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Anaesthesia
Research
A priori choice of neuraxial labour analgesia and breastfeeding initiation success: a community-based cohort study in an Italian baby-friendly hospital
  1. Roberto Giorgio Wetzl1,
  2. Enrica Delfino1,
  3. Luca Peano2,
  4. Daniela Gogna1,
  5. Yvette Vidi1,
  6. Francesca Vielmi2,
  7. Eleonora Bianquin2,
  8. Serena Cerioli1,
  9. Maria Enrica Bettinelli3,
  10. Maria Lorella Giannì4,
  11. Gabriella Frassy1,
  12. Elena Boris1,
  13. Cesare Arioni2
  1. 1 Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d’Aosta, Aosta, Valle d’Aosta, Italy
  2. 2 Mother-Child Department, Ospedale Regionale della Valle d’Aosta, Aosta, Valle d’Aosta, Italy
  3. 3 Mother and Child Health Unit, Agenzia di Tutela della Salute della Città Metropolitana di Milano, Milano, Italy
  4. 4 Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda, Study University of Milan, Milano, Italy
  1. Correspondence to Dr Roberto Giorgio Wetzl; robertowetzl{at}libero.it

Abstract

Objective To investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth.

Design Single-centre community-based cohort study.

Setting An Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015.

Participants Inclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed. Exclusion criteria: women who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia.

Results Compared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (64.3%), vs 93/189 (49.2%; p<0.001; RD, 15.1%)). Multivariable analyses with antelabour-only confounders confirmed both associations (planned vaginal birth: relative risk (RR), 0.65; 95% CI, 0.48 to 0.87; actual vaginal birth: RR, 0.59; 95% CI, 0.43 to 0.80). Although women who requested analgesia as a last resort had less BIS than did those successfully coping with labour pain in the bivariable analyses (planned vaginal birth: 1804/2853 (63.2%), vs 317/568 (55.8%; p=0.001; RD, 7.4%); actual vaginal birth: 1665/2546 (65.4%), vs 259/448 (57.8%; p=0.002; RD, 7.6%)), multivariable analyses with either antelabour-only or peripartum confounders did not confirm these associations (planned vaginal birth: RR, 0.99; 95% CI, 0.80 to 1.23; actual vaginal birth: RR, 0.90; 95% CI, 0.69 to 1.16).

Conclusions Compared with trying to cope with labour pain, a priori choice of neuraxial analgesia is negatively associated with BIS. Conversely, compared with having successfully coped with pain, requesting neuraxial analgesia as a last resort is not negatively associated with BIS.

  • anaesthesia in obstetrics
  • perinatology
  • toxicology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-025179

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    Footnotes

    • Contributors Study conceptualisation and design: RGW, ED, EBi, MEB, MLG and CA. Data collection instruments design and statistical data analyses: LP, MLG. Data acquisition: DG, GF and EBo (breastfeeding case notes), YV (antepartum anaesthesia examination case notes), FV (neonatal case notes), EBi (delivery room case notes) and SC (anaesthesia case notes). Data analysis and interpretation: RGW, ED, LP, YV, FV, SC, MEB, MLG, GF and EBo. Drafting of the manuscript: RGW, ED, YV, EBi, MLG and EBo. Revision of the draft for important intellectual content: LP, DG, FV, SC, MEB, GF and CA. Literature search: DG. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. RGW is the guarantor of the work as a whole, and affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval This study project was reviewed and approved by the Institutional Ethics Committee of Parini Regional Hospital, Aosta, Aosta Valley, Italy (register 166798).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

    • Patient consent for publication Not required.