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J Clin Anesth. 2019 Dec 31:109697. doi: 10.1016/j.jclinane.2019.109697. [Epub ahead of print]

Acute postcesarean pain is associated with in-hospital exclusive breastfeeding, length of stay and post-partum depression.

Author information

1
Department of Anesthesiology, University of Texas Medical Branch, Galveston Texas and Outcomes Research Consortium, Cleveland Clinic, OH, United States of America. Electronic address: rb@or.org.
2
Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America.
3
C. T. Bauer College of Business, University of Houston, United States of America; Baylor College of Medicine and The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America.
4
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America.
5
Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America.

Abstract

STUDY OBJECTIVE:

The primary aim of the proposed study was to determine the association between postoperative pain and breastfeeding after cesarean delivery during hospital stay.

DESIGN:

Retrospective cohort study.

SETTING:

Postoperative recovery area and operating room.

PATIENTS:

Data was obtained on singleton pregnancies undergoing scheduled cesarean deliveries under spinal anesthesia between 2013 and 2016.

INTERVENTIONS:

Determine the association between postoperative pain and breastfeeding after cesarean delivery.

MEASUREMENTS:

Postoperative pain score, breastfeeding, LATCH score post-partum depression and length of stay values collected.

MAIN RESULTS:

The dataset consisted of electronic medical records from 5350 patients. We found that the pain score is negatively associated with the LATCH score; higher pain was associated with lower LATCH scores, -0.01 [-0.01,-0.00], p < .0402. Every one-point increase in average pain score was associated with a 21% reduction in the odds of in-hospital exclusive breast-feeding relative to exclusive formula-feeding, OR = 0.79 [0.70-0.90], p < .0002. We observed that the post-partum depression status was associated with the average postoperative pain score, F (1, 5347) = 41.51, p < .0001. We also found a significant positive association between the average pain score and the duration of hospital stay (p < .0001); every one-point increase in the average pain-score was associated with a 7.98 [6.28, 9.68] hour increase in length of stay.

CONCLUSIONS:

Our results demonstrate significant association between the increase in post-cesarean pain scores and deterioration of breastfeeding initiation while also exposing slight reductions in the quality of breastfeeding. Additionally, we found that increases in post-cesarean pain scores also positively associate with postpartum depression and duration of stay, with each increase in pain score resulted in an almost one-day increase in the length of stay.

KEYWORDS:

Exclusive breastfeeding; Post-partum depression; Postcesarean pain

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