title: Effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally.
abstract: BACKGROUND
  Epidural anesthesia is commonly administered to laboring women. Some studies have suggested that epidural anesthesia might inhibit breast-feeding. This study explores the association between labor epidural anesthesia and early breast-feeding success.
  
  
  METHODS
  Standardized records of mother-baby dyads representing 115 consecutive healthy, full-term, breast-feeding newborns delivered vaginally of mothers receiving epidural anesthesia were analyzed and compared with 116 newborns not exposed to maternal epidural anesthesia. Primary outcome was two successful breast-feeding encounters by 24 hours of age, as defined by a LATCH breast-feeding assessment score of 7 or more of 10 and a latch score of 2/2. Means were compared with the Kruskal-Wallis test. Categorical data were compared using the Mantel-Haenszel chi-square test. Stratified analysis of potentially confounding variables was performed using Mantel-Haenszel weighted odd ratios (OR) and chi-square for evaluation of interaction.
  
  
  RESULTS
  Both epidural and nonepidural anesthesia groups were similar except maternal nulliparity was more common in the epidural anesthesia group. Two successful breast-feedings within 24 hours of age were achieved by 69.6% of mother-baby units that had had epidural anesthesia compared with 81.0% of mother-baby units that had not (odds ratio [OR] 0.53, P = .04). These relations remained after stratification (weighted odds ratios in parenthesis) based on maternal age (0.52), parity (0.58), narcotics use in labor (0.49), and first breast-feeding within 1 hour (0.49). Babies of mothers who had had epidural anesthesia were significantly more likely to receive a bottle supplement while hospitalized (OR 2.63; P < .001) despite mothers exposed to epidural anesthesia showing a trend toward being more likely to attempt breast-feeding in the 1 hour (OR 1.66; P = .06). Mothers who had epidural anesthesia and who did not breast-feed within 1 hour were at high risk for having their babies receive bottle supplementation (OR 6.27).
  
  
  CONCLUSIONS
  Labor epidural anesthesia had a negative impact on breast-feeding in the first 24 hours of life even though it did not inhibit the percentage of breast-feeding attempts in the first hour. Further studies are needed to elucidate the exact nature of this association.
authors.affiliation: Department of Family Medicine, University of Wisconsin Medical School, Milwaukee Clinical Campus, St. Luke's Medical Center, Aurora Health Care, Milwaukee, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Baumgarder
authors.forename: Patricia
authors.initials: P
authors.lastname: Muehl
authors.forename: Mary
authors.initials: M
authors.lastname: Fischer
authors.forename: Bridget
authors.initials: B
authors.lastname: Pribbenow
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001903:Bottle Feeding / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D013997:Time Factors