Journal of Family and Reproductive Health 2016. 10(4):176-183.

Effects of Intrathecal Opioids Use in Cesarean Section on Breastfeeding and Newborns’ Weight Gaining
Fardin Yousefshahi, Fatemeh Davari-Tanha, Atabak Najafi, Mahbod Kaveh, Mohsen Rezaei Hemami, Patricia Khashayar, Mohammad Anbarafshan


Objective: To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section.
Materials and methods: The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter.
Results: There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants’ weight at the end of second month was lower in spinal opioid group (P value = 0.036).
Conclusion: The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation.


Breastfeeding; Cesarean Section; Intrathecal Opioid; Spinal

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Thulier D, Mercer J. Variables associated with breastfeeding duration. J Obstet Gynecol Neonatal Nurs 2009;38:259-68.

Dashti M, Scott JA, Edwards CA, Al-Sughayer M. Predictors of Breastfeeding Duration among Women in Kuwait: Results of a Prospective Cohort Study. Nutrients 2014; 6: 711-28.

O’Leary A, Kopsell D, Haller S. Breastfeeding incidence after early discharge and factors influencing breastfeeding cessation. J Obstet Gynecol Neonatal Nurs 1997; 26: 289-94.

Vandiver, T. Relationship of mothers’ perceptions and behaviors to the duration of breastfeeding. Psychol Rep 1997; 80: 1375-84.

Rowe-Murray HJ, Fisher JR. Baby friendly hospital practices. Cesarean section is a persistent barrier to early initiation of breastfeeding. Birth 2002; 29:124-31.

Henderson JJ, Dickinson JE, Evans SF, McDonald SJ, Paech MJ. Impact of intrapartum epidural analgesia on breast-feeding duration. Aust N Z J Obstet Gynaecol 2003; 43:372-7.

Karlström A, Engström-Olofsson R, Nystedt A, Sjöling M, Hildingsson I. Women's postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesarean section. J Clin Nurs 2010;19:1326-34.

Szabo AL. Review article: Intrapartum neuraxial analgesia and breastfeeding outcomes: limitations of current knowledge. Anesth Analg 2013; 116:399-405.

Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs 2003; 32:322–31.

Baumgarder DJ, Muehl P, Fischer M, Pribbenow B. Effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally. J Am Board Fam Pract 2003; 16:7–13.

Loftus JR, Hill H, Cohen SE. Placental transfer and neonatal effects of epidural Sufentanyl and fentanyl administered with bupivacaine during labor. Anesthesiology 1995; 83:300–8.

Bader AM, Fragneto R, Terui K, Arthur R, Loferski B, Datta S. Maternal and neonatal fentanyl and bupivacaine concentrations after epidural infusion during labor. Anesth Analg 1995; 81: 829–32.

Fernando R, Bonello E, Gill P, Urquhart J, Reynolds F, Morgan B. Neonatal welfare and placental transfer of fentanyl and bupivacaine during ambulatory combined spinal epidural analgesia for labor. Anaesthesia 1997; 52:517–24.

Carrie L, O’Sullivan G, Seegobin R. Epidural fentanyl in labor. Anaesthesia 1981; 36:965–9.

Rajan L. The impact of obstetric procedures and analgesia/anaesthesia during labor and delivery on breastfeeding. Midwifery 1994; 10:87– 103.

Halpern SH, Levine T, Wilson DB, MacDonell J, Katsiris SE, Leighton BL. Effect of labor analgesia on breastfeeding success. Birth 1999; 26:83-8.

Devroe S, De Coster J, Van de Velde M. Breastfeeding and epidural analgesia during labour. Curr Opin Anaesthesiol 2009; 22:327-9.

Goma HM, Said RN, El-Ela AM. Study of the newborn feeding behaviors and fentanyl concentration in colostrum after an analgesic dose of epidural and intravenous fentanyl in cesarean section. Saudi Med J 2008; 29:678-82.

Jordan S, Emery S, Bradshaw C, Watkins A, Friswell W. The impact of intrapartum analgesia on infant feeding. BJOG 2005; 112:927-34.

Hamlyn B, Brooker S, Oleinikova K, Wands S. Department of Health, Infant Feeding Survey 2000. London: The Stationery Office, 2002.

DiMatteo MR, Morton SC, Lepper HS, Damush TM, Carney MF, Pearson M, et al . Cesarean childbirth and psychosocial outcomes: A meta-analysis. Health Psychol 1996; 15:303–14.

Wright A, Rice S, Wells S. Changing hospital practices to increase the duration of breastfeeding. Pediatrics 1996; 97:669-75.

Lie B, Juul J. Effect of epidural vs. general anesthesia on breastfeeding. Acta Obstet Gynecol Scand 1988; 67:207–9.

Beilin Y, Bodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, et al. Effect of Labor Epidural Analgesia with and without fentanyl on Infant Breast-feeding: A Prospective, Randomized, Double-blind Study. Anesthesiology 2005; 103:1211–7.

Ransjo-Arvidson AB, Matthiesen AS. Maternal Analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth 2001; 28:5-12.

Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labor. Cochrane Database Syst Rev 2005; 4: CD000331.

Volmanen P, Valanne J, Alahuhta S. Breast-feeding problems after epidural analgesia for labor: a retrospective cohort study of pain, obstetrical procedures and breast-feeding practices. Int J Obstet Anesth 2004; 13:25-9.

Kiehl EM, Anderson GC, Wilson ME, Fosson L. Social status, motherinfant time together, and breastfeeding duration J Hum Lact 1996; 12:201-6.

Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J 2006;1:24.

Wittels B, Glosten B, Faure EA, Moawad AH, Ismail M, Hibbard J, et al. Post cesaren analgesia with both epidural pethidinee and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. Anesth Analg 1997; 85: 600-6.

Halpern SH, Levine T, Wilson DB, MacDonell J, Katsiris SE, Leighton BL. Effect of labor analgesia on breastfeeding success. Birth 1999;26: 83-8.

Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs 2003; 32:322-31.

Riordan J, Gross A, Angeron J, Krumwiede B, Melin J. The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. J Hum Lact 2000; 16:7-12.

Yousefshahi F, Asadi M, Rahimi F, Hoseinzade MJ, Davari Tanha F, Barkhordari K, et al.The effect of peripartum meperidine on breastfeeding and neonatal weight. J Family Reprod Health 2013; 7; 29-34.

Oberlander TF, Robeson P, Ward V, Huckin RS, Kamani A, Harpur A, et al. Prenatal and breast milk morphine exposure following maternal intrathecal morphine treatment. J Hum Lact 2000; 16:137-42.


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