title: Epidural analgesia: breast-feeding success and related factors.
abstract: OBJECTIVE
  to compare the early breast-feeding behaviours of full-term newborns whose mothers had received epidural analgesia (EDA) during an uncomplicated labour, with a group of newborns whose mothers had not received EDA.
  
  
  METHODS
  a retrospective comparative study design was used and the study was carried out in a labour ward in Stockholm, Sweden between January 2000 and April 2000. The ward has about 5500 deliveries per year.
  
  
  METHODS
  all maternity records of women who had received EDA during labour (n=585) were included in the study. For each EDA record, a control record was selected, matched for parity, age and gestational age at birth. Women with emergency caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation or an intra-uterine death, as well as neonates with an Apgar score <7 at 5 mins were excluded. After exclusion, the study population consisted of 351 healthy women and babies in each group.
  
  
  METHODS
  logistic regression was performed. The dependent variables: (1) initiation of breast feeding after birth; (2) artificial milk given during hospital stay; and (3) breast feeding at discharge were studied in response to: (a) parity; (b) gestational age at birth; (c) length of first and second stage of labour; (d) administration of oxytocin; (e) administration of EDA; and (f) neonatal weight, as independent variables.
  
  
  RESULTS
  significantly fewer babies of mothers with EDA during labour suckled the breast within the first 4 hours of life [odds ratio (OR) 3.79]. These babies were also more often given artificial milk during their hospital stay (OR 2.19) and fewer were fully breast fed at discharge (OR 1.79). Delayed initiation of breast feeding was also associated with a prolonged first (OR 2.81) and second stage (OR 2.49) and with the administration of oxytocin (OR 3.28). Fewer newborns of multiparae received artificial milk during their hospital stay (OR 0.58). It was also, but to a lesser extent, associated with oxytocin administration (OR 2.15). Full breast feeding at discharge was also positively associated with multiparity (OR 0.44) and birth weight between 3 and 4 kg (OR 0.42).
  
  
  CONCLUSIONS
  the study shows that EDA is associated with impaired spontaneous breast feeding including breast feeding at discharge from the hospital. Further studies are needed on the effects of EDA on short- and long-term breast-feeding outcomes.
authors.affiliation: Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institutet, S-182 88 Stockholm, Sweden. ingela.wiklund@bb.ptj.se
authors.forename: Ingela
authors.initials: I
authors.lastname: Wiklund
authors.forename: Margareta
authors.initials: M
authors.lastname: Norman
authors.forename: Kerstin
authors.initials: K
authors.lastname: Uvnäs-Moberg
authors.forename: Anna-Berit
authors.initials: AB
authors.lastname: Ransjö-Arvidson
authors.forename: Ellika
authors.initials: E
authors.lastname: Andolf
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000706:statistics & numerical data*; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007774:Lactation / Q000187:drug effects; D008880:Midwifery / Q000458:organization & administration; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000706:statistics & numerical data; D049590:Postpartum Period / Q000187:drug effects; D011247:Pregnancy; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult