Labor Epidural Analgesia and Breastfeeding: A Systematic Review.

Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively.

Postplacement relationships between birth mothers and their romantic partners.

Using a mixed-methods approach, the understudied population of birth mothers who placed their infants for adoption 12-20 years ago was explored in the context of their romantic relationships. In a semistructured interview, 104 birth mothers answered detailed questions about their romantic relationships and adoption-related experiences. All birth mothers had disclosed the adoption placement to their romantic partners, and most had done so early because they wanted to be truthful about their past. On average, the birth mothers were satisfied with their romantic relationships and almost half did not believe that the adoption had affected it. Regarding contact in the adoption, a majority of the birth mothers' romantic partners (63.5%) were not directly involved in contact with the adoptive family or adopted youth. Implications about how adoption is perceived and processed within intimate relationships are discussed.