Identification of the association between medicines administered in labour and breastfeeding raised public and professional awareness of a health risk and engendered practice changes, including lower doses of opioid analgesics. Subsequently, breastfeeding

Description:
Identification of the association between medicines administered in labour and breastfeeding raised public and professional awareness of a health risk and engendered practice changes, including lower doses of opioid analgesics. Subsequently, breastfeeding
 
Indicator:
Breastfeeding initiation rates improved from 66.2 to 73.7% 2005/6 to 2010/11 7 guidelines recommend restrictions on epidural fentanyl doses. National Institute for Health and Care Excellence elaborated the Intrapartum Care Guideline and included recommendations against high doses and the need for further research. Recommendations on page 14 include informing women that “opioids may interfere with breastfeeding”. The US Academy of Breastfeeding Medicine Protocol (2008 p.129), citing our 2005 work, states: consideration should be given to the type and dose of analgesia. Higher doses of intrapartum fentanyl may impede establishment of breastfeeding. Taking our work with a small trial, Reynolds recommends: When prolonged epidural analgesia using local anaesthetic-opioid combination is extended for emergency section, it is unwise, for the baby’s sake, to give further opioid epidurally or systemically until after delivery (Reynolds 2010 p.298).
 
Improvement:
8. Breastfeeding initiation rates improved from 66.2 to 73.7% 2005/6 to 2010/11. We recommended that doses of analgesia be minimised and mothers receiving multiple medicines in labour targeted for additional breastfeeding support (R1-3). These recommendations reached most midwives and students in the English-speaking world through NICE (National Institute for Health and Care Excellence), Intrapartum Care Guideline 2007 (C1 p.123) and our textbooks (R4, 5). NICE guidelines form the basis of hospital policies and procedures in the UK and beyond
 
Transferability:
4. In fact, 40 of 65 midwifery courses in the United Kingdom have adopted the textbook produced by the team, while the book has been bought by midwives from Australia, USA, Ireland and Malta
 
Evidence(s):
Jordan, S., Emery, S., Bradshaw, C., Watkins, A., Friswell, W. (2005). The Impact of Intrapartum Analgesia on Infant Feeding. BJOG: An International Journal of Obstetrics and Gynecology. 112, 927-34. doi: 10.1111/j.1471-0528.2005.00548.x
Jordan, S., Emery, S., Watkins, A., Evans, J., Storey, M., Morgan, G. (2009). Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG: An International Journal of Obstetrics and Gynecology, 116(12) 1622-30. doi: 10.1111/j.1471-0528.2009.02256.x
Brown, A.E., Jordan, S. (2013). Impact of Birth Complications on Breastfeeding duration: an internet survey. Journal of Advanced Nursing. 69(4), 828-39. doi: 10.1111/j.1365-2648.2012.06067.x
Brown, A., Jordan, S. (2014). Active Management of the Third Stage of Labor May Reduce Breastfeeding Duration Due to Pain and Physical Complications. Breastfeed Med, 9(10): 494-502. doi: 10.1089/bfm.2014.0048
Academy of Breastfeeding Medicine (ABM) clinical protocol 5. Breastfeeding Medicine: official journal of the ABM; 2008 Jun;3(2):129-32 Also: National Guideline Clearginghouse 2009 Peripartum breastfeeding management for the healthy mother and infant at term. US. Dept Health & Human Services
West, D., Marasco, L. (2009). The breastfeeding mother's guide to making more milk New York, McGraw-Hill@9780071598583 0071598588 ISBN-10:007159857X |ISBN-13:978-0071598576
REF 2014 Impact Case Studies
National Collaborating Centre for Women's and Children's Health, commissioned by NICE (2007). Intrapartum care; care of healthy women and their babies during childbirth: clinical guideline. London: RCOG Press. 122-3, section 6.5, ref. 187
New Zealand College of Midwives (2011). NZCOM Consensus Statement: Prescribing and administration of Narcotic Analgesia in Labour Auckland, New Zealand
Hey, E. (2007). Neonatal formulary and Drug Use in the First Year of Life. 5th edition. Wiley Blackwell / BMJ Books, Oxford.
Royal College of Midwives 2012 Evidence-based Guidelines for Midwifery-led Care in Labour: Early Breastfeeding
Ministerio De Sanidad Y Política Social (2010). Guía de Práctica Clínica sobre la Atención al Parto Normal (clinical practice guidelines on normal childbirth care). Servicio Central de Publicaciones del Gobierno Vasco. ref 356. 235-7
Reynolds, F. (2010). The effects of maternal labour analgesia on the fetus. Best Practice & Research Clinical Obstetrics & Gynaecology. 24(3), 298-302. doi: 10.1016/j.bpobgyn.2009.11.003
UNICEF Baby Initiative in the United Kingdom
The group's textbooks ensure that their results reach most of the medical students who work in English, Persian, and Indonesian
An increase in public awareness has been achieved on this issue with research that was reported through the media through the BBC
Brown, A., Jordan, S. (2012). Impact of birth complications on breastfeeding duration: an internet survey. JAN. Leading Global Nursing Research. 69(4), 828-839. doi: 10.1111/j.1365-2648.2012.06067.x