The Effect of Neuraxial Analgesia on Maternal Breastfeeding
Status:
Completed
Trial end date:
2016-12-01
Target enrollment:
Participant gender:
Summary
A previous randomized trial showed a possible negative association with labor neuraxial
analgesia with high compared to low doses of fentanyl, and breastfeeding at 6 weeks
postpartum. The significance of this study would be to validate or refute these findings. In
addition, we hope to better evaluate the impact of cumulative dose of fentanyl on
breastfeeding success in the initial postpartum period as well as at 6 weeks and 6 months
post delivery. In order to better assess the quality of breastfeeding, we will utilize a
validated breastfeeding assessment tool, LATCH (Latch, Audible swallowing, Type of Nipple,
Comfort, and Help). This validated tool can assess maternal and infant variables, define
areas of needed intervention, and determine priorities in providing patient teaching. The
LATCH assessment has been shown to be a predictor of breastfeeding duration. We also plan to
vary the dosage of fentanyl analgesia to determine the relationship between doses below 150
micrograms and changes in breastfeeding assessments. If a clear association between decreased
breastfeeding and total fentanyl is identified, then regimens to reduce cumulative doses of
fentanyl can be developed to improve the likelihood of breastfeeding success in mothers that
desire to breastfeed.
Prior observational studies have inferred epidurals negatively affect breastfeeding by
decreasing maternal plasma oxytocin release which may adversely affect infant neurobehavioral
development. In a study by Beilin et al., it was reported that mothers receiving a high
cumulative dose (> 150 microgram) epidural fentanyl were more likely to have stopped nursing
6 weeks postpartum compared with groups receiving no fentanyl or those receiving < 150
microgram. The study however, was underpowered to detect differences in breastfeeding prior
to hospital discharge. In addition, the breastfeeding assessment tool utilized resulted in
binary assessments, and therefore, a global rating of the quality of breastfeeding was not
available.