Effect of Labor Analgesia on Breastfeeding Success

Halpern, Stephen H.; Levine, Tracey; Wilson, Darrin S; MacDonell, Jo Watson; Katsiris, Sandra E; Leighton, Barbara L.

doi:10.1046/j.1523-536x.1999.00083.x

Cited by 87 publications

(63 citation statements)

References 26 publications

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“…Similarly, the study of 171 women by Halpern et al 15 showed no early or late (6 to 8 weeks' postpartum) adverse effects on breast-feeding by the use of epidural anesthesia during labor. Women having cesarean sections were included and not segregated in either study.…”

mentioning

confidence: 86%

Effect of Labor Epidural Anesthesia on Breast-feeding of Healthy Full-term Newborns Delivered Vaginally

Baumgarder¹,

Muehl²,

Fischer³

et al. 2003

The Journal of the American Board of Family Medicine

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Background: Epidural anesthesia is commonly administered to laboring women. Some studies have suggested that epidural anesthesia might inhibit breast-feeding. This study explores the association between labor epidural anesthesia and early breast-feeding success.Methods: Standardized records of mother-baby dyads representing 115 consecutive healthy, fullterm, breast-feeding newborns delivered vaginally of mothers receiving epidural anesthesia were analyzed and compared with 116 newborns not exposed to maternal epidural anesthesia. Primary outcome was two successful breast-feeding encounters by 24 hours of age, as defined by a LATCH breast-feeding assessment score of 7 or more of 10 and a latch score of 2/2. Means were compared with the KruskalWallis test. Categorical data were compared using the Mantel-Haenszel chi-square test. Stratified analysis of potentially confounding variables was performed using Mantel-Haenszel weighted odd ratios (OR) and chi-square for evaluation of interaction.Results: Both epidural and nonepidural anesthesia groups were similar except maternal nulliparity was more common in the epidural anesthesia group. Two successful breast-feedings within 24 hours of age were achieved by 69.6% of mother-baby units that had had epidural anesthesia compared with 81.0% of mother-baby units that had not (odds ratio [OR] 0.53, P ‫؍‬ .04). These relations remained after stratification (weighted odds ratios in parenthesis) based on maternal age (0.52), parity (0.58), narcotics use in labor (0.49), and first breast-feeding within 1 hour (0.49). Babies of mothers who had had epidural anesthesia were significantly more likely to receive a bottle supplement while hospitalized (OR 2.63; P < .001) despite mothers exposed to epidural anesthesia showing a trend toward being more likely to attempt breast-feeding in the 1 hour (OR 1.66; P ‫؍‬ .06). Mothers who had epidural anesthesia and who did not breast-feed within 1 hour were at high risk for having their babies receive bottle supplementation (OR 6.27). Conclusions

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mentioning

confidence: 86%

Effect of Labor Epidural Anesthesia on Breast-feeding of Healthy Full-term Newborns Delivered Vaginally

Baumgarder¹,

Muehl²,

Fischer³

et al. 2003

The Journal of the American Board of Family Medicine

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“…Lactational amenorrhea decreases iron loss. Lactation reduces the risk of postpartum hemorrhage, makes it easier to return to pre-pregnancy weight, increases bone remineralization, reduces the possibility of osteoporosis and reduces the risks of developing breast, ovarian and uterine cancers premenopausally [15,[26][27][28][29].…”

Section: Breastfeedingmentioning

confidence: 99%

“…Halpern et al [26] prospectively enrolled 189 women who delivered at a hospital. A total of 59% of the women received epidural analgesia.…”

Section: Neuraxial Analgesia During Labormentioning

confidence: 99%

Epidural Analgesia and Lactation

Akbaş

Akcan

2011

EAJM

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Present-day mothers have an increased desire to breastfeed, but this desire has increased in parallel with the increased use of epidural analgesia during labor. Epidural anesthesia requires a high level of technical proficiency to avoid serious complications and should always be performed by a trained anesthetist using a strict aseptic technique to reduce the risk of infection. There is currently no consensus regarding the relationship between breastfeeding and epidural analgesia during labor. The purpose of this review was to evaluate the effect of epidural analgesia on breastfeeding. Key Words: Breastfeeding, Epidural analgesia, Labor ÖzetGünümüzde annelerin bebeklerini anne sütüyle besleme istekleri giderek artmaktadır. Fakat aynı zamanda doğum eylemi sırasında epidural analjezi kullanımı da artmaktadır. Epidural anestezi uygulamaları ciddi komplikasyonlardan kaçınabilmek için yüksek teknik yeterlilik gerektirir, enfeksiyon riskinden kaçınmak için mutlak aseptik tekniklere dikkat ederek deneyimli bir anestezist tarafından uygulanmalıdır. Doğumda epidural analjezi kullanımı ve emzirme konusunda ortak bir görüş yoktur. Bu derlemenin amacı epidural analjezinin emzirme üzerine etkisini değerlendirmektir.

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“…Observational studies concerning EDA are, however, subject to selection bias. Moreover, there are studies with no difference in breastfeeding performance (Halpern et al 1999). In a systematic review, Leighton and Halpern (2002) concluded that EDA does not affect breast-feeding initiation or management.…”

Section: Effects Of Maternal Analgesia On the Neonatementioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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Effect of Labor Analgesia on Breastfeeding Success

Cited by 87 publications

References 26 publications

Effect of Labor Epidural Anesthesia on Breast-feeding of Healthy Full-term Newborns Delivered Vaginally

Effect of Labor Epidural Anesthesia on Breast-feeding of Healthy Full-term Newborns Delivered Vaginally

Epidural Analgesia and Lactation

Intravenous patient-controlled analgesia with remifentanil in early labour

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