Friday, December 15, 2006

Do Drugs for Pain During Birth Affect Breastfeeding?

Via 4women.gov, Epidural During Birth May Negatively Affect Breast-Feeding.

The full study is free online [click the Provisional PDF link to download], as International Breastfeeding is an open access journal via BioMed Central. Citation: Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006;1(24).

The authors followed 1260 Australian women who had a live birth in 1997 and were available for follow-up. Women were excluded from the study if they had babies who were admitted in intensive care or were adopted, if the women were critically ill, unable to give informed consent or complete the questionnaires, or had multiple pregnancies. Women received questionnaires via mail at 8, 16, and 24 weeks postpartum; the first survey collected information on characteristics of the mother, partner, obstetric details, and breastfeeding information. Women were also asked about breastfeeding in subsequent questionnaries, allowing the women to be categorized as fully breastfeeding, partially breastfeeding (milk+some formula) or not breastfeeding. If they had stopped breastfeeding since the previous survey, they indicated when.

Women's use of analgesia (pain relief) during labor was classified as: 1) non-pharmacological only (breathing exercises, massage, hypnosis, etc.); 2) gas (nitrous oxide); 3) pethidine (with or without gas); 4) epidural (with or without pethidine or gas; 5) general anesthetic (with or without any of 1-4). Epidural drug in use at the time was bupivacain 0.16% with fentanyl 3.3micrograms/ml.

Findings:
  • Of the 1260 women, 416 (33%) had epidurals.
  • In the first week postpartum, 1182 (93%) were either fully or partially breastfeeding.
  • 704 (60%) of those were continuing to breastfeed at 24 weeks.
  • Of 85 women not breastfeeding at all in the first week, 48% indicated they had planned not to breastfeed. The only survey factor associated with no breastfeeding was maternal education (less educated women were more likely not to breastfeed at all in the first postpartum week).
  • Factors associated with partial breastfeeding in the first week were intrapartum analgesia (drugs during birth), type of birth, onset of labor, and parity.
  • Women who were partially breastfeeding in the first week were almost twice as likely to have ceased breastfeeding by 24 weeks compared to women who had been fully breastfeeding during that week.
  • The authors found that women who did not use phamarcological analgesia during birth had the lowest rate of breastfeeding cessation during the first 24 weeks. Women who used epidurals had the highest rates of cessation.
    Additional details are provided in the article tables.

    One common concern about the research (and similar studies): women who are motivated to go through childbirth without traditional drug-based pain relief may also be more motivated to breastfeed. The authors also do not attempt to provide any sort of physiologic explanation for epidurals causing problems with breastfeeding, so the study finds a correlation but not causation. It also does not describe the type/amount of lactation support the women received, nor fully compare the women's intent for the duration of their breastfeeding.

    Additional References:
  • Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005 Aug;21(3):305-14. [Abstract; these authors did not find a significant difference in breastfeeding at 4 weeks dependent on analgesia use during labor]
  • Crowell MK, Hill PD, Humenick SS. Relationship between obstetric analgesia and time of effective breast feeding. J Nurse Midwifery. 1994 May-Jun;39(3):150-6.
  • Dickinson JE, Paech MJ, McDonald SJ, Evans SF. The impact of intrapartum analgesia on labour and delivery outcomes in nulliparous women. Aust N Z J Obstet Gynaecol. 2002 Feb;42(1):59-66.
  • Halpem SH, Ioscovich A. Epidural analgesia and breast-feeding. Anesthesiology. 2005 Dec;103(6):1111-2.
  • Henderson JJ, Dickinson JE, Evans SF, MdDonald SJ, Peach MJ, Impact of intrapartum epidural analgesia on breast-feeding duration. Aust N Z J Obstet Gynaecol. 2003 Oct;43(5):373-7.
  • Lee N. Comments on "Epidural analgesia during labor and delivery" article by Chang and Heaman. J Hum Lact. 2006 Feb;22(1):11; author reply 11-2.
  • Rajan L. The impact of obstetric procedures and analgesia/anaesthesia during labour and delivery on breast feeding. Midwifer. 1994 Jun;10(2):87-103.
  • Riordan J, Gross A, Angeron J, Krumwide B, Melin J. The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. J Hum Lact. 2000 Feb;16(1):7-12.
  • Vomanen P, Valanne J, Alahuhta S. Breast-feeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and breast-feeding practices. Int J Obstet Anesth. 2004 Jan;13(1):25-9.

    See the MedlinePlus Medical Dictionary, powered by Merriam-Webster, to look up unfamiliar terms.

    Technorati Tags: ; ; ;
    MeSH Tags: Analgesia, Obstetrical; Breast Feeding
  • 2 Comments:

    Blogger CanuckedBrit said...

    I doubt it's the epidural. I think this comes down to those who took the time to learn the best methods for natural childbirth also likely took the time to educate themselves on breastfeeding techniques.

    One caveat being that I was part of the blind luck number with my first child. Painkiller free pitocin induced labour followed by successful breastfeeding.

    5:12 PM  
    Blogger Rachel said...

    CancuckedBrith - I tend to agree with you. I think that the women who chose to go through the birth without drugs were probably more likely to be committed to breastfeeding in the first place.

    5:15 PM  

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