///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00

Epidural Analgesia Inclusive of Fentanyl Has Little Impact on Breastfeeding Compliance in Multiparous Patients Undergoing Vaginal Delivery

Abstract Number: 153
Abstract Type: Original Research

Paul M Wieczorek M.D.1 ; Vibhuti Shah M.D., MSc2; Mrinalini Balki M.D.3; Susan Guest R.N., M.N.4; Jose C.A. Carvalho M.D., PhD5

Background: A negative effect of epidural labor analgesia on breastfeeding in multiparous patients has been proposed, especially relating to the high doses of fentanyl contained in epidural mixtures. In our clinical experience, this effect is not as significant as quoted in the literature (1). This prospective, observational cohort study was designed to evaluate the impact of epidural analgesia inclusive of fentanyl on breastfeeding at our institution.

Methods: Term multiparous patients who received epidural analgesia for labor, had previously breastfed, and who intended to breastfeed after this pregnancy were recruited. Baseline demographics, as well as detailed epidural, obstetric, neonatal, and initial breastfeeding data were collected. Patients were telephoned both one and six weeks after delivery, and a seven-page questionnaire concerning breastfeeding success, supplementation, problems, and support was completed. Patients were segregated into two cohorts, defined by the cumulative dose of fentanyl administered over the course of labor (<150g, low dose or >150g, high dose). These divisions were based on previous research defining low and high dose fentanyl groups (1). Our primary outcome was breastfeeding cessation at 6 weeks.

Results: One-hundred and six patients were recruited, with eighteen patients excluded. Forty-eight patients received high dose fentanyl (mean 216.7g), and forty patients received low dose fentanyl (mean 105.4g). Only four patients stopped breastfeeding at 6 weeks because of issues related to the baby: one in the high dose group (1/48, 2.1%), and three in the low dose group (3/40, 7.5%). Compared to Beilin et al. (1), our incidence of patients not breastfeeding at 6 weeks who received high dose fentanyl was significantly lower (2.1% vs. 19%, p=0.0069). In the high dose fentanyl group, only 13% of patients continuing to breastfeed at the 6 week mark had difficulties with feeding, most of which were mild. The neonatal outcomes were similar between groups. No neonates demonstrated respiratory depression due to sedation. There were no admissions to the NICU, and no cases of hypoglycemia. Eighty-one percent of the patients who had previously worked outside of the home planned to take at least 6 months off after delivery, with a mean maternity leave of 10.7 months. Sixty-seven percent of the women received some degree of lactation support in the peri-partum period.

Conclusions: In multiparous patients with previous breastfeeding experience who undergo vaginal delivery with epidural analgesia inclusive of high dose epidural fentanyl, the incidence of successful breastfeeding at 6 weeks is much greater than previously reported in the literature. Free lactation support and long maternity leaves may explain this difference.

References: 1. Beilin Y, Bodian CA, Weiser J, et al. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding. Anesthesiology 2005; 103: 1211-7.

SOAP 2009