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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

The effect of labor epidural analgesia on breastfeeding outcomes: a prospective observational cohort study in a mixed parity cohort

Abstract Number: S5A-1
Abstract Type: Original Research

Sharon Orbach-ZInger MD1 ; Leonid A Eidelman MD2; Oren Ovad MD3; Avi Ben-Haroush MD4; Moshe Hoshen PhD5; Ruth Landau MD6

Background

Conflicting data about the impact of labor epidural analgesia (LEA) on successful breastfeeding (BF) exists, but intrapartum exposure to high epidural fentanyl doses has recently been refuted as a possible mechanism affecting BF outcomes. (1) We hypothesized that LEA would not influence BF status 6 weeks postpartum in women who intended to breastfeed in an environment that encourages BF.

Methods

In this prospective observational cohort study, 1204 women intending to breastfeed, delivering vaginally with or without LEA, were included. Primary outcome was BF at 6 weeks. A multivariable logistic regression was performed to assess factors affecting BF.

Results

The overall BF rate at 6 weeks was 76.9%; it was significantly lower among women delivering with LEA (67.2 %) compared with women delivering without (78.9%; p<0.001; Table).

There were 398 nulliparous women, of which 84.9% delivered with LEA; the LEA rate was significantly lower among multiparous women (61.8%; p<0.001).

Using multivariable logistic regression to assess the entire cohort, LEA was significantly associated with reduced BF at 6 weeks (OR 0.66, 95% CI 0.46-0.95; p=0.029).

Multiparous women (N=806) were more likely to breastfeed at 6 weeks (80.0% vs 70.6% nulliparas, p<0.001), furthermore the BF rate was significantly higher among multiparas who had previously breastfed (N=719) vs all other women with no BF experience (84.3% vs 66.0% respectively; OR 2.9 95% CI 2.1-3.6; p <0.001); furthermore, there was no difference in BF rates with or without LEA among women with prior BF experience (82.3% vs 87.3% respectively, OR 1.48 95% CI 0.97-2.20; p=0.08).

Using multivariable logistic, including the interaction term between LEA and prior BF experience, only prior BF was associated with increased BF at 6 weeks (OR 3.17 95% CI 1.72-5.80, p<0.001).

Conclusions

In our mixed parity cohort, delivering with LEA was associated with reduced likelihood of BF at 6 wks. However, integrating women's prior BF experience, the BF rate was not different between women delivering with or without LEA among the subset of multiparous women with prior BF experience.

Therefore, our findings suggest that offering lactation support to the subset of women with no prior BF experience, may be a simple approach to improve BF success.

This concept subscribes to the notion that women at risk for an undesired outcome be offered tailored interventions with a personalized approach.

1. Anesthesiology 2017;127614-24



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