The adaptive psychological changes of elective induction of labor in breastfeeding women

Abstract

Background: Labor induction has been associated with breastfeeding suppression, but reasons for why this association exists have not been well determined.

Methods: We examined the influence of elective labor induction by vaginal prostaglandin at gestational week 41⁺³days on affective, cognitive, and behavioural adaptations early in puerperium and on breastfeeding pattern at 1 and 3months.

Results: One hundred and eighty consecutive puerperae were assigned to two groups: mothers having received vaginal prostaglandin E2 gel (Prepidil®, dinoprostone) before labor (PGE group, n=90) and mothers having received no treatment (unmedicated group, n=90). The day of discharge mothers completed the Edinburg Postnatal Depression Scale, (EPDS), State and Trait Anxiety Inventory (STAI-Y), and Mother to-Infant Bonding Scale (MIBS). Later they participated in telephone interviews concerning their breastfeeding practices at 1 and 3months, which were classified according to WHO definitions. When compared with unmedicated, PGE group puerperae scored [median, (IQR)] significantly higher EPDS [9 (7-13) vs 5 (3-8), p 0.003], STAI-state [46 (39-51) vs 39 (34-48), p 0.002], STAI-trait [39 (36-48) vs 34 (32-45), p 0.04], and MIBS [10 (5.25-10) vs 5 (3-4), p 0.002] scores. In addition, while the breastfeeding practices were similar at hospital discharge, at follow-up the labor induced mothers were less likely to maintain full breastfeeding with respect to untreated mothers: 1month (p 0.001); and 3months (p 0.003).

Conclusion: We present evidence that elective induction of labor by prostaglandins at gestational week 41⁺³days is associated with reduced exclusive breastfeeding rates at 1 and 3months after discharge and higher EPDS, STAI, and MIBS scores.

Keywords: Breastfeeding; Edinburg Postnatal Depression Scale; Elective induction of labor; Mother to-Infant Bonding Scale; State and Trait Anxiety Inventory.