Running head: THE USE OF EPIDURAL ANALGESIA
Students Must Follow APA style
The Use of Epidural Analgesia During Delivery and Breastfeeding
King Saud University
College of Nursing
1439-1440 H
2018-2018
Course Name: NUR 412
Maryam Atinuke Isiaq
ID: 436204580
Supervised by: Dr. Jawaher Bin Jumah
1
1
INTRODUCTION
The encounter of labor is one of the most painful experiences to human. Many
nonpharmacological methods, for example the use of TENS (transcutaneous electrical nerve
stimulation), water immersion, acupunctures, etc. Pharmacological methods are used to relieve and
reduce the feeling of labor pain. Epidural anesthesia is one of the most effective pharmacological
method of reducing labor pain and increasing mothers’ satisfaction during delivery. There are several
researches on epidural side effects that suggested that it increases the risk of assisted vaginal birth,
maternal hypotension, maternal blockade, maternal fever, urinary retention, long term backache,
longer second stage of labor, and has negative impact on breastfeeding (1st author family name, 2nd
author family name & 3rd author family name, year).
Breastfeeding is the best source of nutrition to infant, it increases the immunity of the infant,
and prevents from ear infections, respiratory illnesses, and bouts of diarrhea, and lower the risk of
having allergy or asthma, etc. (Author, year). The influence of epidural analgesia on infant
breastfeeding is not described sufficiently and findings are contradictory. These contradictory
findings in different studies could be due to study design and/or the use of different drugs, such as
bupivacaine, mepivacaine, fentanyl, sufentanil, dosages and methods of administration (Author
family name, year). (ONE PARGRAPH ONLY)
Problem Statement
Numerous effects of epidural analgesia on neonates have been discussed vigorously about by
many researchers. Breastfeeding serves as the best source of nutrition for neonates. Till date, only
few researches have been made on the effect of epidural analgesia on breastfeeding.
Purpose of the Study (one purpose)
The aim of this study is to determine the influence of maternal epidural analgesia on early
breastfeeding of neonates.
Hypothesis (one hypothesis)
The use of epidural analgesia during delivery has a negative effect on infant breastfeeding.
2
2
Research Question (one research question)
Does epidural analgesia during delivery has a negative effect on infant breastfeeding?
Literature Review (Three Articles)
Numerous advantages are associated with breastfeeding either for the mother such as increase
in mother-baby relationship, prevention from breast cancer, increase involution of the uterus, etc. or
for the infant as discussed earlier. Many factors, mainly the use of epidural analgesia is presumed to
have a negative influence on breastfeeding.
The purpose of the study conducted by Dennis, Patricia, Mary, and Bridget (2003) was to
explore the association between labor epidural anesthesia and early breast-feeding success. 115
consecutive healthy, full-term, breast-feeding newborns who were exposed to maternal epidural
anesthesia, were analyzed and compared with 116 newborns that were not exposed to maternal
epidural anesthesia. The result showed 69.6% of mother-baby units that had had epidural anesthesia
compared with 81.0% of mother-baby units that had not had epidural anesthesia, to achieve two
successful breast-feedings within 24 hours of age, as defined by a LATCH breast-feeding assessment
score of 7 or more of 10 and a latch score of 2/2. Significantly, while hospitalized, bottle supplement
was more likely received by babies of mothers who had had epidural anesthesia. Notwithstanding,
exposed mothers to epidural anesthesia showed a trend toward being more likely to attempt breastfeeding in the 1 hour. Mothers who had epidural anesthesia and who did not breast-feed within 1
hour were at high risk for having their babies receive bottle supplementation. Although maternal
nulliparity was shown to be common in the epidural analgesia group, and researchers was unable to
collect data on labor length or difficulty.
A prospective cohort study conducted by Siranda, Christine, Judy, Jane and David (2006)
reported that a sample of 1280 women aged ≥ 16 years, who gave birth to a single live infant in the
Australian Capital Territory in 1997 – that: partial breastfeeding and difficulty breastfeeding in the
few days after birth, and also to stop breastfeeding in the first 24 weeks postpartum was experienced
3
3
by mother who needed or chose epidural analgesia during delivery. The restriction of analyses to
women who had vaginal births weakens the strength of association between epidurals and partial
breastfeeding and between epidurals and breastfeeding difficulties, in addition it deprives the
association between epidurals and partial breastfeeding it’s statistical significance, which suggests
that at least some of the effect of epidurals could be due to its association with type of birth.
Although this study did not collect information on all possible reasons why these women stopped
breastfeeding, and different sorts of analgesia were chosen by these women who are dissimilar in
characteristics. Women who choose non-pharmacological methods may be more likely to continue
breastfeeding for at least the first 24 weeks, which could explain, -either partially or fully- the
association between intrapartum analgesia and breastfeeding cessation. Other factors of epidural
analgesia like the type of analgesia and the dose also plays a vital role in understanding and
determining the association between epidural analgesia and breastfeeding.
The purpose of the a prospective, randomized, double-blinded study was to explore if the
women who had successfully breast-fed previously and who now delivered a child vaginally with
epidural analgesia; 60 women were randomly assigned to receive no fentanyl, 59 were randomly
assigned to receive an intermediate dose, and 58 were randomly assigned to receive high-dose
fentanyl; it was found that those women who were randomly assigned to receive more than [150 µg]
epidural fentanyl were less likely to be breast-feeding 6 weeks postpartum as compared with women
who were randomly assigned to receive less fentanyl or no fentanyl. No difference in Apgar score
among the three groups at 1 or 5 min was found. Also, no significant difference in the number of
infants who had supplemental bottle feeding or the number of women who received 5 mg oxycodone
with 325 mg acetaminophen within 24 h of delivery was seen. Although a negative association
between epidural fentanyl and breast-feeding success was found, the overall incidence of breastfeeding problems was small, 14% at 24 h and 9% at 6 weeks, as assessed by the mother. The
lactation consultants reported a greater incidence of breast-feeding problems -that the mothers could
not detect- with no difference among the groups approximately 40% (Yaakov et al. 2005). As a
4
4
result, there are insufficient controversial findings with different study designs that shows the
influence and the relationship between epidural analgesia. More findings with advanced study
designs are needed to clearly show this relationship.(summaries the literature)
Methods
prospective cohort study, an observational longitudinal design through which participants
with similar characteristics are divided according to their exposure to an agent or a risk factor,
followed up over a period, and studied, to know the outcome of the exposure/risk factor. It is useful
in developing the etiologies and risk factors of diseases and disorders (Auther family name, year).
This design is selected in order to study the effect of epidural analgesia [independent variable] on
breastfeeding [dependent variable] of infants.
Sampling
The act of selecting units (individuals, communities.) that equally represent the whole
population in which the study will be carried out (Author family name, year). The convenient sample
of 150 mothers will be used in this study. The included criteria will be participants age between 20-
30yrs, multipara [ without history of the use of epidural or CS in previous delivery], primigravida.
English speakers will be included. Inclusion criteria will be participants age less than 20 and more
than 30, multipara with history of the use of epidural or CS in previous delivery. Participants nonEnglish speakers will be excluded.
Ethical Consideration
In order to protect the participants’ right the following ethical issues must be considered:
Beneficence: Establishes a duty on researchers to reduce harm and increase benefits. the
purpose of human research should produce benefits for participants for others. It covers: the right to
freedom from harm and discomfort, and right to protection from exploitation (Author family name,
year).
5
5
Respect for Human Dignity: This principle aims to protecting the multiple and
interdependent interests of the participants from bodily to psychological to cultural integrity. It
consists: the right to self-determination, and the right to full disclosure (Author family name, year).
Justice: Requires equal selection of participants, i.e., avoiding participant populations that
may be unfairly forced into participating, such as prisoners and institutionalized children. The
principle of justice requires that those who undertake the burdens of research must be likely to
benefit from the research. It consists of: the right to fair treatment, and the right to privacy.
Recruiting Procedures
The researcher will develop the inform consent for the research.
Data Collection Procedures
Based on where the study will be conducted
Instruments
Based on the procedure of data collection.
Data Analysis
The hypothesis “The use of epidural analgesia during delivery has a negative effect on infant
breastfeeding” will be analyzed by T-test.
T-Test
T-Test is a type of inferential statistics used to determine whether there is a significant
difference between the means of two groups. With all inferential statistics, it is assumed that
the dependent variable fits a normal distribution, which allows the identification of the probability of
a particular outcome. After the collection of data, the test statistic is calculated with a formula. the
test statistic is then compared with a critical value found on a table to see if the results fall within the
acceptable level of probability (Author family name, year).
Summary
The encounter of labor is one of the most painful experiences to human, Epidural anesthesia
is one of the most effective pharmacological method of reducing labor pain and increasing mothers’
6
6
satisfaction during delivery. There are controversial researches with different research designs on the
influence of epidural on breastfeeding. This research will study 150 mothers of: age between 20-
30yrs, multipara [ without history of the use of epidural or CS in previous delivery], primigravida, to
determine the influence of maternal epidural analgesia on early breastfeeding of neonates.
7
7
References
Baumgarder, D. J., Muehl, P. Fischer, M., & Pribbenow, B. (2012). Effect of Labor Epidural
Anesthesia on Breast-feeding of Healthy Full-term Newborns Delivered. Article Name, 2,(12),
34-40.
