Does the administration of epidural anesthesia influence breastfeeding duration or exclusivity?

Background: Anecdotal evidence suggests that epidural anesthesia (EA) has a detrimental effect on breastfeeding (BF) but research is limited and has not consistently established any correlation between epidural use and BF duration or exclusivity.

Methods: Secondary analyses used data from a prospective cohort study of 842 BF women with uncomplicated, singleton term deliveries (recruited postpartum from two urban community hospitals). Respondents completed an enrollment interview and mailed surveys (2 weeks, 3 and 6 months) to assess BF duration and exclusivity. Labor and delivery data were obtained from the birth certificate. Kaplan Meier curves assessed the unadjusted relationship between EA and cessation of BF within 30 days. Hazard ratios (HR) and 95% confidence intervals (CI) of BF cessation by 30 days were estimated using the Cox proportional hazard model and adjusted for maternal demographic and obstetric characteristics. Adjusted odds ratios (aOR) and CI for BF exclusivity at day 14 were calculated by logistic regression controlling for similar covariates.

Results: While Kaplan-Meier results did not find a crude association between EA and BF cessation at 30 days (p=0.06), EA was significantly associated with BF cessation in multivariate analysis (HR 1.320; CI 1.005-1.735). Additionally, women who were not exclusively BF at day 14 were more likely to have received EA (aOR 1.47; CI 1.03-2.11).

Conclusions: These findings demonstrate a relationship between the EA and BF cessation (at 30 days) and BF exclusivity (at 14 days). Further primary research is warranted, to include other relevant factors (e.g. epidural type; specific anesthetics).