Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Maternal and Child Health Journal
Published in: Maternal and Child Health Journal 4/2013

01-05-2013

Labor Epidural Anesthesia, Obstetric Factors and Breastfeeding Cessation

Authors: Ann M. Dozier, Cynthia R. Howard, Elizabeth A. Brownell, Richard N. Wissler, J. Christopher Glantz, Sharon R. Ternullo, Kelly N. Thevenet-Morrison, Cynthia K. Childs, Ruth A. Lawrence

Published in: Maternal and Child Health Journal | Issue 4/2013

Login to get access

Abstract

Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia’s association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. A pooled analysis using Kaplan–Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within 1 month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95 % confidence interval 1.10, 1.44], p < 0.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01, 1.41], p < 0.04; non-BFH: 1.65 [1.31, 2.08], p < 0.01). A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies.
Literature
1.
Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep), 153, 1–186.
2.
Gartner, L. M., Morton, J., Lawrence, R. A., Naylor, A. J., O’Hare, D., Schanler, R. J., et al. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496–506.PubMedCrossRef
3.
WHO, Unicef, USAID, AED, UCDAVIS, & IFPRI. (2008). Indicators for assessing infant and young child feeding practices. Part I definitions. World Health Organization: Geneva.
4.
5.
6.
Wilson, M. J., MacArthur, C., Cooper, G. M., Bick, D., Moore, P. A., & Shennan, A. (2010). Epidural analgesia and breastfeeding: A randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia, 65(2), 145–153.PubMedCrossRef
7.
Leighton, B. L., & Halpern, S. H. (2002). The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. American Journal of Obstetrics and Gynecology, 186(5 Suppl Nature), S69–S77.PubMed
8.
Britton. C., McCormick, F. M., Renfrew, M. J., Wade, A., & King, S. E. (2007). Support for breastfeeding mothers. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD001141. doi:10.​1002/​14651858.​CD001141.​pub3.
9.
Dyson, L., McCormick, F. M., & Renfrew, M. J. (2005). Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD001688. doi:10.​1002/​14651858.​CD001688.​pub2.
10.
Abdulwadud, O. A., & Snow, M. E. (2007). Interventions in the workplace to support breastfeeding for women in employment. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD006177. doi:10.​1002/​14651858.​CD006177.​pub2.
11.
Anim-Somuah, M., Smyth, R. M. D., & Howell, C. J. (2005). Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD000331. doi:10.​1002/​14651858.​CD000331.​pub2.
12.
Chen, L. K., Hsu, H. W., Lin, C. J., Huang, C. H., Tsai, S. K., Lee, C. N., et al. (2000). Effects of epidural fentanyl on labor pain during the early period of the first stage of induced labor in nulliparous women. Journal of the Formosan Medical Association, 99(7), 549–553.PubMed
13.
Baumgarder, D. J., Muehl, P., Fischer, M., & Pribbenow, B. (2003). Effect of labor epidural anesthesia on breastfeeding of healthy full-term newborns delivered vaginally. Journal of the American Board of Family Practice, 16(1), 7–13.PubMedCrossRef
14.
Beilin, Y., Bodian, C. A., Weiser, J., Hossain, S., Arnold, I., Feierman, D. E., et al. (2005). Effect of labor epidural analgesia with and without fentanyl on infant breastfeeding: A prospective, randomized, double-blind study. Anesthesiology, 103(6), 1211–1217.PubMedCrossRef
15.
Henderson, J. J., Dickinson, J. E., Evans, S. F., McDonald, S. J., & Paech, M. J. (2003). Impact of intrapartum epidural analgesia on breastfeeding duration. Australian and New Zealand Journal of Obstetrics and Gynaecology, 43(5), 372–377.PubMedCrossRef
16.
Jordan, S., Emery, S., Bradshaw, C., Watkins, A., & Friswell, W. (2005). The impact of intrapartum analgesia on infant feeding. BJOG, 112(7), 927–934.PubMedCrossRef
17.
Radzyminski, S. (2003). The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(3), 322–331.PubMedCrossRef
18.
Ransjo-Arvidson, A. B., Matthiesen, A. S., Lilja, G., Nissen, E., Widstrom, A. M., & Uvnas-Moberg, K. (2001). Maternal analgesia during labor disturbs newborn behavior: Effects on breastfeeding, temperature, and crying. Birth., 28(1), 5–12.PubMedCrossRef
19.
Riordan, J., Gross, A., Angeron, J., Krumwiede, B., & Melin, J. (2000). The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. Journal of human Lactation, 16(1), 7–12.PubMedCrossRef
20.
Volmanen, P., Valanne, J., & Alahuhta, S. (2004). Breastfeeding problems after epidural analgesia for labour: A retrospective cohort study of pain, obstetrical procedures and breastfeeding practices. International Journal of Obstetrics and Anesthesia, 13(1), 25–29.CrossRef
21.
Wiklund, I., Edman, G., & Andolf, E. (2007). Cesarean section on maternal request: Reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers. Acta Obstetricia et Gynecologica Scandinavica, 86(4), 451–456.PubMedCrossRef
22.
Jordan, S., Emery, S., Watkins, A., Evans, J. D., Storey, M., & Morgan, G. (2009). Associations of drugs routinely given in labour with breastfeeding at 48 hours: Analysis of the Cardiff Births Survey. BJOG, 116(12), 1622–1629.PubMedCrossRef
23.
Chang, Z. M., & Heaman, M. I. (2005). Epidural analgesia during labor and delivery: Effects on the initiation and continuation of effective breastfeeding. Journal of Human Lactation, 21(3), 305–314.PubMedCrossRef
24.
Halpern, S. H., Levine, T., Wilson, D. B., MacDonell, J., Katsiris, S. E., & Leighton, B. L. (1999). Effect of labor analgesia on breastfeeding success. Birth, 26(2), 83–88.PubMedCrossRef
25.
Rosen, A., & Lawrence, R. A. (1994). The effect of epidural anesthesia on infant feeding. Journal of University of Rochester Medical Center, 6(1), 3–7.
26.
Stuebe, A. M., Greenberg, J. A., Ecker, J. L., & McElrath, T. F. (2006). The effects of parity, epidural anesthesia, and cesarean delivery on early breastfeeding. Obstetrics and Gynecology, 107(4 suppl), 68S–69S.CrossRef
27.
Wieczorek, P. M., Guest, S., Balki, M., Shah, V., & Carvalho, J. C. A. (2010). Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: An observational cohort study. International Journal of Obstetric Anesthesia, 19, 273–277.PubMedCrossRef
28.
Devroe, S., De Coster, J., & Van de Velde, M. (2009). Breastfeeding and epidural analgesia during labour. Current Opinion in Anaesthesiology, 22(3), 327–329.PubMedCrossRef
29.
Jonas, K., Johansson, L. M., Nissen, E., Ejdeback, M., Ransjo-Arvidson, A. B., & Uvnas-Moberg, K. (2009). Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin, in response to suckling during the second day postpartum. Breastfeed Medicine, 4(2), 71–82.CrossRef
30.
Rahm, V. A., Hallgren, A., Hogberg, H., Hurtig, I., & Odlind, V. (2002). Plasma oxytocin levels in women during labor with or without epidural analgesia: A prospective study. Acta Obstetricia et Gynecologica Scandinavica, 81(11), 1033–1039.PubMedCrossRef
31.
Jonas, W., Nissen, E., Ransjo-Arvidson, A. B., Matthiesen, A. S., & Uvnas-Moberg, K. (2008). Influence of oxytocin or epidural analgesia on personality profile in breastfeeding women: A comparative study. Archives of Women’s Mental Health, 11(5–6), 335–345.PubMedCrossRef
32.
Williams, G. L., Gazal, O. S., Leshin, L. S., Stanko, R. L., & Anderson, L. L. (2001). Physiological regulation of maternal behavior in heifers: Roles of genital stimulation, intracerebral oxytocin release, and ovarian steroids. Biology of Reproduction, 65(1), 295–300.PubMedCrossRef
33.
Slattery, D. A., & Neumann, I. D. (2008). No stress please! Mechanisms of stress hyporesponsiveness of the maternal brain. Journal of Physiology, 586(2), 377–385.PubMedCrossRef
34.
Levy, F., Kendrick, K. M., Keverne, E. B., Piketty, V., & Poindron, P. (1992). Intracerebral oxytocin is important for the onset of maternal behavior in inexperienced ewes delivered under peridural anesthesia. Behavioral Neuroscience, 106(2), 427–432.PubMedCrossRef
35.
Feldman, R., Weller, A., Zagoory-Sharon, O., & Levine, A. (2007). Evidence for a neuroendocrinological foundation of human affiliation: plasma oxytocin levels across pregnancy and the postpartum period predict mother–infant bonding. Psychological Science, 18(11), 965–970.PubMedCrossRef
36.
Montgomery, A., & Hale, T. W. (2006). ABM clinical protocol #15: Analgesia and anesthesia for the breastfeeding mother. Breastfeed Medicine, 1(4), 271–277.CrossRef
37.
38.
Roohan, P. J., Josberger, R. E., Acar, J., Dabir, P., Feder, H. M., & Gagliano, P. J. (2003). Validation of birth certificate data in New York state. Journal of Community Health, 28(5), 335–346.PubMedCrossRef
39.
Northam, S., & Knapp, T. (2006). The reliability and validity of birth certificates. JOGNN, 35(1), 3–12.PubMedCrossRef
40.
DiGiuseppe, D., Aron, D., Random, L., Harper, D., & Rosenthal, G. (2002). Reliability of birth certificate data: A multi-hospital comparison to medical record information. Maternal and Child Health Journal, 6(3), 169–179.PubMedCrossRef
41.
Andersen, P. K., & Gill, R. D. (1982). Cox’s regression model for countin processes: A large sample study. The Annals of Statistics, 10(4), 1110–1120.CrossRef
42.
Box-Steffensmeier, J. M., & Zorn, C. (2002). Duration models for repeated events. Journal of Politics, 64(4), 1069–1094.CrossRef
43.
Fleming, T. H., & Harrington, D. P. (1991). Counting processes and survival analysis. New York: Wiley.
44.
Martens, P. J., & Romphf, L. (2007). Factors associated with newborn in-hospital weight loss: Comparisons by feeding method, demographics, and birthing procedures. Journal of Human Lactation, 23(3), 233–241.PubMedCrossRef
45.
Walker, M. (1997). Do labor medications affect breastfeeding? Journal of Human Lactation, 13(2), 131–137.PubMedCrossRef
46.
Mizuno, K., Fujimaki, K., & Sawada, M. (2004). Sucking behavior at breast during the early newborn period affects later breastfeeding rate and duration of breastfeeding. Pediatrics International, 46(1), 15–20.PubMedCrossRef
47.
Dewey, K. G., Nommsen-Rivers, L. A., Heinig, M. J., & Cohen, R. J. (2003). Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics, 112(3 Pt 1), 607–619.PubMedCrossRef
48.
Handlin, L., Jonas, W., Petersson, M., Ejdeback, M., Ransjo-Arvidson, A. B., Nissen, E., et al. (2009). Effects of sucking and skin-to-skin contact on maternal ACTH and cortisol levels during the second day postpartum-influence of epidural analgesia and oxytocin in the perinatal period. Breastfeed Medicine, 4(4), 207–220.CrossRef
49.
Stricker, B. H., & Stijnen, T. (2010). Analysis of individual drug use as a time-varying determinant of exposure in prospective population-based cohort studies. European Journal of Epidemiology, 25(4), 245–251.PubMedCrossRef
50.
Li, R., Scanlon, K. S., & Serdula, M. K. (2005). The validity and reliability of maternal recall of breastfeeding practice. Nutrition Reviews, 63(4), 103–110.PubMedCrossRef
Metadata
Title
Labor Epidural Anesthesia, Obstetric Factors and Breastfeeding Cessation
Authors
Ann M. Dozier
Cynthia R. Howard
Elizabeth A. Brownell
Richard N. Wissler
J. Christopher Glantz
Sharon R. Ternullo
Kelly N. Thevenet-Morrison
Cynthia K. Childs
Ruth A. Lawrence
Publication date
01-05-2013
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 4/2013
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-012-1045-4

Other articles of this Issue 4/2013

Maternal and Child Health Journal 4/2013 Go to the issue

OriginalPaper

Pre-pregnancy Body Size Dissatisfaction and Excessive Gestational Weight Gain

OriginalPaper

Disparate Patterns of Prenatal Care Utilization Stratified by Medical and Psychosocial Risk

OriginalPaper

Maternal Smoking, Breastfeeding, and Risk of Childhood Overweight: Findings from a National Cohort

OriginalPaper

Interpregnancy Intervals and the Risk for Infant Mortality: A Case Control Study of Arizona Infants 2003–2007

Report

Fertility Desires Among HIV-Infected Men and Women in Los Angeles County: Client Needs and Provider Perspectives

OriginalPaper

Folic Acid Use in Planned Pregnancy: An Italian Survey