The impact of intrapartum analgesia on infant feeding

OBJECTIVE: To investigate the impact of intrapartum analgesia on infant feeding at hospital discharge. DESIGN: Retrospective cohort. SETTING: Maternity unit of a UK district general hospital. POPULATION: A random sample of 425 healthy primiparae delivering healthy singleton babies at term in 2000. METHODS: A random sample of primiparae delivering term neonates was identified from the birth register. We retrieved and analysed the corresponding joint midwifery/obstetric case notes. MAIN OUTCOME MEASURE: Infant feeding method at discharge from hospital. RESULTS: Women 190/424 (45%)] were exclusively bottle feeding their babies at discharge from hospital. No one commenced breastfeeding after hospital discharge. Regression analysis revealed that the main determinants of bottle feeding were as follows: maternal age odds ratio (OR) 0.90, 95% confidence interval CI] 0.85-0.95 per year]; occupation (OR 0.63, 95% CI 0.40-0.99 for each category, unemployed, manual, non-manual); antenatal feeding intentions (OR 0.12, 95% CI 0.080-0.19 for each category, bottle feeding, undecided, breastfeeding); caesarean section (OR 0.25, 95% CI 0.13-0.47, caesarean or vaginal delivery); and dose of fentanyl administered intrapartum (OR 1.004, 95% CI 1.000-1.008, 90% CI 1.001-1.007 for each microgram administered, range 8-500 mug). CONCLUSIONS: A dose-response relationship between fentanyl and artificial feeding has not been reported elsewhere. When well-established determinants of infant feeding are accounted for, intrapartum fentanyl may impede establishment of breastfeeding, particularly at higher doses.