Are the complex physiological processes Involved In establishing lactation vulnerable to the pharmacological effects of Intrapartum regional anaesthesia?

摘要

Introduction: The importance of breastfeeding in relation to short- and long-term maternal and infant health is significant and well-documented. Despite strong global interest in the life preserving importance of breastfeeding, the duration of exclusive breastfeeding remains suboptimal (Lawn et al 2005). Evidence from the most recent UK-wide infant feeding survey indicates that only 81% of women initiate breastfeeding; furthermore, only 55% of infants are receiving breast milk at six weeks' postpartum (McAndrew et al 2012). Regional anaesthesia is considered to be the most effective form of pharmacological pain relief for labour pain and is currently experienced by approximately one fifth of parturient women in the UK; moreover, rates of epidural use are continuing to rise (Purva 2013). Susceptibility to the use of breast milk substitute is often regarded as determined by socio-cultural factors; however, research suggests that the impact of neuraxial analgesia may inhibit innate maternal and neonatal abilities and thus reduce the likelihood of breastfeeding initiation (Smith 2007). To date, public health interventions have been unsuccessful in achieving the set target to increase the number of babies receiving breast milk by 2% per year (NHS Health Development Agency 2004); therefore, investigations of interventions that may compromise the transition of a mother and her infant to becoming a successful breastfeeding dyad must be accorded high priority.