Effect of Labor Epidural Analgesia with and without Fentanyl on Infant Breast-feeding

Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study

“…2 They demonstrated that 19% of multiparous subjects delivering vaginally who received >150 lg of epidural fentanyl cumulatively over the course of labor, stopped breastfeeding by 6 weeks postpartum. This was higher than with patients who received <150 lg or no fentanyl.…”

“…To legitimize comparison of our results with those of the study by Beilin et al 2 we included only multiparous women >37 weeks gestation who requested epidural analgesia for labor. In addition, they must have previously breastfed successfully for >6 weeks (defined as milk given at the breast for over 90% of feeds during the first 6 weeks), and be intending to breastfeed this infant.…”

“…Recently, the use of labor epidural analgesia inclusive of opioids has been implicated as having a negative impact on breastfeeding success. [2][3][4][5][6][7][8] Opioids are known to cross the placenta, potentially depressing the neonate. 9 This newborn depression may prevent the development of good feeding behavior in the initial hours of life, predisposing the mother to quit breastfeeding prematurely.…”

“…2 Controlling for confounders such as parity, breastfeeding experience, and the mode of delivery, they found that multiparous women with a history of successful breastfeeding who received >150 lg of epidural fentanyl had a breastfeeding failure rate of 19% at 6 weeks secondary to issues related to the baby. This was significantly higher than in those patients receiving <150 lg of epidural fentanyl.…”

Labour analgesia and the baby: good news is no news

“…87 Though rather insensitive to small effects, 88 it appears to correlate with breast feeding. 89,90 Meta-analyses of randomized trials revealed no significant difference in NACS between epidural and systemic opioid analgesia, 77 though minor differences depending on epidural technique have been brought to light (see Variations in neuraxial drugs).…”