Labor epidural anesthesia, obstetric factors and breastfeeding cessation

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

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)689-698
Number of pages10
JournalMaternal and Child Health Journal
Volume17
Issue number4
DOIs
StatePublished - May 1 2013
Externally publishedYes

Keywords

  • Breastfeeding
  • Epidural analgesia
  • Lactation
  • Oxytocin

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health

Fingerprint Dive into the research topics of 'Labor epidural anesthesia, obstetric factors and breastfeeding cessation'. Together they form a unique fingerprint.

  • Cite this

    Dozier, A. M., Howard, C. R., Brownell, E. A., Wissler, R. N., Glantz, J. C., Ternullo, S. R., Thevenet-Morrison, K. N., Childs, C. K., & Lawrence, R. A. (2013). Labor epidural anesthesia, obstetric factors and breastfeeding cessation. Maternal and Child Health Journal, 17(4), 689-698. https://doi.org/10.1007/s10995-012-1045-4