• J Clin Anesth · Feb 2021

    Review

    Labor neuraxial analgesia and breastfeeding: An updated systematic review.

    • Philip Heesen, Stephen H Halpern, Yaakov Beilin, Paola A Mauri, Leonid A Eidelman, Michael Heesen, and Sharon Orbach-Zinger.
    • Faculty of Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland. Electronic address: heesenphilip99@gmail.com.
    • J Clin Anesth. 2021 Feb 1; 68: 110105.

    IntroductionThere have been numerous reports studying the effect of neuraxial analgesia on breastfeeding success, but the results are inconsistent.MethodsWe performed a literature search in various databases for studies comparing neuraxial analgesia to non-neuraxial or no analgesia. Outcomes were the percentage of women breastfeeding fully or mixed with formula. Where possible, nulliparous parturients were analyzed separately. We conducted an analysis excluding studies of serious and critical risk of bias. Odds ratios and 95% confidence intervals were calculated.ResultsWe included 15 studies (13 observational studies, 1 secondary analysis of a randomized controlled trial, 1 case-control study) with 16,112 participants. Overall, there were 6 studies that found no difference between groups, 6 studies that showed a significantly lower incidence of breastfeeding in the neuraxial group and 3 studies finding mixed results (at some time-points statistically significant and at some time-point statistically non-significant results). In nulliparous only studies, 2 found no difference between study groups, 1 found a lower breastfeeding rate in the neuraxial group and 3 studies showed mixed results. Excluding studies with a serious and critical risk of bias, 1 study found no difference between study groups, 3 studies found a decrease of breastfeeding rates in the neuraxial group, and 1 study showed mixed results.DiscussionIn our review we found a high disparity in results. One reason is probably the high potential of confounding (immediate skin to skin placement, maternity leave etc.). Education programs and breastfeeding support are likely more important in determining long term breastfeeding success.Copyright © 2020 Elsevier Inc. All rights reserved.

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