The relationship between maternal labour analgesia and infant breastfeeding in the first four days after birth

Abstract

The Relationship between Maternal Labour Analgesia and Infant Breastfeeding in the First Four Days After Birth. -- This prospective ex post facto study explored the relationship between two commonly used labour analgesics, meperidine and alphaprodine, and delay in establishing effective breastfeeding in healthy neonates from birth to four days post-birth. -- The major purposes of the study were to describe the pattern of initiation of breastfeeding in healthy neonates whose mothers received no analgesia in labour and to compare the patterns of initiating breastfeeding in babies of mothers who received no medication in labour with those babies whose mothers received labour analgesic medication. -- Infant suckling was assessed by an Infant Breastfeeding Assessment Tool (IBFAT). The IBFAT is a new instrument which was developed for the purpose of the study to assess and measure infant breastfeeding competence. -- The subjects of the study were 60 healthy fullterm newborn infants who were delivered spontaneously following uncomplicated labours and deliveries. Selection was on an as-they-come basis on admission to the well-baby, nursery. Final sample was 86.9% of the total eligible population. -- The IBFAT was completed by the mother for every feeding and by the researcher at some randomly selected feedings until effective feeding was established. Inter-rater reliability was assessed by comparing the researcher's scores with the mother's scores. Inter-rater reliability was 91%. -- The researcher was blind to the medication status of each baby until data collection was completed. Following completion of data collection the babies were divided into three groups depending upon whether or not medication had been administered to the mother. The final groups were two medicated groups and one non-medicated comparison group. -- First, a descriptive analysis was done on the pattern of initiation of breastfeeding in babies of unmedicated mothers. Then the hypothesis, that babies of mothers who received analgesia during labour would take longer to establish effective breastfeeding than babies of unmedicated mothers, was tested with oneway analysis of variance and Dunnett’s t-test. To rule out parity as a confounding variable, the analysis was repeated on the babies of multiparous mothers only in the alphaprodine (n = 20) and the non-medicated (n = 18) groups. -- The results of the study showed that 66.6% of babies of mothers who received no analgesia during labour were breastfeeding effectively by 12.5 hours after birth and that 85.7% had established breastfeeding by 24 hours. A statistical analysis of inter-group scores in both the mixed parity and the multiparous only groups, suggested that babies of mothers who received a standard dose of analgesic medication within one to four hours prior to delivery took significantly longer to establish effective breastfeeding than those whose mothers received no medication. There was no statistically significant difference when the mother received the medication within one hour prior to delivery. Babies of primiparous mothers took significantly longer than babies of multiparous mothers in all groups. A number of possible explanations are advanced for this result. -- Delay in initiation of breastfeeding has potentially deleterious effects on both mother and baby. From the results of the study a number of suggestions for further nursing research, practice and education are put forward.