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Andrew MS, Selvaratnam RJ, Davies-Tuck M, Howland K, Davey MA. The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study. Int Breastfeed J 2022; 17:48. [PMID: 35791002 PMCID: PMC9254645 DOI: 10.1186/s13006-022-00492-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth. Methods This was a population-based cohort study of singleton livebirths at ≥37 weeks’ gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed. Results In total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86–0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome. Conclusion Common intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.
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Heesen P, Halpern SH, Beilin Y, Mauri PA, Eidelman LA, Heesen M, Orbach-Zinger S. Labor neuraxial analgesia and breastfeeding: An updated systematic review. J Clin Anesth 2020; 68:110105. [PMID: 33069970 DOI: 10.1016/j.jclinane.2020.110105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There have been numerous reports studying the effect of neuraxial analgesia on breastfeeding success, but the results are inconsistent. METHODS We performed a literature search in various databases for studies comparing neuraxial analgesia to non-neuraxial or no analgesia. Outcomes were the percentage of women breastfeeding fully or mixed with formula. Where possible, nulliparous parturients were analyzed separately. We conducted an analysis excluding studies of serious and critical risk of bias. Odds ratios and 95% confidence intervals were calculated. RESULTS We included 15 studies (13 observational studies, 1 secondary analysis of a randomized controlled trial, 1 case-control study) with 16,112 participants. Overall, there were 6 studies that found no difference between groups, 6 studies that showed a significantly lower incidence of breastfeeding in the neuraxial group and 3 studies finding mixed results (at some time-points statistically significant and at some time-point statistically non-significant results). In nulliparous only studies, 2 found no difference between study groups, 1 found a lower breastfeeding rate in the neuraxial group and 3 studies showed mixed results. Excluding studies with a serious and critical risk of bias, 1 study found no difference between study groups, 3 studies found a decrease of breastfeeding rates in the neuraxial group, and 1 study showed mixed results. DISCUSSION In our review we found a high disparity in results. One reason is probably the high potential of confounding (immediate skin to skin placement, maternity leave etc.). Education programs and breastfeeding support are likely more important in determining long term breastfeeding success.
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Affiliation(s)
- Philip Heesen
- Faculty of Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
| | - Stephen H Halpern
- Department of Anesthesia, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - Yaakov Beilin
- Department of Anesthesiology, Perioperative and Pain Medicine, and Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Paola A Mauri
- School of Midwifery, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via della Commenda 19, 20122 Milano, Italy; Department of Mother Child and Newborn Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy.
| | - Leonid A Eidelman
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Zeev Jabutinskiy Rd 39, Petah Tikva 49100, Israel.
| | - Michael Heesen
- Department of Anesthesia, Kantonsspital Baden, Im Ergel 1, 5404 Baden, Switzerland.
| | - Sharon Orbach-Zinger
- Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Zeev Jabutinskiy Rd 39, Petah Tikva 49100, Israel.
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Wetzl RG, Delfino E, Peano L, Gogna D, Vidi Y, Vielmi F, Bianquin E, Cerioli S, Bettinelli ME, Giannì ML, Frassy G, Boris E, Arioni C. A priori choice of neuraxial labour analgesia and breastfeeding initiation success: a community-based cohort study in an Italian baby-friendly hospital. BMJ Open 2019; 9:e025179. [PMID: 30842116 PMCID: PMC6429869 DOI: 10.1136/bmjopen-2018-025179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth. DESIGN Single-centre community-based cohort study. SETTING An Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015. PARTICIPANTS Inclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed. EXCLUSION CRITERIA women who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia. RESULTS Compared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (64.3%), vs 93/189 (49.2%; p<0.001; RD, 15.1%)). Multivariable analyses with antelabour-only confounders confirmed both associations (planned vaginal birth: relative risk (RR), 0.65; 95% CI, 0.48 to 0.87; actual vaginal birth: RR, 0.59; 95% CI, 0.43 to 0.80). Although women who requested analgesia as a last resort had less BIS than did those successfully coping with labour pain in the bivariable analyses (planned vaginal birth: 1804/2853 (63.2%), vs 317/568 (55.8%; p=0.001; RD, 7.4%); actual vaginal birth: 1665/2546 (65.4%), vs 259/448 (57.8%; p=0.002; RD, 7.6%)), multivariable analyses with either antelabour-only or peripartum confounders did not confirm these associations (planned vaginal birth: RR, 0.99; 95% CI, 0.80 to 1.23; actual vaginal birth: RR, 0.90; 95% CI, 0.69 to 1.16). CONCLUSIONS Compared with trying to cope with labour pain, a priori choice of neuraxial analgesia is negatively associated with BIS. Conversely, compared with having successfully coped with pain, requesting neuraxial analgesia as a last resort is not negatively associated with BIS.
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Affiliation(s)
- Roberto Giorgio Wetzl
- Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Enrica Delfino
- Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Luca Peano
- Mother-Child Department, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Daniela Gogna
- Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Yvette Vidi
- Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Francesca Vielmi
- Mother-Child Department, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Eleonora Bianquin
- Mother-Child Department, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Serena Cerioli
- Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Maria Enrica Bettinelli
- Mother and Child Health Unit, Agenzia di Tutela della Salute della Città Metropolitana di Milano, Milano, Italy
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda, Study University of Milan, Milano, Italy
| | - Gabriella Frassy
- Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Elena Boris
- Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
| | - Cesare Arioni
- Mother-Child Department, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy
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Abola R, Romeiser J, Grewal S, Rizwan S, Adsumelli R, Steinberg E, Bennett-Guerrero E. Association of postoperative nausea/vomiting and pain with breastfeeding success. Perioper Med (Lond) 2017; 6:18. [PMID: 29201358 PMCID: PMC5700740 DOI: 10.1186/s13741-017-0075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 10/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Successful breastfeeding is a goal set forth by the World Health Organization to improve neonatal care. Increasingly, patients express the desire to breastfeed, and clinicians should facilitate successful breastfeeding. The primary aim of this study is to determine if postoperative nausea and vomiting (PONV) or postoperative pain are associated with decreased breastfeeding success after cesarean delivery. Methods This is a historical cohort study using the Stony Brook Elective Cesarean Delivery Database. Self-reported breastfeeding success at 4 weeks postoperative was analyzed for associations with postoperative antiemetic use and postoperative pain scores. Breastfeeding success was also analyzed for associations with patient factors and anesthetic medications. Results Overall, 86% of patients (n = 81) who intended on breastfeeding reported breastfeeding success. Breastfeeding success was not associated with postoperative nausea or vomiting as measured by post anesthesia care unit antiemetic use (15% use in successful vs. 18% use in unsuccessful, p = 0.67) or 48-h antiemetic use (28% use in successful group vs 36% use in unsuccessful group, p = 0.732). Pain visual analog scale scores at 6, 12 and 24 h postoperatively were not significantly different between patients with or without breastfeeding success. Breastfeeding success was associated with having had at least 1 previous child (86% vs 36%, p < 0.001). Patients with asthma were less likely to have breastfeeding success (45% vs 4%, p = 0.002). Conclusions Efforts to improve PONV and pain after cesarean delivery may not be effective in improving breastfeeding success. To possibly improve breastfeeding rates, resources should be directed toward patients with no previous children and patients with asthma.
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Affiliation(s)
- Ramon Abola
- Stony Brook Medicine, Department of Anesthesiology, HSC-4-060, Stony Brook, NY 11794 USA
| | - Jamie Romeiser
- Stony Brook Medicine, Department of Anesthesiology, HSC-4-060, Stony Brook, NY 11794 USA
| | - Suman Grewal
- Stony Brook Medicine, Department of Anesthesiology, HSC-4-060, Stony Brook, NY 11794 USA
| | - Sabeen Rizwan
- Stony Brook Medicine, Department of Anesthesiology, HSC-4-060, Stony Brook, NY 11794 USA
| | - Rishimani Adsumelli
- Stony Brook Medicine, Department of Anesthesiology, HSC-4-060, Stony Brook, NY 11794 USA
| | - Ellen Steinberg
- Stony Brook Medicine, Department of Anesthesiology, HSC-4-060, Stony Brook, NY 11794 USA
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Kothari A, Khurjekar K, Hadgaonkar S, Kulkarni H, Sancheti P. Cauda Equina Syndrome in a Lactating Mother - A Safe Treatment Approach. J Clin Diagn Res 2017; 11:RD03-RD05. [PMID: 28969225 DOI: 10.7860/jcdr/2017/27064.10494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/26/2017] [Indexed: 01/31/2023]
Abstract
Cauda equina syndrome is widely considered as a surgical emergency. The cause of cauda equina syndrome usually is a large central lumbar disc herniation, prolapse or sequestration. Decompression at the earliest has been suggested by many authors but the planning of surgical management becomes challenging when the patient is a breastfeeding mother. Fear of harmful effects of the drugs (administered in the mother) on the infant, always confuses clinicians regarding the treatment approach. So the multidisciplinary approach is necessary with involvement of anaesthetist, paediatrician and also a gynaecologist if necessary. Thorough knowledge of the safety of drugs to be used in operative and post operative period becomes a necessity keeping the baby into consideration. We present a case of one month postpartum female with cauda equina syndrome and present a stepwise multidisciplinary approach, which involves active contributions from surgeon, for safety of the mother and the infant.
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Affiliation(s)
- Ajay Kothari
- Assistant Professor, Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Ketan Khurjekar
- Chief Consultant, Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Shailesh Hadgaonkar
- Deputy Chief Consultant, Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Himanshu Kulkarni
- Junior Consultant, Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag Sancheti
- Director, Department of Orthopaedics, Arthroscopy and Arthroplasty, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
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Fernández-Cañadas Morillo A, Marín Gabriel MA, Olza Fernández I, Martínez Rodríguez B, Durán Duque M, Malalana Martínez AM, Gonzalez Armengod C, Pérez Riveiro P, García Murillo L. The Relationship of the Administration of Intrapartum Synthetic Oxytocin and Breastfeeding Initiation and Duration Rates. Breastfeed Med 2017; 12:98-102. [PMID: 28165755 DOI: 10.1089/bfm.2016.0185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM The consequences that intrapartum administration of hormones can have on breastfeeding are unclear. The aim of the study is to determine if synthetic intrapartum oxytocin, used routinely for induction/stimulation, has a relationship to initiation/duration of breastfeeding. PATIENTS AND METHODS We conducted a cohort study that was carried out in a tertiary university hospital distinguished by WHO-UNICEF as a BFHI (Baby-Friendly Hospital Initiative). A group of 53 mother and newborn dyads who had been exposed to intrapartum synthetic oxytocin were compared with 45 nonexposed dyads. A breastfeeding questionnaire was administered by a midwife blind to patient group through phone calls 3 and 6 months after delivery. RESULTS No statistically significant differences were observed between the two groups in the rates of mothers exclusively breastfeeding (EBF) or nonexclusively breastfeeding. The percentage of those who were EBF when discharged was 97.3% in the oxytocin-nonexposed group and 87.1% in the oxytocin-exposed group (p = 0.14). At 3 months, the group rates of exclusive breastfeeding were 72.5% in the nonoxytocin-exposed group versus 65.9% in the oxytocin-exposed group (p = 0.71). At 6 months, rates of breastfeeding were 31.4% versus 27.9% (p = 0.53) in the oxytocin-nonexposed and oxytocin-exposed groups, respectively. CONCLUSIONS In this study, no statistically significant effect of intrapartum synthetic oxytocin administration was observed pertaining to the initiation or duration of breastfeeding.
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Affiliation(s)
| | - Miguel A Marín Gabriel
- 2 Department of Pediatrics, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
| | - Ibone Olza Fernández
- 3 Department of Psychiatry, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
| | - Begoña Martínez Rodríguez
- 4 Division of Neonatology and Newborn Nursery, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
| | - Modesto Durán Duque
- 1 Department of Midwifery, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
| | - Ana M Malalana Martínez
- 2 Department of Pediatrics, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
| | | | - Pilar Pérez Riveiro
- 4 Division of Neonatology and Newborn Nursery, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
| | - Lourdes García Murillo
- 3 Department of Psychiatry, Puerta de Hierro Majadahonda University Hospital , Madrid, Spain
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Abstract
Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively.
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Affiliation(s)
- Cynthia A French
- Columbia University, Graduate Program in Nurse Anesthesia, New York, NY, USA Yale New Haven Hospital, New Haven, CT, USA
| | - Xiaomei Cong
- University of Connecticut, School of Nursing, Storrs, CT, USA
| | - Keun Sam Chung
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
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8
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Brimdyr K, Cadwell K, Widström A, Svensson K, Neumann M, Hart EA, Harrington S, Phillips R. The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth. Birth 2015; 42:319-28. [PMID: 26463582 PMCID: PMC5057303 DOI: 10.1111/birt.12186] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin, have been previously studied in relation to neonatal outcomes, especially breastfeeding, with conflicting results. We examined the normal neonatal behavior of suckling within the first hour after a vaginal birth while in skin-to-skin contact with mother in relation to these commonly used drugs. Suckling in the first hour after birth has been shown in other studies to increase desirable breastfeeding outcomes. METHOD Prospective comparative design. Sixty-three low-risk mothers self-selected to labor with intrapartum analgesia/anesthesia or not. Video recordings of infants during the first hour after birth while being held skin-to-skin with their mother were coded and analyzed to ascertain whether or not they achieved Stage 8 (suckling) of Widström's 9 Stages of newborn behavior during the first hour after birth. RESULTS A strong inverse correlation was found between the amount and duration of exposure to epidural fentanyl and the amount of synthetic oxytocin against the likelihood of achieving suckling during the first hour after a vaginal birth. CONCLUSIONS Results suggest that intrapartum exposure to the drugs fentanyl and synthetic oxytocin significantly decreased the likelihood of the baby suckling while skin-to-skin with its mother during the first hour after birth.
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Affiliation(s)
- Kajsa Brimdyr
- Healthy Children Project, Inc.East SandwichMAUSA,Maternal Child HealthUnion Institute and UniversityCincinnatiOHUSA
| | - Karin Cadwell
- Healthy Children Project, Inc.East SandwichMAUSA,Maternal Child HealthGraduate Program in Health and WellnessUnion Institute and UniversityCincinnatiOHUSA
| | - Ann‐Marie Widström
- Division of Reproductive HealthDepartment of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Kristin Svensson
- Division of Reproductive HealthDepartment of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Monica Neumann
- Obstetric AnesthesiologyLoma Linda University School of MedicineLoma Linda University Children's HospitalLoma Linda University Medical CenterLoma LindaCAUSA
| | - Elaine A. Hart
- Loma Linda University School of MedicineLoma Linda University Children's HospitalLoma Linda University Medical CenterLoma LindaCAUSA
| | - Sarah Harrington
- Kern Medical CenterBakersfieldCAUSA,Loma Linda University School of MedicineLoma LindaCAUSA
| | - Raylene Phillips
- Department of PediatricsLoma Linda University School of MedicineLoma Linda University Children's HospitalLoma Linda University Medical CenterLoma LindaCAUSA
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9
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Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, Demirakca S, Eckardt R, Eggers V, Eichler I, Fietze I, Freys S, Fründ A, Garten L, Gohrbandt B, Harth I, Hartl W, Heppner HJ, Horter J, Huth R, Janssens U, Jungk C, Kaeuper KM, Kessler P, Kleinschmidt S, Kochanek M, Kumpf M, Meiser A, Mueller A, Orth M, Putensen C, Roth B, Schaefer M, Schaefers R, Schellongowski P, Schindler M, Schmitt R, Scholz J, Schroeder S, Schwarzmann G, Spies C, Stingele R, Tonner P, Trieschmann U, Tryba M, Wappler F, Waydhas C, Weiss B, Weisshaar G. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. Ger Med Sci 2015; 13:Doc19. [PMID: 26609286 PMCID: PMC4645746 DOI: 10.3205/000223] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 02/08/2023]
Abstract
In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.
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Affiliation(s)
| | | | | | | | - Stephan Braune
- German Society of Internal Medicine Intensive Care (DGIIN)
| | - Hartmut Buerkle
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Peter Dall
- German Society of Gynecology & Obstetrics (DGGG)
| | - Sueha Demirakca
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | | | - Verena Eggers
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Ingolf Eichler
- German Society for Thoracic and Cardiovascular Surgery (DGTHG)
| | | | | | | | - Lars Garten
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | | | - Irene Harth
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | | | | | - Johannes Horter
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Ralf Huth
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | - Uwe Janssens
- German Society of Internal Medicine Intensive Care (DGIIN)
| | | | | | - Paul Kessler
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | | | | | - Matthias Kumpf
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | - Andreas Meiser
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Anika Mueller
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | | | | | - Bernd Roth
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | | | | | | | - Monika Schindler
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
| | - Reinhard Schmitt
- German Society for Specialised Nursing and Allied Health Professions (DGF)
| | - Jens Scholz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Stefan Schroeder
- German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN)
| | | | - Claudia Spies
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | | | - Peter Tonner
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Uwe Trieschmann
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Michael Tryba
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Frank Wappler
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Christian Waydhas
- German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI)
| | - Bjoern Weiss
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Guido Weisshaar
- German Society of Neonatology and Pediatric Intensive Care (GNPI)
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10
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Dimitraki M, Tsikouras P, Manav B, Gioka T, Koutlaki N, Zervoudis S, Galazios G. Evaluation of the effect of natural and emotional stress of labor on lactation and breast-feeding. Arch Gynecol Obstet 2015; 293:317-28. [DOI: 10.1007/s00404-015-3783-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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11
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Abstract
Present-day mothers have an increased desire to breastfeed, but this desire has increased in parallel with the increased use of epidural analgesia during labor. Epidural anesthesia requires a high level of technical proficiency to avoid serious complications and should always be performed by a trained anesthetist using a strict aseptic technique to reduce the risk of infection. There is currently no consensus regarding the relationship between breastfeeding and epidural analgesia during labor. The purpose of this review was to evaluate the effect of epidural analgesia on breastfeeding.
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Affiliation(s)
- Mert Akbas
- Department of Anesthesiology, Division of Algology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - A Baris Akcan
- Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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12
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Zuppa AA, Alighieri G, Riccardi R, Cavani M, Iafisco A, Cota F, Romagnoli C. Epidural analgesia, neonatal care and breastfeeding. Ital J Pediatr 2014; 40:82. [PMID: 25432659 PMCID: PMC4335561 DOI: 10.1186/s13052-014-0082-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
The objective of our study is to evaluate the correlation between epidural analgesia during labor, start of breastfeeding and type of maternal-neonatal care.Two different assistance models were considered: Partial and Full Rooming-in.In this cohort study, 2480 healthy infants were enrolled, 1519 in the Partial Rooming-in group and 1321 in the Full Rooming-in group; 1223 were born to women subjected to epidural analgesia in labor.In case of Partial Rooming-in the rate of exclusive or prevailing breastfeeding is significant more frequent in newborns born to mothers who didn't receive analgesia. Instead, in case of Full Rooming-in the rate of exclusive or prevailing breastfeeding is almost the same and there's no correlation between the use or not of epidural analgesia.The good start of lactation and the success of breastfeeding seems to be guaranteed by the type of care offered to the couple mother-infant, that reverses any possible adverse effects of the use of epidural analgesia in labor.
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Affiliation(s)
- Antonio Alberto Zuppa
- Department of Pediatric, Division of Neonatology, "A. Gemelli" General Hospital, Largo Agostino Gemelli, 8, 00168, Roma, RM, Italy.
| | - Giovanni Alighieri
- Department of Pediatric, Division of Neonatology, "A. Gemelli" General Hospital, Largo Agostino Gemelli, 8, 00168, Roma, RM, Italy.
| | - Riccardo Riccardi
- Department of Pediatric, Division of Neonatology, "A. Gemelli" General Hospital, Largo Agostino Gemelli, 8, 00168, Roma, RM, Italy.
| | - Maria Cavani
- Department of Pediatric, Division of Neonatology, "A. Gemelli" General Hospital, Largo Agostino Gemelli, 8, 00168, Roma, RM, Italy.
| | - Alma Iafisco
- Department of Pediatric, Division of Neonatology, "A. Gemelli" General Hospital, Largo Agostino Gemelli, 8, 00168, Roma, RM, Italy.
| | - Francesco Cota
- Department of Pediatric, Division of Neonatology, "A. Gemelli" General Hospital, Largo Agostino Gemelli, 8, 00168, Roma, RM, Italy.
| | - Costantino Romagnoli
- Department of Pediatric, Division of Neonatology, "A. Gemelli" General Hospital, Largo Agostino Gemelli, 8, 00168, Roma, RM, Italy.
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13
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Saleh RH, Ebade AA, Ibrahim M, Tomerek RH. Transplacental transfer and neonatal influences of sonophoretically administered sufentanil versus epidural sufentanil in labor peridural analgesia: A randomized prospective double-blind contemplate. Egyptian Journal of Anaesthesia 2014. [DOI: 10.1016/j.egja.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | | | - Mohamed Ibrahim
- Department of Chemical Analysis and Evaluation, Egyptian Petroleum Research Institute , Egypt
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14
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Alus Tokat M, Serçekuş P, Yenal K, Okumuş H. Early Postpartum Breast-Feeding Outcomes and Breast-Feeding Self-Efficacy in Turkish Mothers Undergoing Vaginal Birth or Cesarean Birth With Different Types of Anesthesia. Int J Nurs Knowl 2014; 26:73-9. [DOI: 10.1111/2047-3095.12037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Merlinda Alus Tokat
- Obstetric and Gynecologic Nursing Department; Dokuz Eylul University Faculty of Nursing; Izmir Turkey
| | - Pinar Serçekuş
- Obstetric and Gynecologic Nursing Department; Pamukkale University Denizli School of Health; Denizli Turkey
| | - Kerziban Yenal
- Obstetric and Gynecologic Nursing Department; Şifa University Faculty of Health Science; Izmir Turkey
| | - Hülya Okumuş
- Obstetric and Gynecologic Nursing Department; Şifa University Faculty of Health Science; Izmir Turkey
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15
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Abstract
There has been an increase in breast-feeding supported by the recommendations of the American Academy of Pediatrics and the World Health Organization. An anesthesiologist may be presented with a well-motivated breast-feeding mother who wishes to breast-feed her infant in the perioperative period. Administration of anesthesia entails acute administration of drugs with potential for sedation and respiratory effects on the nursing infant. The short-term use of these drugs minimizes the possibility of these effects. The aim should be to minimize the use of narcotics and benzodiazepines, use shorter acting agents, use regional anesthesia where possible and avoid agents with active metabolites. Frequent clinical assessments of the nursing infant are important. Available literature does suggest that although the currently available anesthetic and analgesic drugs are transferred in the breast milk, the amounts transferred are almost always clinically insignificant and pose little or no risk to the nursing infant.
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Affiliation(s)
- Priti G Dalal
- Department of Anesthesiology, Penn State University College of Medicine, Milton S Hershey Medical Center, Hershey, PA, USA
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16
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Dozier AM, Howard CR, Brownell EA, Wissler RN, Glantz JC, Ternullo SR, Thevenet-Morrison KN, Childs CK, Lawrence RA. Labor epidural anesthesia, obstetric factors and breastfeeding cessation. Matern Child Health J 2013; 17:689-98. [PMID: 22696104 DOI: 10.1007/s10995-012-1045-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Ann M Dozier
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA.
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Cassels TG. The long-term effects of birthing interventions on childhood empathy. Midwifery 2014; 30:471-5. [PMID: 23866684 DOI: 10.1016/j.midw.2013.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 05/10/2013] [Accepted: 05/24/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES birthing practices have changed drastically over the past century. It is now more common for women to birth in a hospital, receive drug interventions, and to birth via caesarean section, yet there is a paucity of research on long-term outcomes associated with practices. The research was designed to determine if there were any long-term effects of the birthing experience on child empathic behaviour. METHODS two-hundred-and-sixty-four mother-child dyad (M(child_age)=5.92 years; SD=.85 years; 127 boys) completed either a questionnaire on birthing practices (mothers) or a modified Stickers Task to assess empathic behaviour (child). RESULTS there was a non-significant effect (Δ=.22, p=.395) of home versus hospital birth and a small-moderate, significant (Δ=.33, p=.017) effect of the use of epidurals during, with children of mothers who did not use an epidural or who birthed at home showing greater empathic behaviour. CONCLUSIONS the birthing location and the decision to have an epidural can have long-term consequences on children's empathy. While researchers need to further examine the mechanisms behind these findings, parents should be made aware of the potential long-term effects in order to allow them to make fully informed decisions.
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Abstract
INTRODUCTION Few women who reside in Hong Kong exclusively breastfeed, and one-half stop breastfeeding within the first few months. There is little research in this population on the association between intrapartum interventions and breastfeeding duration. METHODS A sample of 1280 mother-infant pairs were recruited from the obstetric units of 4 public hospitals in Hong Kong and followed prospectively for 12 months or until the infant was weaned. The outcome variables for this analysis were the duration of any and exclusive breastfeeding. Predictor variables were 4 intrapartum interventions: receipt of opioid pain medication, induction versus spontaneous labor, epidural administration, and mode of birth. We used Cox proportional hazards modeling to assess the impact of intrapartum interventions on the duration of any and exclusive breastfeeding, and we constructed Kaplan-Meier survival curves to evaluate the cumulative impact of multiple intrapartum interventions on breastfeeding outcomes. RESULTS Bivariate analysis showed that induction of labor (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.09-1.41), opioid pain medication (HR, 1.21; 95% CI, 1.06-1.37), and having an emergency cesarean birth (HR, 1.22; 95% CI, 1.01-1.48) were associated with a shorter duration of any breastfeeding. Induction of labor (HR, 1.23; 95% CI, 1.08-1.39) and having an emergency cesarean birth (HR, 1.25; 95% CI, 1.05-1.51) were associated with a shorter duration of exclusive breastfeeding. After controlling for known confounding variables, there was no longer any association between individual intrapartum interventions and the duration of any or exclusive breastfeeding. The median duration of breastfeeding for participants who experienced a natural birth with no intrapartum interventions was 9 weeks compared with 5 weeks for participants who experienced at least 3 intrapartum interventions. DISCUSSION Clinicians working with new breastfeeding mothers should focus on providing additional support to mothers who experience a difficult labor and birth with multiple interventions to improve their breastfeeding experiences.
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19
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Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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MESH Headings
- Analgesia, Epidural/adverse effects
- Analgesia, Epidural/methods
- Analgesia, Obstetrical/adverse effects
- Analgesia, Obstetrical/methods
- Analgesics/adverse effects
- Analgesics/pharmacokinetics
- Analgesics/therapeutic use
- Anesthesia, Epidural/adverse effects
- Anesthesia, Epidural/methods
- Anesthesia, Obstetrical/adverse effects
- Anesthesia, Obstetrical/methods
- Anesthetics/adverse effects
- Anesthetics/pharmacokinetics
- Anesthetics/therapeutic use
- Breast Feeding
- Female
- Humans
- Hypnotics and Sedatives/adverse effects
- Hypnotics and Sedatives/pharmacokinetics
- Hypnotics and Sedatives/therapeutic use
- Infant, Newborn
- Milk, Human/chemistry
- Milk, Human/drug effects
- Pain Management/methods
- Postnatal Care
- Pregnancy
- Surgical Procedures, Operative
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20
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Gizzo S, Di Gangi S, Saccardi C, Patrelli TS, Paccagnella G, Sansone L, Barbara F, D'Antona D, Nardelli GB. Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding. Breastfeed Med 2012; 7:262-8. [PMID: 22166068 DOI: 10.1089/bfm.2011.0099] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The effect of epidural analgesia on labor and effective breastfeeding is still being debated. The aim of this study is to define its impact on the trend of labor, the newborns' well-being, and early breastfeeding. METHODS We considered first-term physiologic pregnant women who delivered by the vaginal route. We divided them into two groups: group A received epidural analgesia during labor, whereas group B received no analgesia. We recorded maternal age, gestational age, modality of delivery, length of labor, and length of active labor. All newborns received skin-to-skin contact; early breastfeeding was encouraged. We recorded data on birth weight and length, Apgar score at minutes 1 and 5, type of crying, neonatal reactivity, and time between birth and exposure to the breast. Statistical significance was considered for p<0.05. RESULTS Of 934 pregnant women who delivered by the vaginal route, 317 patients required labor analgesia, and 245 patients agreed to participate in our study. Only 128 patients met inclusion criteria. We randomized them in 64 women in group A and 64 women in group B. Data on maternal age, gestational age, type of delivery, neonatal birth weight and length, and Apgar score showed no significant differences. Total length of labor was 363.58±62.20 minutes in Group A versus 292.30±64.75 minutes in group B (p<0.001). The length of active labor showed no significant difference. Among neonatal parameters we found a statistically significant difference only for length of first breastfeeding, with a mean duration of <30 minutes in 62.2% in group A versus 29.3% in Group B (p<0.001). CONCLUSIONS Epidural analgesia has little effect on trend of labor and duration of first breastfeed and none on neonatal outcome. A new protocol of epidural analgesia may solve these side effects.
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Affiliation(s)
- Salvatore Gizzo
- Department of Gynecological Sciences and Human Reproduction, University of Padua, Padua, Italy.
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21
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Bajwa SS, Bajwa S. Impact of epidural analgesia on breast feeding: A possible relation and the existing controversies. J Obstet Anaesth Crit Care 2012. [DOI: 10.4103/2249-4472.99339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Abstract
A number of practices during the intrapartum and very early postnatal period may affect breastfeeding initiation. All women should be encouraged to breastfeed soon after birth, with extra attention paid to the identification and offer of extra support for those women at higher risk of not successfully initiating and continuing breastfeeding. Factors that affect breastfeeding initiation include: implementation of the Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding at a service level; avoidance of the use of intramuscular narcotic analgesia, particularly near the end of the first stage of labour; not separating mothers and babies after birth for routine procedures; and placing healthy newborns on their mothers' chest/abdomen (skin-to-skin) routinely. Single strategies are unlikely to increase breastfeeding initiation as stand-alone measures.
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Abstract
Epidural analgesia is an extremely effective and popular treatment for labor pain. In this review, we trace the history of the use of epidural analgesia and its refinements. We then outline the goals of treatment and methods used to attain those goals. The use of low concentrations of local anesthetics, combined with lipid-soluble opioids, does not impede the progress of labor or depress the newborn. The incidence of side effects is low. Maintenance of analgesia that allows patient control enhances patient satisfaction.
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Affiliation(s)
- Marcos Silva
- Department of Anesthesia, Sunnybrook Health Sciences Centre
and University of Toronto, Toronto, Canada
| | - Stephen H Halpern
- Department of Anesthesia, Sunnybrook Health Sciences Centre
and University of Toronto, Toronto, Canada
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Wieczorek P, Guest S, Balki M, Shah V, Carvalho J. Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study. Int J Obstet Anesth 2010; 19:273-7. [DOI: 10.1016/j.ijoa.2010.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/06/2010] [Accepted: 02/09/2010] [Indexed: 11/22/2022]
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Reynolds F. The effects of maternal labour analgesia on the fetus. Best Pract Res Clin Obstet Gynaecol 2010; 24:289-302. [DOI: 10.1016/j.bpobgyn.2009.11.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 11/16/2009] [Indexed: 02/02/2023]
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Affiliation(s)
- Joy L Hawkins
- Department of Anesthesiology, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.
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Martin J, Heymann A, Bäsell K, Baron R, Biniek R, Bürkle H, Dall P, Dictus C, Eggers V, Eichler I, Engelmann L, Garten L, Hartl W, Haase U, Huth R, Kessler P, Kleinschmidt S, Koppert W, Kretz FJ, Laubenthal H, Marggraf G, Meiser A, Neugebauer E, Neuhaus U, Putensen C, Quintel M, Reske A, Roth B, Scholz J, Schröder S, Schreiter D, Schüttler J, Schwarzmann G, Stingele R, Tonner P, Tränkle P, Treede RD, Trupkovic T, Tryba M, Wappler F, Waydhas C, Spies C. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version. Ger Med Sci 2010; 8:Doc02. [PMID: 20200655 PMCID: PMC2830566 DOI: 10.3205/000091] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Indexed: 12/28/2022]
Abstract
Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2(nd) Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). Between 2006-2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3(rd) Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade "A" (very strong recommendation), Grade "B" (strong recommendation) and Grade "0" (open recommendation) were agreed. As a result of this process we now have an interdisciplinary and consensus-based set of 3(rd) Generation Guidelines that take into account all critically illness patient populations. The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success.
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Affiliation(s)
- Jörg Martin
- Department of Anesthesiology and Operative Intensive Care, Klinik am Eichert, Göppingen, Germany
| | - Anja Heymann
- Department of Anesthesiology and Operative Intensive Care, Charité Campus Virchow, Berlin, Germany
| | | | - Ralf Baron
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Rolf Biniek
- Department of Neurology, LVR-Klinik Bonn, Germany
| | - Hartmut Bürkle
- Clinic for Anaesthesiology and Operative Intensive Care and Pain Clinic of Memmingen, Germany
| | | | | | - Verena Eggers
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Ingolf Eichler
- Department of Cardiac and Vascular Surgery, Klinikum Dortmund GgmbH, Germany
| | - Lothar Engelmann
- Department of Internal Medicine and Intensive Care Medicine, University of Leipzig, Germany
| | - Lars Garten
- Department of Neonatology, Charité University Medicine Berlin, Germany
| | - Wolfgang Hartl
- Department of Surgery Grosshadern, University of Munich, Germany
| | - Ulrike Haase
- Department of Anesthesiology and Intensive Care Medicine, Charité Campus Mitte, Berlin, Germany
| | - Ralf Huth
- University Children's Hospital of Mainz, Germany
| | - Paul Kessler
- Department of Anesthesiology and Intensive Care Medicine, Orthopedic University Hospital, Frankfurt, Germany
| | - Stefan Kleinschmidt
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, BG Trauma Clinic Ludwigshafen, Germany
| | - Wolfgang Koppert
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Germany
| | - Franz-Josef Kretz
- Olgahospital, Department of Anesthesiology and Operative Intensive Care, Stuttgart, Germany
| | | | - Guenter Marggraf
- West German Heart Center Essen, Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Germany
| | - Andreas Meiser
- Department of Anesthesiology, Intensive Care and Pain, Saarland University Hospital, Homburg, Germany
| | - Edmund Neugebauer
- IFOM - Institute for Research in Operative Medicine, Institute for Surgical Research, Private University of Witten/ Herdecke GmbH, Köln, Germany
| | - Ulrike Neuhaus
- Department of Anesthesiology and Operative Intensive Care, Charité Campus Virchow, Berlin, Germany
| | - Christian Putensen
- Anesthesiology and Operative Intensive Care, University of Bonn, Germany
| | | | - Alexander Reske
- Department of Anesthesiology and Intensive Care, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Bernard Roth
- Department of General Pediatrics, Cologne, Germany
| | - Jens Scholz
- Department of Anesthesiology and Surgical Intensive Care, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Stefan Schröder
- Department of Psychiatry and Psychotherapy, CMM Hospital Guestrow, Germany
| | - Dierk Schreiter
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | | | - Robert Stingele
- Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Peter Tonner
- Department of Anesthesiology and Intensive Care Medicine, Emergency Medicine Hospital Links der Weser GmbH, Bremen, Germany
| | - Philip Tränkle
- Department of Internal Medicine, Division III, ICU 3IS, Tübingen, Germany
| | - Rolf Detlef Treede
- Department of Neurophysiology, Center for Biomedicine and Medical Technology Mannheim (CBTM), Germany
| | - Tomislav Trupkovic
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, BG Trauma Clinic Ludwigshafen, Germany
| | - Michael Tryba
- Anesthesiology and Operative Intensive Care, Klinikum Kassel, Germany
| | - Frank Wappler
- Department of Anesthesiology and Operative Intensive Care, Hospital Cologne-Merheim, University of Witten/ Herdecke, Cologne, Germany
| | | | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
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Wilson MJA, MacArthur C, Cooper GM, Bick D, Moore PAS, Shennan A. Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia 2010; 65:145-53. [DOI: 10.1111/j.1365-2044.2009.06136.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Noirhomme-Renard F, Noirhomme Q. Les facteurs associés à un allaitement maternel prolongé au-delà de trois mois : une revue de la littérature. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.jpp.2009.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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32
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Wiklund I, Norman M, Uvnäs-Moberg K, Ransjö-Arvidson AB, Andolf E. Epidural analgesia: Breast-feeding success and related factors. Midwifery 2009; 25:e31-8. [DOI: 10.1016/j.midw.2007.07.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 06/11/2007] [Accepted: 07/10/2007] [Indexed: 10/22/2022]
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Carvalho B, Roland LM, Chu LF, Campitelli VA, Riley ET. Single-Dose, Extended-Release Epidural Morphine (DepoDur™) Compared to Conventional Epidural Morphine for Post-Cesarean Pain. Anesth Analg 2007; 105:176-83. [PMID: 17578973 DOI: 10.1213/01.ane.0000265533.13477.26] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A single-dose of neuraxial morphine sulfate provides good post-Cesarean analgesia; however, its efficacy is limited to the first postoperative day. In a recent phase III study, extended-release epidural morphine (EREM) formulation provided more effective, prolonged analgesia after Cesarean delivery, compared to conventional epidural morphine. However, the study protocol did not allow for the use of nonsteroidal antiinflammatory drugs, used various postoperative analgesics, and monitoring and treatment of respiratory depression were not standardized. Our aims in this study were to compare postoperative analgesic consumption, pain scores and side effects of EREM with conventional morphine for the management of post-Cesarean pain in a setting more reflective of current obstetric practice. METHODS Seventy healthy parturients undergoing elective Cesarean delivery were enrolled in this randomized, double-blind study. Using a combined spinal epidural technique, patients received an intrathecal injection of bupivacaine 12 mg and fentanyl 10 mcg. After closure of the fascia, a single-dose of either conventional morphine 4 mg or EREM 10 mg was administered epidurally. Postoperatively, all patients received ibuprofen 600 mg orally every 6 h. Oral oxycodone and IV morphine were available for breakthrough pain. All patients received pulse oximetry and respiratory monitoring for 48 h post-Cesarean delivery. RESULTS Single-dose EREM significantly improved pain scores at rest and during activity. The median (interquartile range) of supplemental opioid medication usage for 48 h post-Cesarean (in milligram-morphine equivalents) decreased from 17 (22) to 10 (17) mg with EREM compared to conventional epidural morphine (P = 0.037). Both drugs were well tolerated with no significant difference in adverse event profiles. CONCLUSION EREM provides superior and prolonged post-Cesarean analgesia compared to conventional epidural morphine with no significant increases in adverse events.
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Affiliation(s)
- Brendan Carvalho
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J 2006; 1:24. [PMID: 17134489 PMCID: PMC1702531 DOI: 10.1186/1746-4358-1-24] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 12/11/2006] [Indexed: 11/13/2022] Open
Abstract
Background Anecdotal reports suggest that the addition of fentanyl (an opioid) to epidural analgesia for women during childbirth results in difficulty establishing breastfeeding. The aim of this paper is to determine any association between epidural analgesia and 1) breastfeeding in the first week postpartum and 2) breastfeeding cessation during the first 24 weeks postpartum. Methods A prospective cohort study of 1280 women aged ≥ 16 years, who gave birth to a single live infant in the Australian Capital Territory in 1997 was conducted. Women completed questionnaires at weeks 1, 8, 16 and 24 postpartum. Breastfeeding information was collected in each of the four surveys and women were categorised as either fully breastfeeding, partially breastfeeding or not breastfeeding at all. Women who had stopped breastfeeding since the previous survey were asked when they stopped. Results In the first week postpartum, 93% of women were either fully or partially breastfeeding their baby and 60% were continuing to breastfeed at 24 weeks. Intrapartum analgesia and type of birth were associated with partial breastfeeding and breastfeeding difficulties in the first postpartum week (p < 0.0001). Analgesia, maternal age and education were associated with breastfeeding cessation in the first 24 weeks (p < 0.0001), with women who had epidurals being more likely to stop breastfeeding than women who used non-pharmacological methods of pain relief (adjusted hazard ratio 2.02, 95% CI 1.53, 2.67). Conclusion Women in this cohort who had epidurals were less likely to fully breastfeed their infant in the few days after birth and more likely to stop breastfeeding in the first 24 weeks. Although this relationship may not be causal, it is important that women at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support.
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Affiliation(s)
- Siranda Torvaldsen
- NSW Centre for Overweight and Obesity, Level 2, K25 Medical Foundation Building, The University of Sydney, NSW 2006, Australia
- Centre for Perinatal Health Services Research, Building DO2, The University of Sydney, NSW 2006, Australia
| | - Christine L Roberts
- Centre for Perinatal Health Services Research, Building DO2, The University of Sydney, NSW 2006, Australia
| | - Judy M Simpson
- School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Jane F Thompson
- Women's & Children's Hospitals Australasia, Level 1, 99 Northbourne Ave, Turner ACT 2612, Australia
| | - David A Ellwood
- The Australian National University Medical School, The Canberra Hospital, ACT 2606, Australia
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Abstract
The interesting and important paper by Torvaldsen and colleagues provides further circumstantial evidence of a positive association between intrapartum analgesia and feeding infant formula. Not all research supports this association. Before 'failure to breastfeed' can be adjudged an adverse effect of intrapartum analgesia, the research evidence needs to be considered in detail. Examination of the existing evidence against the Bradford-Hill criteria indicates that the evidence is not yet conclusive. However, the difficulties of obtaining funding and undertaking large trials to explore putative adverse drug reactions in pregnant women may mean that we shall never have conclusive evidence of harm. Therefore, reports of large cohort studies with regression models, as in the paper published today, assume a greater importance than in other areas of investigation. Meanwhile, women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour.
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Affiliation(s)
- Sue Jordan
- School of Health Sciences, Swansea University, Singleton Park, Swansea, UK.
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Clifford TJ, Campbell MK, Speechley KN, Gorodzinsky F. Factors influencing full breastfeeding in a southwestern ontario community: assessments at 1 week and at 6 months postpartum. J Hum Lact 2006; 22:292-304. [PMID: 16885489 DOI: 10.1177/0890334406290043] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Factors associated with full breastfeeding (FBF) at 1 week and at 6 months postpartum were examined in a cohort of 856 mother-infant dyads. Questionnaires were mailed at 4 time points over the first 6 months postpartum. At 1 week, 68% of infants were FBF; at 6 months, 23% were FBF. Factors significantly associated with FBF at 1 week were hospital of delivery, residing with a smoker, maternal shiftwork during pregnancy, and having no prior breast-feeding experience. Cox proportional hazards regression analysis showed that residing with a smoker, having consumed caffeine during pregnancy, reporting elevated maternal trait anxiety at 1 week postpartum, having been employed full-time outside the home prior to delivery, and having received anesthesia/analgesia during labor/delivery were associated with earlier cessation of FBF, whereas not having previous breastfeeding experience predicted its continuation. Although most mothers are breastfeeding early on, a number of factors adversely affect its successful continuation.
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Affiliation(s)
- Tammy J Clifford
- Epidemiology and Biotatistics, The University of Western Ontario, Canada
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Abstract
A sample of 221 women who delivered at Al Qassimi Hospital, Sharjah, United Arab Emirates, were included in this prospective study to identify breastfeeding patterns at day 1, 1 month, and 6 months postpartum. The exclusive breastfeeding rate was 76.5% on day 1, 48.4% at 1 month, and 13.3% at 6 months. At 6 months, 16.1% had stopped breastfeeding. Simple and multivariable binary logistic regression analyses were used to identify factors associated with better breastfeeding outcomes. Nationality significantly affected exclusive breastfeeding at day 1 and 1 month. Pethidine use was associated with lower levels of exclusive breastfeeding at 1 month. Education was the most significant determinant of breastfeeding behavior at 6 months. Effects of the interrelationships between factors were examined and shown to influence breastfeeding outcomes in different population subgroups. The findings of this study suggest that strategies to improve breastfeeding should focus on risk factors specific to the population subgroup.
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Affiliation(s)
- Ghada K Al Tajir
- Drug Information Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
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Affiliation(s)
- Anne Montgomery
- Department of Family Medicine, University of Washington, Seattle, WA, USA
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Abstract
Research literature supports the notion that maternal comfort should be considered a priority and that mothers should receive adequate information regarding any drug prior to receiving that drug. Some studies indicate that difficulties with breastfeeding may be related to the amount of the anesthetic or analgesic that is administered to the mother. Thus, it seems wise to administer the lowest possible dose to the mother in order to minimize the amount of drug (or metabolite) exposure to the nursing infant. Infant exposure can be further reduced if breastfeeding is avoided during the times when the mother receives high doses of anesthetics and analgesics. However, because relatively small amounts of the drug are excreted into the breast milk, some mothers may opt to continue nursing after weighing the benefits of breastfeeding against the potential risk to the infant. Others may choose to "pump and dump" breast milk while they receive anesthetic or analgesic agents. Any concerns in this regard should be discussed with the anesthesia provider, preferably prior to labor or to any surgeries while breastfeeding.
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Affiliation(s)
- William O Howie
- WILLIAM HOWIE is a staff nurse anesthetist at the R. Adams Cowley Shock Trauma Center in Baltimore, Maryland. He is also a clinical faculty member in the Nurse Anesthesia Program at the University of Maryland School of Nursing in Baltimore
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Abstract
This prospective cohort study examined the association between epidural analgesia during labor and delivery, infant neurobehavioral status, and the initiation and continuation of effective breastfeeding. Healthy, term infants delivered vaginally by mothers who received epidural analgesia (n = 52) or no analgesia (n = 63) during labor and delivery were assessed at 8 to 12 hours postpartum, followed by a telephone interview with the mothers at 4 weeks postpartum. There was no significant difference between the epidural analgesia and no-analgesia groups in breastfeeding effectiveness or infant neurobehavioral status at 8 to 12 hours or in the proportion of mothers continuing to breastfeed at 4 weeks. Therefore, epidural analgesia did not appear to inhibit effective breastfeeding. There was a positive correlation between infant neurobehavioral status and breastfeeding effectiveness (Spearman rho = 0.48, P = .01), suggesting that neurobehavioral assessment may prove beneficial in identifying infants at greater risk for breastfeeding difficulties.
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Affiliation(s)
- Zorina Marzan Chang
- Labor, Delivery, Recovery, Postpartum Unit, Women's Hospital, Health Sciences Centre, Winnipeg, Manitoba, Canada
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Abstract
New low-dose, local anesthetic-opioid combinations, combined spinal epidural analgesia, and new anesthetic drugs, such as ropivacaine and levobupivacaine, have modified the anesthetic practice in obstetric labor analgesia. These new analgesic techniques have less or no neonatal effects when compared with traditional epidural labor analgesia. They also have less effect on mode of delivery, which may in turn affect neonatal outcome. The use of very diluted or low concentrations of local anesthetic solutions may reduce their placental passage and thus the possible subtle neonatal effects. Small doses of epidural or spinal opioids alone or combined with low doses of local anesthetics does not affect the well-being of the neonate at birth. When considering the neonatal outcome, combined spinal epidural analgesia is as well tolerated as low-dose epidural analgesia. Transient fetal heart rate changes have been described immediately after the administration of intrathecal or epidural opioids. Maternal hypotension may also occur at the onset of epidural analgesia. Whether the occurrence of transient fetal heart rate changes or maternal hypotension immediately after the epidural block may influence the neonatal outcome at birth needs verification.
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Affiliation(s)
- Giorgio Capogna
- Department of Anesthesia, Città di Roma Hospital, Rome, Italy.
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Abstract
OBJECTIVE To investigate the impact of intrapartum analgesia on infant feeding at hospital discharge. DESIGN Retrospective cohort. SETTING Maternity unit of a UK district general hospital. POPULATION A random sample of 425 healthy primiparae delivering healthy singleton babies at term in 2000. METHODS A random sample of primiparae delivering term neonates was identified from the birth register. We retrieved and analysed the corresponding joint midwifery/obstetric case notes. MAIN OUTCOME MEASURE Infant feeding method at discharge from hospital. RESULTS Women [190/424 (45%)] were exclusively bottle feeding their babies at discharge from hospital. No one commenced breastfeeding after hospital discharge. Regression analysis revealed that the main determinants of bottle feeding were as follows: maternal age [odds ratio (OR) 0.90, 95% confidence interval [CI] 0.85-0.95 per year]; occupation (OR 0.63, 95% CI 0.40-0.99 for each category, unemployed, manual, non-manual); antenatal feeding intentions (OR 0.12, 95% CI 0.080-0.19 for each category, bottle feeding, undecided, breastfeeding); caesarean section (OR 0.25, 95% CI 0.13-0.47, caesarean or vaginal delivery); and dose of fentanyl administered intrapartum (OR 1.004, 95% CI 1.000-1.008, 90% CI 1.001-1.007 for each microgram administered, range 8-500 mug). CONCLUSIONS A dose-response relationship between fentanyl and artificial feeding has not been reported elsewhere. When well-established determinants of infant feeding are accounted for, intrapartum fentanyl may impede establishment of breastfeeding, particularly at higher doses.
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Affiliation(s)
- Sue Jordan
- School of Health Science, University of Wales, Swansea, UK
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Affiliation(s)
- Pamela D Berens
- Department of Obstetrics and Gynecology, University of Texas Medical School at Houston, Houston, Texas 77030, USA.
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Abstract
BACKGROUND Clinical ambiguity concerning effects of epidural analgesia for pain relief in labour seems to reflect a need for evidence-based knowledge for midwives. AIMS This study aimed to review, with a systematic approach, the literature about effects and risks associated with the use of epidural analgesia for pain relief in labour and childbirth. DESIGN A structured question was formulated and used for deriving search terms, establishing the inclusion of certain criteria and retrieving articles, i.e. what are the effects of epidural analgesia for pain relief in labour and childbirth? References were obtained through searches using MeSH-terms in Medline and Subheadings (SH) in CINAHL (e.g. Obstetrical Analgesia combined either with psychology or adverse effects and together with, Dystocia, Caesarean Section, Infant Newborn and Breastfeeding). The articles were divided into prospective randomized trials (C), non-randomized prospective studies (P) and retrospective studies (R). Scientific quality of the studies was assessed on a three-grade scale: high scientific quality (I), moderate scientific quality (II) or low scientific quality (III). RESULTS Twenty-four articles were retrieved and systematically assessed. Seven studies were judged as high quality, 15 as moderate quality and two as low quality. The majority of studies appraised in this review failed to obtain or establish a cause and effect relationship. According to the data, it seems clear that the use of epidural analgesia is considered to be an effective method of pain relief during labour and childbirth from the perspective of women giving birth. RELEVANCE TO CLINICAL PRACTICE Midwives and doctors can recommend this form of pain relief. However, information about possible associations with adverse effects in mothers and infants must be provided to expectant couples.
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Affiliation(s)
- Astrid Nystedt
- Obstetrics and Gynaecology, Department of Clinical Science, Umeå University, Umeå, Sweden.
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Leung AY. Postoperative pain management in obstetric anesthesia–new challenges and solutions. J Clin Anesth 2004; 16:57-65. [PMID: 14984863 DOI: 10.1016/j.jclinane.2003.02.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2002] [Revised: 02/26/2003] [Accepted: 02/26/2003] [Indexed: 10/26/2022]
Abstract
The current understanding of pain processing mechanisms, the different pharmacologic drugs, and other nonpharmacologic means that can be used to manage postobstetric operation pain are reviewed.
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Affiliation(s)
- Albert Y Leung
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.
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Abstract
Pre-eclampsia is a multisystemic disorder that is characterised by endothelial cell dysfunction as a consequence of abnormal genetic and immunological mechanisms. Despite active research for years, the exact aetiology of this potentially fatal disorder remains unknown. Although understanding of the pathophysiology of pre-eclampsia has improved, management has not changed significantly over the years. Anaesthetic management of these patients remains a challenge. Although general anaesthesia can be used safely in pre-eclamptic women, it is fraught with greater maternal morbidity and mortality. Currently, the safety of regional anaesthesia techniques is well established and they can provide better obstetrical outcome when chosen properly. Thus, regional anaesthesia is extensively used for the management of pain and labour in women with pre-eclampsia. This article highlights the advantages and disadvantages of regional anaesthetic techniques including epidural, spinal and combined spinal-epidural analgesia, used as a part of the management of pre-eclampsia. The problems associated with general anaesthesia and controversies in relation to obstetric regional anaesthesia are discussed.
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Affiliation(s)
- Nanda Gopal Mandal
- Department of Anaesthesia, Peterborough Hospitals NHS Trust, Peterborough, UK.
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Volmanen P, Valanne J, Alahuhta S. Breast-feeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and breast-feeding practices. Int J Obstet Anesth 2004; 13:25-9. [PMID: 15321436 DOI: 10.1016/s0959-289x(03)00104-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2003] [Indexed: 10/26/2022]
Abstract
Various clinical practices have been found to be associated with breast-feeding problems. However, little is known about the effect of pain, obstetrical procedures and analgesia on breast-feeding behaviour. We designed a retrospective study with a questionnaire concerning pain, obstetrical procedures and breast-feeding practices mailed to 164 primiparae in Lapland. Altogether 99 mothers (60%) returned completed questionnaires that could be included in the analysis, which was carried out in two steps. Firstly, all accepted questionnaires were grouped according to the success or failure to breast-feed fully during the first 12 weeks of life. Secondly, an ad hoc cohort study was performed on the sub-sample of 64 mothers delivered vaginally. As many as 44% of the 99 mothers reported partial breast feeding or formula feeding during the first 12 weeks. Older age of the mother, use of epidural analgesia and the problem of "not having enough milk" were associated with the failure to breast-feed fully. Caesarean section, other methods of labour analgesia and other breast-feeding problems were not associated with partial breast feeding or formula feeding. In the sub-sample, 67% of the mothers who had laboured with epidural analgesia and 29% of the mothers who laboured without epidural analgesia reported partial breast feeding or formula feeding (P = 0.003). The problem of "not having enough milk" was more often reported by those who had had epidural analgesia. Further studies conducted prospectively are needed to establish whether a causal relationship exists between epidural analgesia and breast-feeding problems.
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Affiliation(s)
- P Volmanen
- Department of Anaesthesiology, Lapland Central Hospital, Rovaniemi, Finland.
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Abstract
BACKGROUND Although the labour and delivery outcomes of epidural analgesia have been investigated extensively, the effects on breast-feeding success are not clearly identified. AIM To investigate the effects of intrapartum epidural analgesia on breast-feeding duration. METHODS Nulliparous women enrolled in a randomised trial investigating labour and delivery outcomes of intrapartum epidural analgesia were asked about breast-feeding outcomes. Breast-feeding duration was ascertained by a self-report at 2 and 6 months post-partum. Breast-feeding outcomes were analysed as a prospective observational study because of high cross-over rates (43.4%) in the original randomised controlled trial. RESULTS A total of 992 women were recruited to the trial with 690 (69.6%) receiving epidural analgesia in labour. Breast-feeding was initiated by 95% (n = 946). At 2 and 6 months, 625 (63.5%) and 401 (40.7%), respectively, were still breast-feeding. Intrapartum analgesia (trend P-value = 0.036), mode of delivery (P < 0.001), age (P < 0.001), education (P < 0.001), and smoking in pregnancy (P < 0.001) showed univariate associations with breast-feeding duration. In the subgroup of women with spontaneous onset of labour and vaginal deliveries, after controlling for other obstetric and demographic factors, epidural analgesia but not narcotic analgesia was significantly associated with reduced breast-feeding duration (adjusted hazard ratio 1.44, 95% confidence interval 1.04-1.99). CONCLUSIONS Nulliparous women have a high use of epidural analgesia in labour. Nulliparous women who choose epidural analgesia are more likely to breast-feed for shorter durations. Further exploration of the factors underlying this association should be undertaken.
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Affiliation(s)
- Jennifer J Henderson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Australia.
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