Relationship between Use of Labor Pain Medications and Delayed Onset of Lactation

Abstract

Background:

Despite estimates that 83% of mothers in the United States receive labor pain medications, little research has been done on how use of these medications affect onset of lactation.

Objective:

To investigate whether use of labor pain medications is associated with delayed onset of lactation (DOL).

Methods:

We analyzed data from the 2005-2007 Infant Feeding Practices Study II, a longitudinal study of women from late pregnancy through the entire first year after birth (n = 2366). In multivariable logistic regression analyses, we assessed the relationship between mothers’ use of labor pain medication/method and DOL (milk coming in > 3 days after delivery).

Results:

Overall, 23.4% of women in our sample experienced DOL. Compared with women who delivered vaginally and received no labor pain medication, women who received labor pain medications had a higher odds of experiencing DOL: vaginal with spinal/epidural only (aOR 2.05; 95% CI, 1.43-2.95), vaginal with spinal/epidural plus another medication (aOR 1.79; 95% CI, 1.16-2.76), vaginal with other labor pain medications only ([not spinal/epidural]; aOR 1.84; 95% CI, 1.14-2.98), planned cesarean section with spinal/epidural only (aOR 2.13; 95% CI, 1.39-3.27), planned cesarean with spinal/epidural plus another medication (aOR 2.67; 95% CI, 1.35-5.29), emergency cesarean with spinal/epidural only (aOR 2.17; 95% CI, 1.34-3.51), and emergency cesarean with spinal/epidural plus another medication (aOR 3.03; 95% CI, 1.77-5.18).

Conclusion:

Mothers who received labor pain medications were more likely to report DOL, regardless of delivery method. This information could help inform clinical decisions regarding labor/delivery.

Keywords

breastfeeding lactation labor and delivery medication risk factors

Get full access to this article

View all access options for this article.

References

Chung

Raman

. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;(153):1-186.

American Academy of Pediatrics Section on Breastfeeding. Policy Statement: Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.

Committee on Health Care for Underserved Women ACoO, Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;109(2 pt 1):479-480.

Chapman

Perez-Escamilla

. Maternal perception of the onset of lactation is a valid, public health indicator of lactogenesis stage II. J Nutr. 2000;130(12):2972-2980.

Brownell

Howard

Lawrence

Dozier

. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr. 2012;161(4):608-614.

Chapman

Perez-Escamilla

. Identification of risk factors for delayed onset of lactation. J Am Diet Assoc. 1999;99(4):450-454.

Dewey

Nommsen-Rivers

Heinig

Cohen

. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003;112(3 pt 1):607-619.

Chapman

Perez-Escamilla

. Does delayed perception of the onset of lactation shorten breastfeeding duration? J Hum Lact. 1999;15(2):107-111.

Scott

Binns

Oddy

. Predictors of delayed onset of lactation. Matern Child Nutr. 2007;3(3):186-193.

10.

Hurst

. Recognizing and treating delayed or failed lactogenesis II. J Midwifery Womens Health. 2007;52(6):588-594.

11.

Nommsen-Rivers

Chantry

Peerson

Cohen

Dewey

. Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding. Am J Clin Nutr. 2010;92(3):574-584.

12.

Declercq

Sakala

Corry

Applebaum

Herrlich

. Listening to Mothers III: Pregnancy and Birth. New York, NY: Childbirth Connection; 2013.

13.

Hildebrandt

. Maternal perception of lactogenesis time: a clinical report. J Hum Lact. 1999;15(4):317-323.

14.

Fein

Labiner-Wolfe

Shealy

Chen

Grummer-Strawn

. Infant Feeding Practices Study II: study methods. Pediatrics. 2008;122(suppl 2):S28-S35.

15.

Dewey

. Maternal and fetal stress are associated with impaired lactogenesis in humans. J Nutr. 2001;131(11):3012S-3015S.

16.

US Department of Health and Human Services. The 2013 HHS poverty guidelines for the 48 contiguous states and the District of Columbia. Available at: http://aspe.hhs.gov/poverty/13poverty.cfm. Accessed May 30, 2013.

17.

Saadeh

Akre

. Ten steps to successful breastfeeding: a summary of the rationale and scientific evidence. Birth. 1996;23(3):154-160.

18.

DiGirolamo

Grummer-Strawn

Fein

. Effect of maternity-care practices on breastfeeding. Pediatrics. 2008;122(suppl 2):S43-S49.

19.

Smith

. Impact of birthing practices on the breastfeeding dyad. J Midwifery Womens Health. 2007;52(6):621-630.

20.

Loftus

Hill

Cohen

. Placental transfer and neonatal effects of epidural sufentanil and fentanyl administered with bupivacaine during labor. Anesthesiology. 1995;83(2):300-308.

21.

Righard

Alade

. Effect of delivery room routines on success of first breast-feed. Lancet. 1990;336(8723):1105-1107.

22.

Wiklund

Norman

Uvnas-Moberg

Ransjo-Arvidson

Andolf

. Epidural analgesia: breast-feeding success and related factors. Midwifery. 2009;25(2):e31-e38.

23.

Bell

White-Traut

Medoff-Cooper

. Neonatal neurobehavioral organization after exposure to maternal epidural analgesia in labor. J Obstet Gynecol Neonatal Nurs. 2010;39(2):178-190.

24.

Radzyminski

. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs. 2003;32(3):322-331.

25.

Riordan

Gross

Angeron

Krumwiede

Melin

. The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. J Hum Lact. 2000;16(1):7-12.

26.

Matthews

. The relationship between maternal labour analgesia and delay in the initiation of breastfeeding in healthy neonates in the early neonatal period. Midwifery. 1989;5(1):3-10.

27.

Ransjo-Arvidson

Matthiesen

Lilja

Nissen

Widstrom

Uvnas-Moberg

. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth. 2001;28(1):5-12.

28.

Goodfellow

Hull

Swaab

Dogterom

Buijs

. Oxytocin deficiency at delivery with epidural analgesia. Br J Obstet Gynaecol. 1983;90(3):214-219.

29.

Rahm

Hallgren

Hogberg

Hurtig

Odlind

. Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study. Acta Obstet Gynecol Scand. 2002;81(11):1033-1039.