Effect of early breast feeding on pain perception in women undergoing spinal anaesthesia for caesarean delivery: a comparative study

Abstract

BackgroundPostoperative pain reduction is a key priority after caesarean delivery. Current recommendations are to breastfeed the baby as soon as possible after birth, including after caesarean section. However, analgesics can transfer into breast milk, and hence an ideal scenario is a postoperative period free from analgesics and pain. The aim of this study was to determine the effect of early breastfeeding on pain perception after caesarean delivery with spinal anaesthesia in the Gaza Strip. MethodsData for the comparative study were collected by research nurses at the Al Helal Al Emirati Hospital, Rafah, Gaza Strip, occupied Palestinian territory, from May to October, 2019. All women who had delivered at the hospital were encouraged to breastfeed as early as possible after caesarean delivery. Women who underwent caesarean delivery with spinal anaesthesia were assigned to one of two groups. Group 1 were women who breastfed in the first hour after caesarean delivery. Group 2 were women who were unable to breastfeed early (within 24 h) owing to maternal morbidity or neonatal causes such as admission to the neonatal intensive care units or a stillborn baby. A pain assessment scale (PAS; range 1–5, in which 1=no pain and 5=worst pain imaginable) was used to record the pain 1 h after the end of the caesarean delivery and then at 6 h, 12 h, 18 h, and 24 h. The time from the end of the caesarean delivery to the first demand for other analgesia and the total amounts and types of analgesics used in 24 h were recorded. The study was approved by the Palestinian Ministry of Health and the Helsinki Committee, Gaza Strip. Women provided verbal informed consent before participation. FindingsIn the period of the study there were approximately 590 women who delivered by caesarean section at Al Helal Al Emirati hospital, of whom 149 received spinal anaesthesia. Data from these 149 patients (mean age 30·85 years [SD 6·29]) were investigated: 111 (75%) in group 1 and 38 (26%) in group 2. The reported pain was lower in the first and 12th hour in group 1 than in group 2 (first hour, PAS 1·35 for group 1 vs 1·87 for group 2, p=0·004; 12th hour, PAS 1·35 for group 1 vs 1·73 for group 2, p=0·015). In group 1, 40 (36%) of 111 women needed analgesics after caesarean delivery, compared with 22 (58%) of 38 women in group 2 (p=0·018). Of the women who needed additional analgesia, 33 (83%) of 40 took only one analgesic and five (13%) of 40 took two analgesics in group 1, compared with 15 (68%) of 22 who took one analgesic and six (27%) of 22 who took two analgesics in group 2 (p=0·345 for group 1 vs group 2). The mean time to needing other analgesic drugs was longer in group 1 than in group 2 (10·54 h [SD 1·25] vs 6·40 h [SD 1·43]; p=0·035). InterpretationBreastfeeding within 1 h after caesarean delivery with spinal anaesthesia was associated with better pain reduction than no breastfeeding within 24 h. A multicentre study over a longer period post delivery, with a larger study population to include more types of delivery, would be of great benefit. FundingNone.