Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women

Abstract

our study illustrates associations between the use of both pharmacological and non-pharmacological labour pain management techniques and selected birth outcomes while controlling for confounding variables. There remain significant gaps in the evidence base for the use of non-pharmacological labour pain control methods and our findings provide a platform with which to develop a broad clinical research programme around this topic.

Predictors of breastfeeding exclusivity and duration in a hospital without Baby Friendly Hospital Initiative accreditation: A prospective cohort study

“…Epidural analgesia and intramuscular opioid analgesia have been associated with lower rates of exclusive breastfeeding. 23,24 There is anecdotal concern and emerging evidence that the addition of fentanyl (an opioid) to epidural analgesia, rather than epidural with local anaesthetic only, may contribute to difficulty establishing breastfeeding. 24,25 One study has reported a dose-response relationship between fentanyl and artificial feeding with the likelihood of artificial feeding increasing for each microgram of fentanyl administered.…”

“…26 This is supported by an observational study that found women exposed to epidural analgesia were more likely to have their infants given artificial formula during their hospital stay and were less likely to be fully breastfeeding at discharge. 27 Several observational studies have reported an association between epidural analgesia and shorter breastfeeding duration including an increased likelihood of breastfeeding cessation by six weeks 23 and six months. 24 High level evidence that addresses this concern is limited as a 2011 systematic review of epidural versus non-epidural or no analgesia in labour did not report on breastfeeding outcomes.…”

The meaning of labour pain: how the social environment and other contextual factors shape women’s experiences

“…Some women are so fearful of labour pain that they elect a caesarean section in order to avoid labour and vaginal birth altogether [10], and the fear itself can lead women who do labour to experience the pain as more intense and to report a more negative experience [11]. Compared to non-pharmacological methods of pain management, pharmacological methods are also associated with poorer outcomes for babies, including a higher rate of instrumental births and admission to special care, and decreased duration of breastfeeding beyond 6 weeks [12]. Overall, it is clear that current approaches to supporting women to manage labour pain do not always promote physiological birth, can diminish women’s experiences of labour and birth, and can have adverse effects on their babies’ health.…”

Association between early‐term birth and breastfeeding initiation, duration, and exclusivity: A systematic review

“…The majority of reviewed studies adjusted for the mode of birth but only two additionally adjusted for other intrapartum interventions, the use of intrapartum medications and neonatal intensive care unit admission . Intrapartum interventions are associated with a shorter duration of breastfeeding . Furthermore, early‐term infants are more likely to be admitted to the neonatal intensive care unit and have a prolonged hospitalization, both of which are also associated with early breastfeeding cessation.…”

“…27 T A B L E 3 Quality assessment of the reviewed observational studies using the Newcastle-Ottawa scale for cohort studies Intrapartum interventions are associated with a shorter duration of breastfeeding. 33,34 Furthermore, early-term infants are more likely to be admitted to the neonatal intensive care unit 3 and have a prolonged hospitalization, 4 both of which are also associated with early breastfeeding cessation. Therefore, if these variables are not adequately accounted for, differences in breastfeeding practices in early-term infants found in some studies may be related to intrapartum and postpartum experiences rather than gestational age.…”