Impaired breastfeeding and epidural analgesia: Is there an association?

Background: Epidural analgesia is an effective method for labor pain management and its use has increased rapidly in recent years in the US and countries throughout the world. However, the effect of epidural analgesia on breastfeeding initiation and maintenance has been controversial, with some studies reporting impaired breastfeeding after epidural use, while others have not. Methods: 3,006 women aged 18 to 36 who were expecting their first child in Pennsylvania in 2009 to 2011 were interviewed after 34 weeks gestation to measure plans for breastfeeding, and 1 month after childbirth to measure breastfeeding initiation and maintenance. Results: Overall, 2772 women (92.2%) reported prior to delivery that they planned to breastfeed. Among those who planned to breastfeed, 1,979 (71.4%) delivered vaginally and were included in these analyses. Those who had used no pain medication (n = 201) or narcotics only (n = 84) were more likely to report at 1 month postpartum that they were successfully breastfeeding (86.1% and 88.1% respectively), while those who had received epidural analgesia alone (n = 1,082), or in combination with other types of analgesia (n = 566), were less likely to be breastfeeding (76.7% and 70.3%, respectively), p < .0001. Controlling for confounders did not affect this association. Women who received an epidural were more likely to report that the baby had difficulty latching or sucking. Conclusions: Receipt of epidural analgesia during labor decreases the likelihood that a woman who plans to breastfeed will be able to successfully initiate and maintain breastfeeding.