Fentanyl During Labor May Impede Establishment of Breastfeeding
NEW YORK (Reuters Health) Jul 21 - Women who receive fentanyl analgesia
during labor may be less likely to breastfeed their infants, according to UK
investigators. Based on their findings, they propose that women who receive
neuraxial lipophilic opioids during labor receive support to successfully
establish breastfeeding in the hospital.
"Currently, there is no evidence that neuraxial opioids do not impact on
infant feeding, and some suggestions that they do," Dr. Sue Jordan from the
University of Wales in Swansea and colleagues note in their report a report
in the July issue of BJOG: an International Journal of Obstetrics and
Gynecology.
To look into the matter, the team retrospectively analyzed a random sample
of 425 healthy women who delivered a healthy term infant, their first, in
2000. At discharge from the hospital, 45% of the women were exclusively
bottle-feeding their infants and no woman began breast feeding after going
home.
In analyses accounting for "well-established determinants of infant
feeding," intrapartum fentanyl, particularly at higher doses, appeared to
impede the establishment of breastfeeding, the investigators report.
"This is the first report of a dose-response relationship between
intrapartum neuraxial opioid analgesia and infant feedings," they write.
Dr. Jordan and colleagues caution, however, that any impact of intrapartum
analgesia on infant feeding is unlikely to be uniform across the population
studied. In the current study, where women intended to bottle feed,
intrapartum fentanyl made no difference, they report, and delivery by
cesarean section was a more powerful determinant of infant feeding than the
type of analgesia.
On the other hand, "where other factors favoured breastfeeding, intrapartum
fentanyl appeared to thwart the mothers' intentions," the team notes.
For example, for a woman planning to breastfeed and delivering vaginally,
administration of fentanyl increased the probability of bottle-feeding by
63%, from 3.7% to 6.1%.
The authors note that up to 50% of parturient women are given neuraxial
opioids, and suggest that using only local anesthetics could increase
breastfeeding rates.
BJOG 2005;112:927-934.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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