Document Detail


Labor epidural anesthesia, obstetric factors and breastfeeding cessation.
MedLine Citation:
PMID:  22696104     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
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
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Maternal and child health journal     Volume:  17     ISSN:  1573-6628     ISO Abbreviation:  Matern Child Health J     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-08     Completed Date:  2013-12-23     Revised Date:  2014-05-11    
Medline Journal Info:
Nlm Unique ID:  9715672     Medline TA:  Matern Child Health J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  689-98     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesia, Obstetrical / methods*
Anesthesia, Epidural* / adverse effects
Anesthetics, Local / administration & dosage
Breast Feeding*
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Labor, Obstetric* / drug effects
Maternal Age
New York
Oxytocics / administration & dosage*
Oxytocin / administration & dosage*
Postpartum Period
Pregnancy
Proportional Hazards Models
Socioeconomic Factors
Time Factors
Young Adult
Grant Support
ID/Acronym/Agency:
R01 HD055191/HD/NICHD NIH HHS; R01-HD055191/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 0/Oxytocics; 50-56-6/Oxytocin
Comments/Corrections

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