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Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey

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Abstract:

Background 

Little is known about how breastfeeding rates are affected by drugs routinely administered in labour. Objective 

To examine a large obstetric data set to investigate potentially modifiable associations between drugs routinely administered in labour and breastfeeding in healthy women and infants. Design 

Retrospective cohort. SettingĀ 

The Cardiff (Wales UK) Births Survey. Population 

A total of 48 366 healthy women delivering healthy singleton babies at term. Methods 

Analysis of the Cardiff Births Survey. Main outcome measure 

Association between intrapartum medications and breastfeeding at 48 hours postpartum. Results 

At 48 hours, 43.3% (20 933/48 366) women were not breastfeeding. Regression analysis confirmed previously reported associations of lower breastfeeding rates with certain demographic indicators, epidural analgesia, intramuscular opioid analgesia and ergometrine. Novel associations were detected with oxytocin alone or in combination with ergometrine administered for prevention of postpartum haemorrhage (PPH), which were associated with reductions of 6–8%, (intramuscular oxytocin OR 0.75, 95% CI 0.61–0.91, intravenous oxytocin OR 0.68, 95% CI 0.57–0.82, oxytocin/ergometrine OR 0.77, 95% CI 0.65–0.91), and prostaglandins administered for induction of labour. The associations were maintained when subgroups, such as primiparous women, women whose labours were neither induced nor augmented, and women not receiving epidural analgesia were considered. Conclusion 

Prospective studies on drugs in labour are needed to investigate potential causative associations between intrapartum medications and breastfeeding. Such studies will delineate the optimum balance between breastfeeding and maternal health, most importantly the risk of PPH.

Keywords: Breastfeeding; ergometrine; oxytocin; third stage of labour; uterotonics

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1471-0528.2009.02256.x

Affiliations: 1: Reader, School of Health Science, Swansea University, Swansea, UK 2: Consultant Gynaecologist, Singleton Hospital, Swansea, UK 3: Senior lecturer in statistics, European Business Management School, Swansea University, Swansea, UK 4: Data Manager, Cardiff Births Survey, Department of Epidemiology, Statistics and Public Health Centre for Health Sciences Research, Cardiff University, Wales, UK 5: Trial Manager, Paediatrics and Immunology, School of Medicine, Swansea University, Swansea, UK 6: Professor of Paediatrics and Immunology, Paediatrics and Immunology, School of Medicine, Swansea University, Swansea, UK

Publication date: November 1, 2009

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