title: The adaptive psychological changes of elective induction of labor in breastfeeding women.
abstract: Labor induction has been associated with breastfeeding suppression, but reasons for why this association exists have not been well determined.
  
  
  
  We examined the influence of elective labor induction by vaginal prostaglandin at gestational week 41+3days on affective, cognitive, and behavioural adaptations early in puerperium and on breastfeeding pattern at 1 and 3months.
  
  
  
  One hundred and eighty consecutive puerperae were assigned to two groups: mothers having received vaginal prostaglandin E2 gel (Prepidil®, dinoprostone) before labor (PGE group, n=90) and mothers having received no treatment (unmedicated group, n=90). The day of discharge mothers completed the Edinburg Postnatal Depression Scale, (EPDS), State and Trait Anxiety Inventory (STAI-Y), and Mother to-Infant Bonding Scale (MIBS). Later they participated in telephone interviews concerning their breastfeeding practices at 1 and 3months, which were classified according to WHO definitions. When compared with unmedicated, PGE group puerperae scored [median, (IQR)] significantly higher EPDS [9 (7-13) vs 5 (3-8), p 0.003], STAI-state [46 (39-51) vs 39 (34-48), p 0.002], STAI-trait [39 (36-48) vs 34 (32-45), p 0.04], and MIBS [10 (5.25-10) vs 5 (3-4), p 0.002] scores. In addition, while the breastfeeding practices were similar at hospital discharge, at follow-up the labor induced mothers were less likely to maintain full breastfeeding with respect to untreated mothers: 1month (p 0.001); and 3months (p 0.003).
  
  
  
  We present evidence that elective induction of labor by prostaglandins at gestational week 41+3days is associated with reduced exclusive breastfeeding rates at 1 and 3months after discharge and higher EPDS, STAI, and MIBS scores.
authors.affiliation: Division of Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Italy. Electronic address: vincenzo.zanardo@libero.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Zanardo
authors.affiliation: Padua Hospital, Italy. Electronic address: marty.bertin@gmail.com.
authors.forename: Martina
authors.initials: M
authors.lastname: Bertin
authors.affiliation: Padua Hospital, Italy. Electronic address: laura.sansone@unipd.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Sansone
authors.affiliation: Versilia Hospital, Viareggio, Italy. Electronic address: laura89felice@hotmail.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Felice
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000209:etiology; D015232:Dinoprostone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects* / Q000379:methods; D009034:Mother-Child Relations; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy
chemical_list: D010120:Oxytocics; D015232:Dinoprostone
keywords: Breastfeeding; Edinburg Postnatal Depression Scale; Elective induction of labor; Mother to-Infant Bonding Scale; State and Trait Anxiety Inventory