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The Impact of Breastfeeding on Postpartum Pain After Vaginal and Cesarean Delivery
Abstract Number: F 3
Abstract Type: Original Research
Introduction: Animal studies indicate that oxytocin may play a role in pain modulation [1, 2]. The analgesic effects of breastfeeding with its associated endogenous oxytocin release have not been well investigated. The study aim was to determine the impact of breastfeeding on perineal, incisional and cramping pain following vaginal and cesarean delivery.
Methods: Healthy multiparous women who had vaginal (n=43) and cesarean (n=40) deliveries of singleton term infants, and who were breastfeeding were enrolled in this IRB-approved observational cohort study. Women completed diaries to record perineal or incisional, and cramping pain scores 5 minutes before, during, and 5 minutes after breastfeeding. Demographic, obstetric and neonatal variables, as well as analgesic use were recorded.
Results: Cramping pain was significantly increased during, as compared to before or after breastfeeding in both the vaginal (P<0.001) and cesarean (P<0.001) delivery cohorts (Table). There was no difference in incisional pain before, during and after breastfeeding in women post-cesarean delivery (Table). There was a subtle increase in perineal pain during, compared to before (P=0.011) and after breastfeeding (P=0.032) in the vaginal delivery cohort (Table). The median (IQR) time to first successful breastfeed was 90 (60-165) minutes and 210 (175-248) minutes in the cesarean compared to vaginal delivery groups (P=0.041). The number of successful breastfeeds in the first 24 hours post-delivery were 8 ± 2 (P=0.209 between cesarean and vaginal delivery cohorts). At 6 weeks post-delivery 94% and 97% of the cesarean and vaginal delivery women respectively were successfully breastfeeding (P=0.489 between groups).
Discussion: Our findings suggest that breastfeeding increases cramping pain following vaginal and cesarean delivery. The increase in cramping pain is most likely due to the breastfeeding-associated oxytocin surge increasing uterine tone. No analgesic effect on perineal or incisional pain was observed during breastfeeding, indicating that endogenous oxytocin associated with breastfeeding may not play a significant role in postpartum pain modulation. Findings from this study can be utilized to inform patients about the impact of breastfeeding on pain following vaginal and cesarean delivery.
1. Yang J. Peptides 2007;28:1113-9
2. Miranda-Cardenas Y. Pain 2006;122:182-9