Objective  To analyze the current status and occupational factors associated with breastfeeding continuation after maternity leave among female anesthesia residents in China.

  Methods  Our study was based on a nationwide survey "Breastfeeding and Work/Family Balance Among Female Anesthesiologists" conducted by Chinese Society of Anesthesiology, which was targeted to female anesthesia residents giving birthsince January 1, 2015.An anonymous online questionnaire was developed to collect basic information, breastfeeding practices and workload.The inclusion variables were screened using the akaike information criterion (AIC), with the event defined as "termination of breastfeeding".Occupational factors that may affect breastfeeding were included as explanatory variables and non-occupational related factors that may affect breastfeeding were also included in the model to adjust for potential confounding effects.Schoenfeld were used to assess whether the variables were satisfied for each explanatory variable, and for those that were not, the time-dependent covariate for that variable was added to the model, occupational factors affecting breastfeeding duration were analyzed using stepwise Cox regression.

  Results  A total of 436 anesthesia residents from 29 provinces were included.According to the survey, 372(85.3%, 372/436) terminated breastfeeding, of which 268(72.0%, 268/372) ended breastfeeding early due to work, 419(96.1%, 419/436) significantly reduced breast milk after work, and 133(30.5%, 133/436) had no opportunity to breastfeed at work.Their median breastfeeding duration was 10(8, 12) months.Longer work experience at childbirth was associated with a higher risk of discontinuing breastfeeding (HR=1.09, 95% CI: 1.03-1.15, P=0.004).The following occupational factors were associated with a longer breastfeeding duration: prolonged maternity leave (HR=0.85, 95% CI: 0.78-0.93, P < 0.001), tertiary hospital (HR=0.56, 95% CI: 0.43-0.73, P < 0.001), more opportunities for breast pumping during worktime (HR=0.02, 95% CI: 0-0.08, P < 0.001) and reduced workload during the breastfeeding period (HR=0.47, 95% CI: 0.26-0.86, P=0.014).

  Conclusion  Hospital administrators can make efforts to offer prolonged maternity leave, modified rotation plan, breastfeeding rooms, and breastfeeding breaks, which are beneficial to both maternal and fetal health.