The Impact of Intrapartum Analgesia on Infant Feeding

Abstract

Most women in labor require analgesia, but strategies for providing analgesia are changing; today more women receive neuraxial analgesia, whereas the use of general anesthetics and reliance on inhalation or intramuscular analgesia have declined. To learn whether and how these changes have affected infant feeding practices after discharge from the hospital, the investigators undertook a retrospective case review of 425 primiparas who delivered a healthy singleton neonate at term. The mean gestational age was 39.6 weeks, and the mean birth weight was 3.4 kg. Nearly half of the women (45%) were exclusively bottle feeding their infants at discharge. Approximately one in 5 had attempted breast feeding. Approximately one third of all women did not attempt breast feeding at any time. At discharge from the hospital, 55% of women were successfully breast feeding their infants, partially or fully. Rates of bottle feeding were 32% for women given only nitrous oxide with oxygen, 42% for those given only intramuscular opioids plus nitrous oxide with oxygen, 44% for those given neuraxial analgesia containing only local anesthetic, and 54% for those given neuraxial analgesia containing an opioid. In particular, the lipophilic opioids fentanyl and diamorphine correlated with more frequent bottle feeding. The intrapartum use of antiemetics was associated with bottle feeding and also with operative delivery. There were no significant associations between feeding method and antenatal oxytocin, length of hospital stay, duration of labor, maternal body weight, or special infant care. Logistic regression analysis showed feeding at discharge to be predicted by maternal age, antenatal feeding plans, cesarean section, and the dose of fentanyl. Use of this agent correlated with bottle feeding in a dose-response manner. Fentanyl had little influence in women who planned to bottle feed, but for those considered least likely to bottle feed, it had a marked effect. The intrapartum use of fentanyl, especially in high doses, may act against the establishment of breast feeding. Replacing fentanyl-containing analgesic regimens with neuraxial analgesia containing only local anesthetic would be expected to promote breast feeding at the time of hospital discharge.