ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2012

Department of Family Medicine, University of Washington, Seattle, WA, USA.
Breastfeeding Medicine (Impact Factor: 1.25). 02/2006; 1(4):271-7. DOI: 10.1089/bfm.2006.1.271
Source: PubMed


A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

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Available from: Kathleen A Marinelli, Jun 26, 2015
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    ABSTRACT: The optimal timing of epidural analgesia has been a controversial issue, and how early women can benefit from epidural analgesia is still debated. The objective of this trial was to test the hypothesis that patient-controlled epidural analgesia given at cervical dilation of 1.0 cm or more does not increase the risk of prolonged labor or Cesarean delivery. After institutional review board approval and patient consent, 12,793 nulliparous patients requesting neuraxial analgesia were enrolled and randomized to an early epidural (cervical dilation at least 1.0 cm) or delayed epidural (cervical dilation at least 4.0 cm) group. A 15-ml epidural analgesic mixture consisting of 0.125% (1.25 mg/ml) ropivacaine plus 0.3 microg/ml sufentanil was given in a single bolus, followed by patient-controlled pump with a 10-ml bolus without background infusion. Repeatable meperidine (25 mg) was prescribed as being the rescue analgesic to patients in the delayed epidural group. The primary outcome was the rate of Cesarean section. The median diameters of cervical dilation were 1.6 cm and 5.1 cm in the early and delayed epidural groups, respectively (P < 0.0001). The duration of labor from analgesia request to vaginal delivery was equal in both groups (11.3 +/- 4.5 h for early epidural and 11.8 +/- 4.9 h for delayed epidural group women, P = 0.90). No statistically significant difference in the rate of Cesarean section was observed between the two groups on the intention-to-treat analysis (23.2% vs. 22.8% in the early and delayed epidural groups, respectively; P = 0.51). Epidural analgesia in the latent phase of labor at cervical dilation of 1.0 cm or more does not prolong the progression of labor and does not increase the rate of Cesarean in nulliparous women compared with the delayed analgesia at the cervical dilation of 4.0 cm or more.
    Anesthesiology 09/2009; 111(4):871-80. DOI:10.1097/ALN.0b013e3181b55e65 · 5.88 Impact Factor
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    ABSTRACT: Background: Anecdotal evidence suggests that epidural anesthesia (EA) has a detrimental effect on breastfeeding (BF) but research is limited and has not consistently established any correlation between epidural use and BF duration or exclusivity. Methods: Secondary analyses used data from a prospective cohort study of 842 BF women with uncomplicated, singleton term deliveries (recruited postpartum from two urban community hospitals). Respondents completed an enrollment interview and mailed surveys (2 weeks, 3 and 6 months) to assess BF duration and exclusivity. Labor and delivery data were obtained from the birth certificate. Kaplan Meier curves assessed the unadjusted relationship between EA and cessation of BF within 30 days. Hazard ratios (HR) and 95% confidence intervals (CI) of BF cessation by 30 days were estimated using the Cox proportional hazard model and adjusted for maternal demographic and obstetric characteristics. Adjusted odds ratios (aOR) and CI for BF exclusivity at day 14 were calculated by logistic regression controlling for similar covariates. Results: While Kaplan-Meier results did not find a crude association between EA and BF cessation at 30 days (p=0.06), EA was significantly associated with BF cessation in multivariate analysis (HR 1.320; CI 1.005-1.735). Additionally, women who were not exclusively BF at day 14 were more likely to have received EA (aOR 1.47; CI 1.03-2.11). Conclusions: These findings demonstrate a relationship between the EA and BF cessation (at 30 days) and BF exclusivity (at 14 days). Further primary research is warranted, to include other relevant factors (e.g. epidural type; specific anesthetics).
    137st APHA Annual Meeting and Exposition 2009; 11/2009
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