Induction of labor and epidural analgesia are associated with lower likelihood of initiating and maintaining breastfeeding and more breastfeeding problems: A large longitudinal cohort study

Objective: To examine whether induction of labor and epidural analgesia are associated with breastfeeding initiation, maintenance, and breastfeeding problems. Design: Population-based longitudinal cohort study. Setting: The Norwegian Mother, Father and Child Cohort Study (MoBa), linked with data from the Medical Birth Registry of Norway. Sample: A total of 73,069 mothers with singleton infants and vaginal births. Methods: : Information on induction of labor, method of induction, and epidural analgesia were obtained from registry data. Breastfeeding initiation, maintenance of breastfeeding at six months, and breastfeeding problems were reported by mothers six months postpartum. Logistic regression analyses estimated associations between birth interventions and breastfeeding outcomes, adjusting for several maternal sociodemographic and obstetric variables, and maternal and fetal health. Main outcome measures: Initiation of breastfeeding within the first week, maintenance of breastfeeding to six months postpartum, and reported breastfeeding problems. Results: : Induction of labor was associated with reduced likelihood of initiating breastfeeding (adjusted OR 0.65, 95% CI 0.56 - 0.77) and maintaining breastfeeding at six months (adjusted OR 0.86, 95% CI 0.81 – 0.91), and with increased likelihood of breastfeeding problems (adjusted OR 1.11, 95% CI 1.01 – 1.22). Epidural analgesia was also associated with lower initiation (adjusted OR 0.68, 95% CI 0.59 – 0.77) and maintenance (adjusted OR 0.79, 95% CI 0.76 – 0.83), and higher rates of breastfeeding problems (adjusted OR 1.12, 95% CI 1.05 – 1.21). Conclusion: Induction of labor and epidural analgesia may be a risk factor for reduced likelihood of breastfeeding. Awareness can help clinicians target individualized breastfeeding support postpartum.