Effect of Labor Epidural Analgesia With Hydromorphone on Neonatal Neurobehavior and Breastfeeding Behavior in the First 24 Hours of Life

Epidural opioids and local anesthetics may depress the neonatal reflexes necessary for breastfeeding success. Literature review yielded no data for hydromorphone and conflicting results for fentanyl. This study investigated whether breastfeeding effectiveness would be less in infants whose mothers received epidural analgesia with hydromorphone compared with those whose mothers received no analgesia, and whether the total amount of drugs given or the presence of multiple stressful events or interventions would be related to the effectiveness of breastfeeding. Breastfeeding behaviors were studied in 51 infants whose mothers chose epidural analgesia compared with 51 infants whose mothers chose to have no analgesia. Women with epidural analgesia received 1.5% lidocaine with 1:200,000 epinephrine as a test dose and/or 0.25% bupivacaine with 1:200,000 epinephrine as a bolus, and 100 µg hydromorphone followed by continuous infusion of 0.05% bupivacaine with 3 µg/mL hydromorphone at 14 mL/hour. The hospital setting strongly supported breastfeeding. Effectiveness of breastfeeding was measured with the LATCH Breastfeeding Assessment Tool at 3, 12, and 24 hours after birth. LATCH scores did not differ significantly between groups at any time point and were not related to total amount of drugs administered. The presence of multiple stressful events and interventions, e.g., long duration of labor, large amount of IV fluids, oxytocin administration, induction of labor, and meconium staining/suctioning of the baby, did not significantly affect breastfeeding behavior in the overall study population (n=102), altogether contributing not more than 8% of the variability of LATCH scores in the regression model. The group receiving epidural analgesia (n=51) had significantly longer duration of labor, higher rates of oxytocin administration and induction of labor, and larger amounts of IV fluid administration. These factors contributed approximately 30% of the variability of LATCH scores at 3 and 24 hours. However, this finding was not significant. Although the study was limited by its nonrandomized nature, these data indicate that, by itself, epidural analgesia with hydromorphone does not decrease effectiveness of breastfeeding behaviors. Epidural analgesia increases risk of multiple stressful events or interventions, which may contribute to breastfeeding difficulties and necessitate intensive help from the nurse to achieve success in breastfeeding