(275) Association of post-cesarean delivery pain and breastfeeding

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Mariana Espinal, MD (she/her/hers)

Fellow
Northwestern University Feinberg School of Medicine
Bethesda, MD, United States

Coauthor(s)

AB

Alexandra L. Berra, MD

Fellow Physician
Case Western Reserve University Metrohealth Medical Center
Cleveland, OH, United States
JB

Jeanette Boyce, MSN, RN

University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Objective: To evaluate whether pain severity after cesarean delivery (CD) is associated with breastfeeding initiation and continuation up to 90 days postpartum, and to evaluate whether there is an association of morphine milligram equivalents (MME) used and breastfeeding up to two-weeks postpartum.

Study Design: Secondary analysis of a multicenter randomized trial of an individualized opioid prescription protocol compared to a fixed quantity of opioids upon discharge after CD. People with a live singleton newborn were included. The primary outcome was breastfeeding initiation before hospital discharge, determined by chart abstraction. Secondary outcomes included participant-reported breastfeeding at several postpartum time points. The primary exposure was pain severity in the 24 hours prior to discharge, assessed using the Brief Pain Inventory (BPI). Secondary analyses evaluated MME used at each corresponding time point. Outcomes were compared using bivariable and multivariable analyses.

Results: Of 5,291 individuals, 56% reported severe pain (BPI 7-10) and 83% reported initiation of breastfeeding prior to discharge. Those who initiated breastfeeding were older, more likely to be non-Hispanic White, married, had higher income, and less likely to be obese, smoke tobacco, or use illicit drugs. Individuals who reported severe pain prior to discharge were less likely to initiate breastfeeding before discharge (81%) compared to individuals who reported moderate (85%) or mild (84%) pain (p=0.001, Table). Severe pain prior to discharge was associated with lower breastfeeding rates at each postpartum time point (Table), which remained significant in adjusted analyses at and after two-weeks postpartum (Table). Compared to individuals not breastfeeding, those who breastfed took lower MME in the hospital and at one- and two-weeks post-discharge (Figure).

Conclusion: Individuals who experienced severe pain after CD were less likely to initiate and continue breastfeeding up to 90 days postpartum, and those breastfeeding took fewer MME.