A priori choice of neuraxial labour analgesia and breastfeeding initiation success: a community-based cohort study in an Italian baby-friendly hospital

被引：4

作者：

Wetzl, Roberto Giorgio ^{[1
]}

Delfino, Enrica ^{[1
]}

Peano, Luca ^{[2
]}

Gogna, Daniela ^{[1
]}

Vidi, Yvette ^{[1
]}

Vielmi, Francesca ^{[2
]}

Bianquin, Eleonora ^{[2
]}

Cerioli, Serena ^{[1
]}

Bettinelli, Maria Enrica ^{[3
]}

Gianni, Maria Lorella ^{[4
]}

Frassy, Gabriella ^{[1
]}

Boris, Elena ^{[1
]}

Arioni, Cesare ^{[2
]}

机构：

[1] Osped Reg Valle dAosta, Dept Anaesthesia Intens Care & Out Hosp Emergency, Aosta, Valle Daosta, Italy

[2] Osped Reg Valle dAosta, Mother Child Dept, Aosta, Valle Daosta, Italy

[3] Agenzia Tutela Salute Citta Metropolitana Milano, Mother & Child Hlth Unit, Milan, Italy

[4] Study Univ Milan, Dept Clin Sci & Community Hlth, Fdn IRCCS Ca Granda, Milan, Italy

来源：

BMJ OPEN | 2019年 / 9卷 / 03期

关键词：

RANDOMIZED CONTROLLED-TRIAL; EPIDURAL ANALGESIA; MATERNAL OBESITY; DELAYED-ONSET; FENTANYL; DURATION; ASSOCIATIONS; LACTATION; INTENTION; DELIVERY;

D O I：

10.1136/bmjopen-2018-025179

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth. Design Single-centre community-based cohort study. Setting An Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015. Participants Inclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed. Exclusion criteria: women who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia. Results Compared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (64.3%), vs 93/189 (49.2%; p<0.001; RD, 15.1%)). Multivariable analyses with antelabour-only confounders confirmed both associations (planned vaginal birth: relative risk (RR), 0.65; 95% CI, 0.48 to 0.87; actual vaginal birth: RR, 0.59; 95% CI, 0.43 to 0.80). Although women who requested analgesia as a last resort had less BIS than did those successfully coping with labour pain in the bivariable analyses (planned vaginal birth: 1804/2853 (63.2%), vs 317/568 (55.8%; p=0.001; RD, 7.4%); actual vaginal birth: 1665/2546 (65.4%), vs 259/448 (57.8%; p=0.002; RD, 7.6%)), multivariable analyses with either antelabour-only or peripartum confounders did not confirm these associations (planned vaginal birth: RR, 0.99; 95% CI, 0.80 to 1.23; actual vaginal birth: RR, 0.90; 95% CI, 0.69 to 1.16). Conclusions Compared with trying to cope with labour pain, a priori choice of neuraxial analgesia is negatively associated with BIS. Conversely, compared with having successfully coped with pain, requesting neuraxial analgesia as a last resort is not negatively associated with BIS.

引用

页数：13