• Rovnat Babazade, Rakesh B Vadhera, Parthasarathy Krishnamurthy, Ashwin Varma, Gulshan Doulatram, George R Saade, and Alparslan Turan.
• Department of Anesthesiology, University of Texas Medical Branch, Galveston Texas and Outcomes Research Consortium, Cleveland Clinic, OH, United States of America. Electronic address: rb@or.org.
• J Clin Anesth. 2020 Jun 1; 62: 109697.

Study ObjectiveThe primary aim of the proposed study was to determine the association between postoperative pain and breastfeeding after cesarean delivery during hospital stay.DesignRetrospective cohort study.SettingPostoperative recovery area and operating room.PatientsData was obtained on singleton pregnancies undergoing scheduled cesarean deliveries under spinal anesthesia between 2013 and 2016.InterventionsDetermine the association between postoperative pain and breastfeeding after cesarean delivery.MeasurementsPostoperative pain score, breastfeeding, LATCH score post-partum depression and length of stay values collected.Main ResultsThe dataset consisted of electronic medical records from 5350 patients. We found that the pain score is negatively associated with the LATCH score; higher pain was associated with lower LATCH scores, -0.01 [-0.01,-0.00], p < .0402. Every one-point increase in average pain score was associated with a 21% reduction in the odds of in-hospital exclusive breast-feeding relative to exclusive formula-feeding, OR = 0.79 [0.70-0.90], p < .0002. We observed that the post-partum depression status was associated with the average postoperative pain score, F (1, 5347) = 41.51, p < .0001. We also found a significant positive association between the average pain score and the duration of hospital stay (p < .0001); every one-point increase in the average pain-score was associated with a 7.98 [6.28, 9.68] hour increase in length of stay.ConclusionsOur results demonstrate significant association between the increase in post-cesarean pain scores and deterioration of breastfeeding initiation while also exposing slight reductions in the quality of breastfeeding. Additionally, we found that increases in post-cesarean pain scores also positively associate with postpartum depression and duration of stay, with each increase in pain score resulted in an almost one-day increase in the length of stay.Published by Elsevier Inc.

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