• Roberto Giorgio Wetzl, Enrica Delfino, Luca Peano, Daniela Gogna, Yvette Vidi, Francesca Vielmi, Eleonora Bianquin, Serena Cerioli, Maria Enrica Bettinelli, Maria Lorella Giannì, Gabriella Frassy, Elena Boris, and Cesare Arioni.
• Department of Anaesthesia, Intensive Care, and Out-hospital Emergency, Ospedale Regionale della Valle d'Aosta, Aosta, Valle d'Aosta, Italy.
• BMJ Open. 2019 Mar 5; 9 (3): e025179.

ObjectiveTo investigate whether the nature of the decision about receiving neuraxial labour analgesia is associated with breastfeeding initiation success (BIS), defined as exclusive breastfeeding until discharge associated with postnatal weight loss <7% at 60 hours from birth.DesignSingle-centre community-based cohort study.SettingAn Italian baby-friendly hospital, from 1 July 2011 to 22 September 2015.ParticipantsInclusion criteria: women vaginally delivering singleton cephalic newborns and willing to breastfeed.Exclusion Criteriawomen who delivered in uterus-dead fetuses, were single or requested but did not receive neuraxial analgesia. Overall, 775 out of the 3628 enrolled women received neuraxial analgesia.ResultsCompared with women who tried to cope with labour pain, those who decided a priori to receive neuraxial analgesia had less BIS (planned vaginal birth: 2121/3421 (62.0%), vs 102/207 (49.3%; p<0.001; risk difference (RD), 12.7%); actual vaginal birth: 1924/2994 (64.3%), vs 93/189 (49.2%; p<0.001; RD, 15.1%)). Multivariable analyses with antelabour-only confounders confirmed both associations (planned vaginal birth: relative risk (RR), 0.65; 95% CI, 0.48 to 0.87; actual vaginal birth: RR, 0.59; 95% CI, 0.43 to 0.80). Although women who requested analgesia as a last resort had less BIS than did those successfully coping with labour pain in the bivariable analyses (planned vaginal birth: 1804/2853 (63.2%), vs 317/568 (55.8%; p=0.001; RD, 7.4%); actual vaginal birth: 1665/2546 (65.4%), vs 259/448 (57.8%; p=0.002; RD, 7.6%)), multivariable analyses with either antelabour-only or peripartum confounders did not confirm these associations (planned vaginal birth: RR, 0.99; 95% CI, 0.80 to 1.23; actual vaginal birth: RR, 0.90; 95% CI, 0.69 to 1.16).ConclusionsCompared with trying to cope with labour pain, a priori choice of neuraxial analgesia is negatively associated with BIS. Conversely, compared with having successfully coped with pain, requesting neuraxial analgesia as a last resort is not negatively associated with BIS.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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