestational age [ 6 ]. Given that the Robson groups are defined by variables known to influence breastfeeding initiation, it is plausible that this classification system may also help identify patterns in EBF outcomes [8–12]. However, no published studies have directly examined EBF rates at hospital discharge across the ten Robson groups. To address this gap, the primary aim of the present study was to determine whether EBF rates at hospital discharge differ across Robson groups, using data from 23,081 births attended at Hospital Universitario de la Ribera (HULR) between 2010 and 2023. The secondary objectives were to identify relevant sociodemographic and obstetric characteristics associated with EBF and to assess the independent impact of key predictors on breastfeeding outcomes using regression models. 2. Materials and Methods 2.1. Study Design, Population, and Sample This study employed a retrospective observational design based on medical records, analysing all births (including both live births and stillbirths) that occurred at HULR between 1 January 2010 and 31 December 2023. HULR is a public hospital located in the eastern region of Spain, serving a population of approximately 250,000 inhabitants and attending an average of 1300 births annually. It is the only hospital in Spain with data publicly available on the RTGCS WHO platform. Data were collected by reviewing the electronic medical records of all births during the study period; therefore, the study population and sample were effectively identical. Any missing data related to variables required for RTGCS classification were recovered through manual review of clinical records. Importantly, there were no missing data for the breastfeeding variable. 2.2. Analysis Criteria and Exclusions • General analysis (RTGCS): Both live births and stillbirths were included. This approach is consistent with World Health Organization (WHO) recommendations, which endorse the use of the RTGCS for analysing all births—regardless of neonatal outcome—to ensure a standardised and comprehensive evaluation of obstetric care. •Analysis of Breastfeeding Rates: Inclusion: The analytic subset was restricted exclusively to mother-live newborn dyads. Exclusion: Stillbirths were explicitly excluded from this analytic subset to ensure that the evaluation focused on neonatal outcomes compatible with breastfeeding. Nutrients 2025,17, 3708 3 of 16 2.3. Data Collection The RTGCS was used to classify caesarean sections within the study population. An overview of the criteria defining each group is presented below: - Group 1: Nulliparous, singleton cephalic, ≥37 weeks, spontaneous labour. - Group 2a: Nulliparous, singleton cephalic, ≥37 weeks, induced labour. - Group 2b: Nulliparous, singleton cephalic, ≥ 37 weeks, caesarean delivery before labour. - Group 3: Multiparous, singleton cephalic, ≥37 weeks, spontaneous labour. - Group 4a: Multiparous, singleton cephalic, ≥37 weeks, induced labour. - Group 4b: Multiparous, singleton cephalic, ≥ 37 weeks, caesarean delivery before labour. - Group 5: Previous caesarean delivery, singleton cephalic, ≥ 37 weeks, spontaneous or induced labour, or caesarean delivery before labour (VBAC). - Group 6: Nulliparous singleton breech, spontaneous or induced labour, or caesarean delivery before labour. - Group 7: Multiparous singleton breech (including previous caesarean delivery), spontaneous or induced labour, or caesarean delivery before labour. - -Group 8: Multiple pregnancies, spontaneous or induced labour, or caesarean delivery before labour. - Group 9: Abnormal singleton lies (excluding breech but including prior caesarean delivery), spontaneous or induced labour, or caesarean delivery before labour. - Group 10: Singleton cephalic, ≤ 36 weeks (including previous caesarean delivery), spontaneous or induced labour, or caesarean delivery before labour. An anonymised dataset of all births occurring within the study period was extracted from the hospital’s electronic medical records by the systems department. The dataset included all variables required for classification according to the RTGCS and was subsequently analysed by the research team. Classification was based on five key variables: parity and history of previous caesarean delivery; onset of labour (spontaneous, induced, or pre-labour caesarean); fetal presentation (cephalic, breech, or transverse); number of fetuses; and gestational age (preterm or full term). The absolute contribution of a Robson group refers to the percentage of caesarean sections in that group relative to the total number of births (both vaginal and caesarean). This metric provides a population-level perspective, helping to identify the groups that most strongly influence the overall caesarean section rate. In contrast, the relative contribution represents the percentage of caesarean sections in a specific group relative to the total number of caesarean sections performed. This measure reflects each group’s proportional weight within the overall caesarean distribution and is essential for prioritising intervention areas with the greatest potential to reduce the overall rate. Both metrics are complementary and together support the optimisation of obstetric practice. Additional variables collected included: Sociodemographic characteristics: maternal age (in completed years) and country of origin (Spain vs. non-Spanish origin). Obstetric and perinatal characteristics: neonatal sex (male/female); birth weight (grams); parity; umbilical cord arterial pH; Apgar scores at 1 and 5 min; fetal death (yes/no); admission to the Neonatal Intensive Care Unit (NICU) (yes/no); moderate prematurity (<32 weeks) (yes/no); and mode of birth (vaginal or caesarean). Early initiation of breastfeeding (EIBF) was categorised according to the time elapsed from birth to the first breast contact, distinguishing three key intervals: ≤30 min, 31–60 min, and ≥61–120 min. Exclusive breastfeeding (EBF) was categorised as exclusive breastfeeding (Yes) versus mixed feeding or formula feeding (No). The average length of hospital stay in our centre is Nutrients 2025,17, 3708 4 of 16 48 h for vaginal births and 72 h for caesarean births. This variable was considered relevant, as it may influence EBF outcomes at discharge. Maternity nurses routinely recorded the type of feeding in the electronic medical record at the time of discharge, ensuring a standardised and reliable measure across all cases. 2.4. Statistical Analysis A descriptive statistical analysis was conducted to examine the sociodemographic, obstetric, and neonatal characteristics of the study sample. Continuous variables were presented as means and standard deviations (SD), and categorical variables as frequencies and percentages. To assess univariate associations, the chi-square ( χ2 ) test was used. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to evaluate the association between Robson groups and EBF at discharge. For the main EBF analysis, Robson subgroups 2a/2b and 4a/4b were combined into Group 2 and Group 4, respectively. The strength of association between categorical variables was measured using Pearson’s Phi (for 2×2 tables ) or Cramer’s V (for larger contingency tables). Binomial logistic regression analysis was then performed to assess the association between predictor variables and EBF at discharge. Model fit was evaluated using the Hosmer–Lemeshow goodness-of-fit test, and Nagelkerke’s R 2 was calculated to estimate the proportion of variance explained. For all analyses, a p-value < 0.05 was considered statistically significant. Statistical analyses were performed using SPSS, version 28. 3. Results 3.1. Descriptive Analysis The sample consisted of 23,081 records classified according to the RTGCS. Sociodemographic, obstetric, and neonatal characteristics are presented in Table 1. The overall EBF rate at discharge was 74.10%. Rates were 74.62% among vaginal births, 72.74% following emergency caesarean sections, and 69.28% after elective pre-labour caesarean sections, with statistically significant differences observed between these groups. Table 1. Sociodemographic, obstetric, and neonatal characteristics of the study sample (N = 23,081). n% Maternal country of origin Spain 18,019 78.069% Other than Spain 5062 21.931% Neonatal sex Male 11,819 51.207% Female 11,262 48.793% Parity 0 12,731 55.158% >1 10,350 44.842% Number of foetuses Singleton 22,842 98.965% Multiple 239 1.035% Previous caesarean section No 22,476 97.379% Yes 605 2.621% Onset of labour Spontaneous 14,260 61.782% Induced 7602 32.936% Elective caesarean 1048 4.541% Emergency caesarean 171 0.741% Nutrients 2025,17, 3708 5 of 16 Table 1. Cont. n% Mode of birth Vaginal 18,629 80.711% Caesarean 4452 19.289% Robson group 1 6851 29.682% 2 4555 19.735% 3 6437 27.889% 4 2839 12.300% 5 350 1.516% 6 523 2.266% 7 220 0.953% 8 239 1.035% 9 64 0.277% 10 1003 4.346% EBF at discharge Yes 17,102 74.096% No 5979 25.904% EIBF 30 min 1649 50.061% 60 min 1384 42.016% 120 min 261 7.923% Stillbirth No 23,037 99.809% Yes 44 0.191% Moderate prematurity <32w No 23,035 99.801% Yes 46 0.199% Admission to NICU No 20,484 88.748% Yes 2597 11.252% N Minimum Maximum Mean Std. Deviation Maternal age 23,081 13 51 30.872 5.803 Umbilical cord arterial pH 21,264 0.000 7.450 7.240 0.339 Birth weight 21,884 250 5730 3.292.145 476.289 Gestational age at birth 23,081 24 43 39.191 1.558 EBF: Exclusive breastfeeding; EIBF: Early initiation of breastfeeding; NICU: Neonatal Intensive Care Unit. 3.2. Bivariate Analysis of EBF and Perinatal Variables Table 2presents the distribution of EBF at discharge across the different RTGCS groups. The results indicate significant differences in the likelihood of EBF at discharge among the groups. Group 1 showed the highest probability of EBF, whereas Groups 8, 5, and 7 exhibited the lowest rates. EBF prevalence at discharge ranged from 56.49% in Group 8 to 78.34% in Group 1. Corresponding odds ratios (ORs) ranged from 0.359 (Group 8) to 0.973 (Group 2), with Group 2 being the closest to the reference category (Group 1). To assess the temporal stability of EBF patterns, a comparative analysis was conducted using the observed frequencies for the Robson subgroups and for the total sample across two time periods: 2010–2016 and 2017–2023. An overall increase in EBF was observed in 2017–2023 compared with 2010–2016 (p= 0.017). When examining the individual Robson groups, increases in EBF were noted for Groups 1 and 2 (p< 0.001 for both), whereas decreases were observed in Groups 3 (p= 0.014) and 7 (p= 0.023). The remaining groups remained stable over time (p> 0.050) (Table 3). Subgroups 2a and 2b were combined into Group 2, as no significant differences in EBF rates were detected between them (77.875% vs. 75.909%; p= 0.498). Similarly, subgroups 4a and 4b were merged into Group 4 due to the absence of significant differences in EBF (71.189% vs. 68.421%; p= 0.708). Nutrients 2025,17, 3708 6 of 16 Table 2. Distribution of EBF at discharge by RTGCS in the study sample (N = 23,037). Robson Group nCs-Rate (%) χ2OR (CI95%) EBF at Discharge (%) χ2OR (CI95%) p-Value p-Value p-Value p-Value 1 6845 11.852% 5497.205 < 0.001 NA 78.339% 221.958 < 0.001 NA 24549 31.109% 3.358 77.863% 0.973 (3.050–3.698) (0.888–1.065) <0.001 0.465 3 6434 5.406% 0.425 71.064% 0.679 (0.373–0.484) (0.628–0.735) <0.001 <0.001 42834 15.604% 1.375 71.353% 0.689 (1.213–1.558) (0.623–0.761) <0.001 <0.001 5 349 66.571% 14.811 64.000% 0.492 (11.722–18.713) (0.392–0.616) <0.001 <0.001 6 520 98.088% 381.528 72.658% 0.735 (203.182– 716.418) (0.601–0.898) <0.001 0.003 7219 96.818% 226.303 64.384% 0.5 (106.213– 482.173) (0.377–0.663) <0.001 <0.001 8 238 62.762% 12.535 56.485% 0.359 (9.547–16.457) (0.276–0.466) <0.001 <0.001 9 63 100.000% 0 71.875% 0.707 0 (0.409–1.222) 0.0966 0.214 10 986 25.823% 2.589 69.057% 0.617 (2.208–3.036) (0.533–0.715) <0.001 <0.001 NA: Not applicable; CS: caesarean section; χ2 : Chi-squared test; OR: odds ratio; CI95%: Confidence Interval 95%, EBF: Exclusive breastfeeding. Stillbirths were excluded in the analysis of EBF at discharge. Note: Group 2 includes subgroups 2a and 2b; Group 4 includes subgroups 4a and 4b, according to the methodology for the exclusive breastfeeding (EBF) analysis. Table 3. Comparison of EBF between the time periods 2010–2016 and 2017–2023 for each Robson group (N = 23,037). Robson Group EBF at Discharge (%) OR (CI95%) χ2 (p-Value) 2010–2016 2017–2023 N = 13,470 N = 9567 Group 1 Observed 76.755% 80.545% 1.254 (1.114–1.411) 14.104 (<0.001) Expected 78.339% Group 2 Observed 75.889% 80.337% 1.298 (1.126–1.497) 12.886 (<0.001) Expected 77.863% Nutrients 2025,17, 3708 7 of 16 Table 3. Cont. Robson Group EBF at Discharge (%) OR (CI95%) χ2 (p-Value) Group 3 Observed 72.218% 69.381% 0.872 (0.782–0.972) 6.077 (0.014) Expected 71.064% Group 4 Observed 71.666% 70.849% 0.961 (0.813–1.136) 0.218 (0.640) Expected 71.353% Group 5 Observed 64.646% 63.158% 0.938 (0.604–1.456) 0.083 (0.774) Expected 64.000% Group 6 Observed 72.535% 72.803% 1.014 (0.689–1.491) 0.005 (0.945) Expected 72.658% Group 7 Observed 70.073% 54.878% 0.519 (0.294–0.917) 5.165 (0.023) Expected 64.384% Group 8 Observed 53.571% 60.606% 1.333 (0.791–2.248) 1.168 (0.280) Expected 56.485% Group 9 Observed 72.093% 71.429% 0.968 (0.304–3.080) 0.003 (0.956) Expected 71.875% Group 10 Observed 67.637% 71.173% 1.181 (0.894–1.561) 1.373 (0.241) Expected 69.057% Total Observed 73.660% 75.050% 1.076 (1.013–1.142) 5.648 (0.017) Expected 74.237% χ2 : Chi-squared test; OR: odds ratio; CI95%: Confidence Interval 95%; EBF: Exclusive breastfeeding. Stillbirths were excluded in the analysis of EBF at discharge. Additionally, we analysed the overall impact of the variables included in the RTGCS on EBF outcomes at hospital discharge, as well as other perinatal factors known to influence breastfeeding prevalence. Forty-four stillbirths were excluded from the analysis of breastfeeding rates, resulting in a final sample of 23,037 live births (Supplementary Materials Table S1). As shown in Table 4, variables such as mode of delivery, fetal presentation, and gestational age at birth were significantly associated with EBF prevalence, which reached 74.24% in the total sample. However, the strength of these associations was generally weak. Vaginal births were associated with slightly higher EBF rates compared with caesarean sections. Regarding fetal presentation, non-cephalic presentations (breech and oblique/transverse) were significantly associated with lower EBF rates at discharge compared with cephalic presentations. Term births were more strongly associated with EBF than preterm births. In addition, EBF rates at discharge were higher among newborns who were not admitted to the NICU than among those requiring NICU admission. A higher prevalence of EBF was also observed among neonates with Apgar scores > 7 at five minutes compared with those with scores ≤ 7, and among singleton births compared with multiple births. Expected percentages represent the frequencies that would be predicted for each cell in the contingency table if the variables were statistically independent (i.e., if no association existed). These Nutrients 2025,17, 3708 8 of 16 values are calculated by multiplying the marginal row total by the marginal column total for each cell and dividing the result by the total sample size. Table 4. Obstetric variables included in the RTGCS and perinatal outcomes associated with exclusive breastfeeding at hospital discharge. Forty-four stillbirths excluded. (N = 23,037). Variable nEBF at Discharge (Observed%) EBF at Discharge (Expected%) χ2Phi or V Value p-Value Value p-Value Mode of birth Vaginal 18,597 74.783% 74.237% 15.018 <0.001 Phi = 0.026 <0.001 Caesarean 4450 71.955% Foetal presentation Cephalic 22,154 74.456% 74.237% 15.538 <0.001 V = 0.026 <0.001 Breech 814 68.305% ObliqueTransverse 69 73.913% Gestational age >37 22,053 74.475% 74.237% 22.738 <0.001 V = 0.031 <0.001 32–37 951 69.611% <32 33 48.485% Multiple pregnancy No 22,798 74.423% 74.237% 39.792 <0.001 Phi = 0.042 <0.001 Yes 239 56.485% Apgar <7 at 5 min No 22,921 74.338% 74.237% 24.205 <0.001 Phi = 0.032 <0.001 Yes 116 54.310% NICU admission No 20,440 74.560% 74.237% 9.866 0.002 Phi = 0.021 0.002 Yes 2597 71.698% N: sample size; χ2 : Chi-squared test; EBF: Exclusive Breastfeeding; NICU: Neonatal Intensive Care Unit; Pearson’s Phi and Cramer’s V are effect size measures (strength of association) for categorical variables, derived from the Chi-squared test. The interpretation of the values of Pearson’s Phi and Cramer’s V is as follows: 0.001–0.099 weak, 0.100–0.299 small, 0.300 to 0.499 moderate, and ≥0.500 large. 3.3. Caesarean Section Distribution by RTGCS The overall caesarean section rate was 19.29%, with substantial variation across the ten Robson groups. Key differences in group distribution are detailed in Table 5. The greatest relative contribution to the total caesarean rate over the study period was observed in Group 2 (31.83%), followed by Group 1 (18.24%) and Group 6 (11.52%). Table 5. Distribution of caesarean births according to the RTGCS for births attended between 2010 and 2023 at the HULR (N = 23,081). Group Total Number of CS in Each Group Total Number of Women Delivered in Each Group Group Size Group CS Rate Absolute Group Contribution to Overall CS Rate Relative Contribution of the Group to Overall CS Rate 1 812 6851 29.682% 11.852% 3.518% 18.239% 2 1417 4555 19.735% 31.109% 6.139% 31.828% 3 348 6437 27.889% 5.406% 1.508% 7.817% 4 443 2839 12.300% 15.604% 1.919% 9.951% 5 233 350 1.516% 66.571% 1010% 5.234% 6 513 523 2.266% 98.088% 2.223% 11.523% 7 213 220 0.953% 96.818% 0.923% 4.784% 8 150 239 1.035% 62.762% 0.650% 3.369% 9 64 64 0.277% 100.000% 0.277% 1.438% 10 259 1003 4.346% 25.823% 1.122% 5.818% TOTAL 4452 23,081 100.000% / 19.289% 100.000% CS: Caesarean section. Note: Group 2 includes subgroups 2a and 2b; Group 4 includes subgroups 4a and 4b, according to the methodology for the exclusive breastfeeding (EBF) analysis. Nutrients 2025,17, 3708 9 of 16 3.4. Multivariate Logistic Regression Analysis A binomial logistic regression analysis was performed (Table 6), incorporating the variables encompassed by the RTGCS: parity and history of previous caesarean delivery; mode of labour onset (spontaneous, induced, or pre-labour caesarean); fetal presentation (cephalic, breech, or transverse); number of fetuses; and gestational age (preterm or full term). Additionally, variables that showed statistical significance in the bivariate analysis were included. We observed that non-Spanish maternal origin, nulliparity, cephalic presentation, singleton pregnancy, and gestational age ≥ 37 weeks were positively associated with EBF at discharge (p< 0.001 in all cases). Newborn sex (male) and maternal age were also positively associated, although with substantially smaller effect sizes (p< 0.050). Mode of labour onset was not associated with EBF at discharge (p= 0.905). Table 6. Factors associated with exclusive breastfeeding at discharge: Binomial logistic regression analysis. Forty-four stillbirths excluded. (N = 23,037). Summary of the Model Hosmer and Lemeshow Test Log liKehood R Nagelkerke χ2df p-Value 25.243.561 0.065 13.023 8 0.111 EBF Yes No EBF Yes 17,084 18 99.90% No 5903 32 0.50% B SE Wald df p-value OR (CI95%) Age 0.008 0.003 7.720 10.005 1.008 (1.002–1.013) Country of origin Other than Spain 1.239 0.049 650.053 1<0.001 3.452 (3.139–3.797) Sex Male 0.063 0.031 4.235 10.040 1.065 (1.003–1.132) Nulliparity Yes 0.332 0.031 113.639 1<0.001 1.394 (1.312–1.482) Previous caesarean Yes 0.260 0.102 6.439 10.011 1.297 (1.061–1.585) Mode of labour onset Spontaneous 0.004 0.032 0.014 10.905 1.004 (0.942–1.069) Presentation Cephalic 0.252 0.078 10.377 10.001 1.286 (1.104–1.499) Number of foetuses Singleton 0.765 0.137 31.354 1<0.001 2.148 (1.644–2.807) Gestational age >37 weeks 0.321 0.072 19.632 1<0.001 1.378 (1.196–1.588) χ2 : Chi-squared test; df: degrees of freedom; EBF: Exclusive breastfeeding; B: beta coefficient; SE: standard error. Note: Classification model: 74.300%. 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