Peripartum Analgesia and Anesthesia for the Breastfeeding Mother

Women experience labor pain in different ways and have differing levels of pain tolerance. Labor pain may exceed a woman’s ability to cope or be magnified by fear and anxiety. Suffering in labor may lead to dysfunctional labors, poorer psychological outcomes, delayed secretory activation, and increased risk of postpartum depression, all of which may have negative effects on breastfeeding. In addition, severe maternal physiologic stress in labor also causes in utero fetal stress as well as increased physiologic stress for infants, which may affect their readiness to breastfeed at birth. (III)

Maternity care providers should discuss labor pain management options during the prenatal period, before the onset of labor. This discussion should include what is known about the association of various modalities on the progress of labor, risk of instrumented and cesarean delivery, effects on the newborn, and possible breastfeeding effects. (IV)

Regardless of the modality used for labor analgesia, comprehensive patient and provider education, early and uninterrupted initiation of maternal–infant skin-to-skin contact, continuing lactation support in the postpartum phase, and identifying and actively addressing barriers to breastfeeding improve outcomes. ()