Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey

Abstract

Background Little is known about how breastfeeding rates are affected by drugs routinely administered in labour.Objective To examine a large obstetric data set to investigate potentially modifiable associations between drugs routinely administered in labour and breastfeeding in healthy women and infants.Design Retrospective cohort.Setting The Cardiff (Wales UK) Births Survey.Population A total of 48 366 healthy women delivering healthy singleton babies at term.Methods Analysis of the Cardiff Births Survey.Main outcome measure Association between intrapartum medications and breastfeeding at 48 hours postpartum.Results At 48 hours, 43.3% (20 933/48 366) women were not breastfeeding. Regression analysis confirmed previously reported associations of lower breastfeeding rates with certain demographic indicators, epidural analgesia, intramuscular opioid analgesia and ergometrine. Novel associations were detected with oxytocin alone or in combination with ergometrine administered for prevention of postpartum haemorrhage (PPH), which were associated with reductions of 6-8%, (intramuscular oxytocin OR 0.75, 95% CI 0.61-0.91, intravenous oxytocin OR 0.68, 95% CI 0.57-0.82, oxytocin/ergometrine OR 0.77, 95% CI 0.65-0.91), and prostaglandins administered for induction of labour. The associations were maintained when subgroups, such as primiparous women, women whose labours were neither induced nor augmented, and women not receiving epidural analgesia were considered.Conclusion Prospective studies on drugs in labour are needed to investigate potential causative associations between intrapartum medications and breastfeeding. Such studies will delineate the optimum balance between breastfeeding and maternal health, most importantly the risk of PPH.

Labour analgesia and the baby: good news is no news

“…Moreover, this large number of interrelated factors emphasises the need for randomised trials to establish a link between neuraxial analgesia and feeding, yet unrandomised studies continue to be reported. [95][96][97][98][99][100][101][102][103][104][105][106][107][108][109] The 17 studies summarised in Table 4 are of various types, but in none was the use of neuraxial analgesia per se randomised and blinding was not always attempted. Some failed to distinguish between different types of analgesia or confused systemic with neuraxial routes of administration.…”

‘It's your body, but…’ Mixed messages in childbirth education: Findings from a hospital ethnography

“…There was no information given in any of the classes about epidural analgesia increasing the risk of instrumental birth (Anim-Somuah et al, 2011) or decreasing breastfeeding rates (Kendall-Tackett et al, 2015;Jordan et al, 2009;Wiklund et al, 2009) and all midwives stated that there were no known effects on the newborn. While all of the midwives attempted to describe the pain of labour in encouraging terms, such as being 'positive' or 'good' or urging the women to 'trust their bodies', the rules of the institution were constantly being referred to: 'we don't like you to eat', 'you can only bring two support people', 'we expect you to progress one centimetre an hour', 'there is a time we will need you to have your baby by'.…”

The interaction of personality profile and lactation differs between mothers of late preterm and term neonates

“…High prolactin triggers a maternal response in caretaking of a baby (i.e. feeding, keeping safe, attentiveness), but evidence supporting this claim in late preterm deliveries is lacking [7,8]. Conversely, low prolactin may lead to both anxiety and low milk supply, which in turn may lead to high stress [9].…”

“…Conversely, low prolactin may lead to both anxiety and low milk supply, which in turn may lead to high stress [9]. In addition, some clinical studies report reduced breastfeeding following oxytocin administration [6,7,10]. Oxytocin may also play a role in causing maternal personality adaptations in women [11,12], and also plays a part in the bonding between mother and fetus/ infant [13].…”