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- Jonas, W., et al.
(författare)
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Effects of Intrapartum Oxytocin Administration and Epidural Analgesia on the Concentration of Plasma Oxytocin and Prolactin, in Response to Suckling During the Second Day Postpartum
- 2009
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Ingår i: Breastfeeding Medicine. - : Mary Ann Liebert. - 1556-8253 .- 1556-8342. ; 4:2, s. 71-82
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Tidskriftsartikel (refereegranskat)abstract
- Background: Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. The aim of the present study was to make a detailed analysis of maternal release of oxytocin and prolactin in response to breastfeeding during the second day postpartum in mothers who had received oxytocin either intravenously for stimulation of labor or intramuscularly for prevention of postpartum hemorrhage and/or epidural analgesia or those who had received no such treatment in connection with birth.Methods: In a descriptive comparative study plasma oxytocin and prolactin concentrations were measured in response to suckling during the second day postpartum in women who had received intravenous intrapartum oxytocin (n = 8), intramuscular postpartum oxytocin (n = 13), or epidural analgesia, either with (n = 14) or without (n = 6) intrapartum oxytocin infusion, and women who received none of these interventions (n = 20). Hormone levels were analyzed by enzyme immunoassay.Results: All mothers showed a pulsatile oxytocin pattern during the first 10 minutes of breastfeeding. Women who had received epidural analgesia with oxytocin infusion had the lowest endogenous median oxytocin levels. The more oxytocin infusion the mothers had received during labor, the lower their endogenous oxytocin levels were during a breastfeeding during the second day postpartum. A significant rise of prolactin was observed after 20 minutes in all women, but after 10 minutes in mothers having received oxytocin infusion during labor. In all women, oxytocin variability and the rise of prolactin levels between 0 and 20 minutes correlated significantly with median oxytocin and prolactin levels.Conclusion: Oxytocin, released in a pulsatile way, and prolactin were released by breastfeeding during the second day postpartum. Oxytocin infusion decreased endogenous oxytocin levels dose-dependently. Furthermore, oxytocin infusion facilitated the release of prolactin. Epidural analgesia in combination with oxytocin infusion influenced endogenous oxytocin levels negatively.
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| 2. |
- Wiklund, Ingela, et al.
(författare)
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Epidural analgesia : Breast-feeding success and related factors
- 2009
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 25:2, s. e31-e38
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Tidskriftsartikel (refereegranskat)abstract
- Objective: to compare the early breast-feeding behaviours of full-term newborns whose mothers had received epidural analgesia (EDA) during an uncomplicated labour, with a group of newborns whose mothers had not received EDA. Design and setting: a retrospective comparative study design was used and the study was carried out in a labour ward in Stockholm, Sweden between January 2000 and April 2000. The ward has about 5500 deliveries per year. Participants: all maternity records of women who had received EDA during labour (n=585) were included in the study. For each EDA record, a control record was selected, matched for parity, age and gestational age at birth. Women with emergency caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation or an intra-uterine death, as well as neonates with an Apgar score <7 at 5 mins were excluded. After exclusion, the study population consisted of 351 healthy women and babies in each group. Method: logistic regression was performed. The dependent variables: (1) initiation of breast feeding after birth; (2) artificial milk given during hospital stay; and (3) breast feeding at discharge were studied in response to: (a) parity; (b) gestational age at birth; (c) length of first and second stage of labour; (d) administration of oxytocin; (e) administration of EDA; and (f) neonatal weight, as independent variables. Findings: significantly fewer babies of mothers with EDA during labour suckled the breast within the first 4 hours of life [odds ratio (OR) 3.79]. These babies were also more often given artificial milk during their hospital stay (OR 2.19) and fewer were fully breast fed at discharge (OR 1.79). Delayed initiation of breast feeding was also associated with a prolonged first (OR 2.81) and second stage (OR 2.49) and with the administration of oxytocin (OR 3.28). Fewer newborns of multiparae received artificial milk during their hospital stay (OR 0.58). It was also, but to a lesser extent, associated with oxytocin administration (OR 2.15). Full breast feeding at discharge was also positively associated with multiparity (OR 0.44) and birth weight between 3 and 4 kg (OR 0.42). Key conclusions: the study shows that EDA is associated with impaired spontaneous breast feeding including breast feeding at discharge from the hospital. Further studies are needed on the effects of EDA on short- and long-term breast-feeding outcomes. © 2007 Elsevier Ltd. All rights reserved.
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