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The Effect of Labor Epidural Analgesia on Breastfeeding Outcomes: A Prospective Observational Cohort Study in a Mixed-Parity Cohort

Orbach-Zinger, Sharon MD*; Landau, Ruth MD; Davis, Atara BSc*; Oved, Oren MD*; Caspi, Liron MD*; Fireman, Shlomo MD*; Fein, Shai MD*; Ioscovich, Alexander MD; Bracco, Danielle BA*; Hoshen, Moshe PhD§; Eidelman, Leonid A. MD*

doi: 10.1213/ANE.0000000000003442
Obstetric Anesthesiology: Original Clinical Research Report

BACKGROUND: The effect of labor epidural analgesia (LEA) on successful breastfeeding has been evaluated in several studies with divergent results. We hypothesized that LEA would not influence breastfeeding status 6 weeks postpartum in women who intended to breastfeed in an environment that encourages breastfeeding.

METHODS: In this prospective observational cohort study, a total of 1204 women intending to breastfeed, delivering vaginally with or without LEA, were included; breastfeeding was recorded at 3 days and 6 weeks postpartum. Primary outcome was breastfeeding at 6 weeks, and the χ2 test was used for comparisons between women delivering with and without LEA, according to parity status and previous breastfeeding experience. Total epidural fentanyl dose and oxytocin use (yes/no) were recorded. A multivariable logistic regression was performed to assess factors affecting breastfeeding at 6 weeks.

RESULTS: The overall breastfeeding rate at 6 weeks was 76.9%; it was significantly lower among women delivering with LEA (74.0%) compared with women delivering without LEA (83.4%; P < .001). Among 398 nulliparous women, 84.9% delivered with LEA, compared with 61.8% of multiparous women (P < .001). Multiparous women (N = 806) were more likely to breastfeed at 6 weeks (80.0% vs 70.6% nullipara; P < .001). Using multivariable logistic regression that accounted for 14 covariates including parity, and an interaction term between parity and LEA use, LEA was significantly associated with reduced breastfeeding at 6 weeks (odds ratio, 0.60; 95% confidence interval, 0.40–0.90; P = .015). In a modified multivariable logistic regression where parity was replaced with previous breastfeeding experience, both as a covariate and in the interaction term, only previous breastfeeding experience was associated with increased breastfeeding at 6 weeks (odds ratio, 3.17; 95% confidence interval, 1.72–5.80; P < .001).

CONCLUSIONS: In our mixed-parity cohort, delivering with LEA was associated with reduced likelihood of breastfeeding at 6 weeks. However, integrating women’s previous breastfeeding experience, the breastfeeding rate was not different between women delivering with and without LEA among the subset of multiparous women with previous breastfeeding experience. Therefore, our findings suggest that offering lactation support to the subset of women with no previous breastfeeding experience may be a simple approach to improve breastfeeding success. This concept subscribes to the notion that women at risk for an undesired outcome be offered tailored interventions with a personalized approach.

From the *Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel

Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York

Department of Anesthesia, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel

§Clalit Research Institute, Tel Aviv, Israel.

Published ahead of print 04 April 2018.

Accepted for publication April 4, 2018.

Funding: Departmental.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

S. Orbach-Zinger and R. Landau contributed equally and share first authorship.

This study was registered on clinical registration number NCT02495350.

Reprints will not be available from the authors.

Address correspondence to Sharon Orbach-Zinger, MD, Department of Anesthesia, Rabin Medical Center Beilinson Hospital, Rabin Medical Center Beilinson Hospital, 39 Jabotinsky St, Petach Tikva, Israel. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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