Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA.
Matern Child Health J. 2013 May;17(4):689-98. doi: 10.1007/s10995-012-1045-4.
Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia's association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. A pooled analysis using Kaplan-Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within 1 month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95% confidence interval 1.10, 1.44], p < 0.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01, 1.41], p < 0.04; non-BFH: 1.65 [1.31, 2.08], p < 0.01). A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies.
母乳喂养对母婴健康都有益。在分娩过程中使用硬膜外麻醉的情况越来越普遍，并且可能会干扰母乳喂养。分析硬膜外麻醉与母乳喂养结果之间关系的研究结果喜忧参半；许多研究都存在方法上的缺陷。我们在调整标准和新颖的协变量的同时，特别考虑到引产，分析了硬膜外麻醉与产后 30 天内完全停止母乳喂养之间的潜在关联。使用 Kaplan-Meier 曲线和改良的 Cox 比例风险模型进行的汇总分析包括来自纽约州北部的 772 位母乳喂养母亲，她们均足月阴道分娩健康的单胎婴儿。这些对象来自两项队列研究（在 2005 年至 2008 年之间产后招募），包括母亲的自我报告以及母亲和婴儿的病历数据。对硬膜外麻醉与 1 个月内完全停止母乳喂养之间的潜在关联进行分析时，还纳入了其他协变量，并特别考虑到了引产。在调整了标准人口统计学和产时因素后，硬膜外麻醉显著预测了母乳喂养的停止（风险比 1.26 [95%置信区间 1.10，1.44]，p < 0.01），医院类型、母亲年龄、收入、教育程度、计划的母乳喂养目标以及母乳喂养信心也是如此。在按婴儿友好医院（BFH）状况分层的事后分析中，硬膜外麻醉显著预测了母乳喂养的停止（BFH：1.19 [1.01，1.41]，p < 0.04；非 BFH：1.65 [1.31，2.08]，p < 0.01）。尽管发现了硬膜外麻醉与母乳喂养之间的关系，但这种关系很复杂，涉及机构、临床、母婴等多方面因素。这些发现对临床护理和医院政策具有影响，并指出需要进行前瞻性研究。
