Does anesthesia affect breastfeeding rates at discharge?
Article Title: Path analysis model of epidural/spinal anesthesia on breastfeeding among healthy nulliparous women: Secondary analysis of the United States Certificate of Live Births 2016
Journal: Birth
Article Highlights
Main Takeaway:
Epidurals and spinal anesthesia are associated with nonbreastfeeding at discharge, mediated through medically assisted delivery. Health care providers should consider these risks and provide adequate support to help all women attain their breastfeeding goals.
Why?
Women need to be informed about possible risks of anesthesia in labor to enhance the probability of breastfeeding success.
Quotable Droplet with the most kCals per mL:
“… the path from the use of epidural anesthesia to the level of breastfeeding at discharge was fully mediated through increased medically assisted delivery.” (Hongo, et al., 2022)
A few more details:
Parameters: This study used a “chain of risk model,” (p. 262), by reviewing all U.S. 2016 birth certificate records and selecting out all but about 10%, to include healthy nulliparous women in a defined age range, gestating singletons full term, delivering in a hospital. This selection allowed quantifying the direct, indirect, and total effect of anesthesia on breastfeeding at discharge, with the mediator as a medically assisted birth. Their model suggests that the association between epidurals or spinal anesthesia and breastfeeding was significantly and fully mediated through medically assisted birth.
Limitations: This study does not address specific doses nor types of drugs, nor whether women might have used pharmacological anesthesia other than the epidural or spinal. It does not look beyond discharge, nor consider the intentions of individual women. These may warrant additional research.
Other hypotheses: This paper recognizes – and does not discount – other hypotheses regarding the mechanisms of how anesthesia may affect breastfeeding. These include, but are not limited to, lack of skin to skin and delayed initiation due to separation,1, 2 disturbing the infants’ instinctive movements such as massaging the breast and suckling during skin to skin contact immediately after birth,3, 4, 5 direct or indirect effect on endogenous oxytocin levels thereby effecting maternal milk production,6 and the increased risk of operative vaginal deliveries (noting few studies have quantified or statistically tested this).3, 7
Future studies: To address the “multilevel, dynamic processes of birth and to explore any modifiable risk factors that lead to breastfeeding difficulty,” (p. 270-271) are topics where future studies are needed.
Citation details
Article Title: Path analysis model of epidural/spinal anesthesia on breastfeeding among healthy nulliparous women: Secondary analysis of the United States Certificate of Live Births 2016
Authors: Manami Anna Hongo MD, MSPH, IBCLC; Kimberly Fryer MD, MSCR; Catherine Zimmer PhD; Christina Tucker PhD; Aunchalee E. L. Palmquist PhD, IBCLC
Journal: Birth, vol 49, issue 2
Publication Date: May 12, 2022
References noted:
World Health Organization. Guideline: Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services. World Health Organization; 2017.
Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2016;11:CD003519.
Smith LJ. Impact of birthing practices on the breastfeeding dyad. J Midwifery Women’s Health, 2007;52:621-630.
Matthiesen A, Lilja G, Widström A, Uvna K. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth. 2001; 28:5-12.
Brimdyr K, Cadwell K, Widström A-M, et al. The association between common labor drugs and suckling when skin-to-skin during the first hour after birth. Birth. 2015;42:319-328.
Dozier AM, Howard CR, Brownell EA, et al. Labor epidural anesthesia, obstetric factors and breastfeeding cessation NIH public access. Matern Child Heal J. 2013;17:689-698.
French CA, Cong X, Chung KS. Labor epidural analgesia and breastfeeding: a systematic review. J Hum Lact. 2016;32:507-520.
KEEPING UP-TO-DATE WITH BREASTFEEDING MEDICINE
Droplets of Knowledge: Helping practitioners stay up to date with the latest information on breastfeeding, as well as a look at some of the classic studies.
Prepared by Constance Pond
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