title: Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study.
abstract: BACKGROUND
  Epidural labor analgesia inclusive of high-dose fentanyl has been thought to affect breastfeeding in multiparous patients. In our experience, this effect is not as significant as quoted in the literature. This study was designed to evaluate breastfeeding success in women receiving epidural analgesia with fentanyl-containing solutions at our institution.
  
  
  METHODS
  Term multiparous women who received epidural analgesia for labor, had previously breastfed, and who intended to breastfeed, were recruited. Baseline demographics, as well as detailed epidural, obstetric and neonatal data, were collected. Epidural analgesia was achieved with a mixture of bupivacaine and fentanyl. Subjects were telephoned both 1 and 6 weeks after delivery, and a breastfeeding questionnaire was completed. Our primary outcome was breastfeeding cessation at 6 weeks.
  
  
  RESULTS
  One hundred and five women were recruited, with 18 exclusions. The median cumulative epidural fentanyl dose was 151.4 microg (30-570 microg). No neonates developed complications attributable to labor analgesia. Four women stopped breastfeeding because of issues related to the baby (4.6%); only one of them received a fentanyl dose >150 microg. The breastfeeding success rate was therefore >95%. The women had a median maternity leave of 12 months, and 69% received post-partum lactation support.
  
  
  CONCLUSIONS
  The incidence of successful breastfeeding in multiparous women who undergo vaginal delivery with epidural analgesia inclusive of fentanyl is much greater at our institution than previously reported in the literature. This may be due to favorable conditions such as time off work and post-natal support.
authors.affiliation: Departments of Anesthesia and Pain Management, Obstetrics and Gynecology, Pediatrics and Nursing, Mount Sinai Hospital, University of Toronto, Ontario, Canada. paul.wieczorek@gmail.com
authors.forename: P M
authors.initials: PM
authors.lastname: Wieczorek
authors.forename: S
authors.initials: S
authors.lastname: Guest
authors.forename: M
authors.initials: M
authors.lastname: Balki
authors.forename: V
authors.initials: V
authors.lastname: Shah
authors.forename: J C A
authors.initials: JC
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local; D001942:Breast Feeding; D002045:Bupivacaine; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation / Q000502:physiology; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine