Department of Obstetrics and Gynaecology, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.
The Ritchie Centre, The Hudson Institute, Clayton, Victoria, Australia.
Int Breastfeed J. 2022 Jul 5;17(1):48. doi: 10.1186/s13006-022-00492-7.
The use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth.
This was a population-based cohort study of singleton livebirths at ≥37 weeks' gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed.
In total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86-0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome.
Common intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.
全球范围内，产时干预的使用越来越普遍。分娩过程中的干预措施，包括剖宫产（CS）、硬膜外镇痛和合成催产素输注，可以在优化产科护理方面发挥重要作用，但也有可能影响母乳喂养。本研究旨在确定在分娩期间接受某些干预措施的女性在产后即刻和出生后几个月内出现不良母乳喂养结局的可能性是否更大。
这是一项基于人群的队列研究，纳入了 2010 年至 2018 年期间在澳大利亚维多利亚州≥37 周妊娠的单胎活产，使用了来自维多利亚围产期数据收集（VPDC）和儿童发育信息系统（CDIS）的常规收集的全州范围数据。纳入的干预措施包括产前 CS、产时 CS、硬膜外镇痛和合成催产素输注（引产和/或催产）。结局包括医院配方奶补充、出院前最后一次喂养方法以及产后 3 个月和 6 个月的母乳喂养状况。采用描述性统计和多变量逻辑回归模型调整潜在混杂因素。
共有 599191 名女性开始母乳喂养。产时 CS（比值比 1.96，95%置信区间 1.93，1.99）、产前 CS（比值比 1.75，95%置信区间 1.72，1.77）、硬膜外镇痛（比值比 1.45，95%置信区间 1.43，1.47）和合成催产素输注（比值比 1.24，95%置信区间 1.22，1.26）增加了医院配方奶补充的可能性。105599 名婴儿有长期母乳喂养数据。产时 CS（比值比 0.79，95%置信区间 0.76，0.83）、产前 CS（比值比 0.73，95%置信区间 0.71，0.76）、硬膜外镇痛（比值比 0.77，95%置信区间 0.75，0.80）和合成催产素输注（比值比 0.89，95%置信区间 0.86，0.92）降低了产后 3 个月时纯母乳喂养的可能性，6 个月时情况相似。接受的干预措施数量与每种不良母乳喂养结局的可能性之间存在剂量反应关系。
常见的产时干预措施与产后即刻和出生后几个月内更不利的母乳喂养结局有关。这证实了仅在必要时才进行干预的重要性。当在产程中使用干预措施时，必须对早期停止母乳喂养风险增加的妇女进行评估和识别。对于那些在产程中接受过干预措施并希望母乳喂养的妇女，需要提供有针对性的母乳喂养支持。
