• Anne B Woods, Barbara Crist, Shirley Kowalewski, Joyce Carroll, Joan Warren, and Joan Robertson.
• Franklin Square Hospital Center, Baltimore, MD, and Department of Nursing, Messiah College, Grantham, PA 17027, USA. nwoods@messiah.edu
• J Obstet Gynecol Neonatal Nurs. 2012 May 1; 41 (3): 339-46.

ObjectiveTo assess patient controlled epidural analgesia (PCEA) versus patient controlled analgesia (PCA) for postcesarean analgesia and to determine the impact of analgesic modality on breastfeeding in the first 24 hours postpartum.DesignA retrospective, descriptive, comparative, correlational design.SettingA metropolitan, community, teaching hospital in the northeast United States.ParticipantsMedical records for all women with cesarean births in 2007 of at least 34 weeks gestational age (N = 621).MethodsFollowing Institutional Review Board approval, electronic medical records and clinical charts were reviewed by the study team. Data were analyzed with PASW version 18.0.ResultsWomen with PCEA reported significantly less average pain (p = .000) and required significantly less analgesic adjuvant medication doses (p = .038) than women with PCA. Statistically significant negative correlations were found for average total pain score with number of breastfeeding sessions (p = .023). Controlling for confounders, women with PCEA had 2.2 times the odds of mild pain compared to PCA (p = .03). Women with mild pain (adjusted odds ratio [aOR] = 2.4, p = .03), term neonate (aOR = 3.2, p = .006), breastfeeding within 2 hours (aOR = 3.2, p = .000), and no supplemental feedings (aOR = 6.9, p = .002) had significantly greater odds of breastfeeding 6+ times in the first 24 hours.ConclusionPatient-controlled epidural anesthesia confers greater pain control postcesarean than PCA. Women with greater pain are less likely to breastfeed six or more times within the first 24 hours. This could potentially affect duration of breastfeeding. Intraprofessional measures to improve pain management are warranted.© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

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