Intrapartum epidural analgesia and breastfeeding: A prospective cohort study

NSW Centre for Overweight and Obesity, Level 2, K25 Medical Foundation Building, The University of Sydney, NSW 2006, Australia.
International Breastfeeding Journal 12/2006; 1(1):24. DOI: 10.1186/1746-4358-1-24
Source: PubMed


Anecdotal reports suggest that the addition of fentanyl (an opioid) to epidural analgesia for women during childbirth results in difficulty establishing breastfeeding. The aim of this paper is to determine any association between epidural analgesia and 1) breastfeeding in the first week postpartum and 2) breastfeeding cessation during the first 24 weeks postpartum.
A prospective cohort study of 1280 women aged > or = 16 years, who gave birth to a single live infant in the Australian Capital Territory in 1997 was conducted. Women completed questionnaires at weeks 1, 8, 16 and 24 postpartum. Breastfeeding information was collected in each of the four surveys and women were categorised as either fully breastfeeding, partially breastfeeding or not breastfeeding at all. Women who had stopped breastfeeding since the previous survey were asked when they stopped.
In the first week postpartum, 93% of women were either fully or partially breastfeeding their baby and 60% were continuing to breastfeed at 24 weeks. Intrapartum analgesia and type of birth were associated with partial breastfeeding and breastfeeding difficulties in the first postpartum week (p < 0.0001). Analgesia, maternal age and education were associated with breastfeeding cessation in the first 24 weeks (p < 0.0001), with women who had epidurals being more likely to stop breastfeeding than women who used non-pharmacological methods of pain relief (adjusted hazard ratio 2.02, 95% CI 1.53, 2.67).
Women in this cohort who had epidurals were less likely to fully breastfeed their infant in the few days after birth and more likely to stop breastfeeding in the first 24 weeks. Although this relationship may not be causal, it is important that women at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support.

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    • "Whether or not neuraxial analgesia may impact breastfeeding initiation and duration is controversial. Observational studies give conflicting results.30,31 Beilin et al reported a randomized controlled trial using three different doses of fentanyl for maintenance of epidural analgesia. "
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    ABSTRACT: Epidural analgesia is an extremely effective and popular treatment for labor pain. In this review, we trace the history of the use of epidural analgesia and its refinements. We then outline the goals of treatment and methods used to attain those goals. The use of low concentrations of local anesthetics, combined with lipid-soluble opioids, does not impede the progress of labor or depress the newborn. The incidence of side effects is low. Maintenance of analgesia that allows patient control enhances patient satisfaction.
    Local and Regional Anesthesia 12/2010; 3(1):143-53. DOI:10.2147/LRA.S10237
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    • "Among women for whom initiation of breastfeeding was delayed, we found lower rates of full breastfeeding -- or, conversely, higher rates of partial breastfeeding and of formula feeding. This is of concern, as it is known from other studies that women who commence partial, rather than full breastfeeding, are at risk of early cessation of breastfeeding [17]. In our cohort, partial breastfeeding in the first postpartum week is likely to be indicative of problems in establishing breastfeeding, including delayed lactogenesis Stage II. "
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    International Breastfeeding Journal 05/2010; 5(1):5. DOI:10.1186/1746-4358-5-5
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    • "Other cohort studies, ranging in size from 99 to 411 parturients, have supported the link between epidural analgesia and feeding infant formula [9-13]. With one of the largest cohorts in the area (n = 1178), Torvaldsen and colleagues are making an important contribution to this field [1]. However, even the largest well conducted cohort studies will never provide evidence as robust as that obtained by experimental methods, most particularly, well conducted double-blind randomised placebo-controlled trials. "
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    ABSTRACT: The interesting and important paper by Torvaldsen and colleagues provides further circumstantial evidence of a positive association between intrapartum analgesia and feeding infant formula. Not all research supports this association. Before 'failure to breastfeed' can be adjudged an adverse effect of intrapartum analgesia, the research evidence needs to be considered in detail. Examination of the existing evidence against the Bradford-Hill criteria indicates that the evidence is not yet conclusive. However, the difficulties of obtaining funding and undertaking large trials to explore putative adverse drug reactions in pregnant women may mean that we shall never have conclusive evidence of harm. Therefore, reports of large cohort studies with regression models, as in the paper published today, assume a greater importance than in other areas of investigation. Meanwhile, women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour.
    International Breastfeeding Journal 02/2006; 1(1):25. DOI:10.1186/1746-4358-1-25
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