The impact of breastfeeding on postpartum pain after vaginal and cesarean delivery

Abstract Study Objective Oxytocin may play a role in pain modulation. The analgesic effects of breastfeeding with its associated endogenous oxytocin release have not been well investigated. To determine the impact of breastfeeding on incisional, perineal, and cramping pain after cesarean and vaginal delivery. Design Institutional review board–approved prospective observational study. Setting Labor and delivery and maternity wards. Patients Healthy (American Society of Anesthesiology physical statuses 1 and 2) multiparous women who had cesarean (n = 40) and vaginal (n = 43) deliveries of singleton term infants and who were breastfeeding were enrolled. Interventions Women completed diaries to record incisional, perineal, or cramping pain scores 5 minutes before, during, and 5 minutes after breastfeeding. Measurements Demographic, obstetric, and neonatal variables, as well as analgesic use, were recorded. Main Results There was no difference in incisional pain before, during, and after breastfeeding in women post–cesarean delivery. Cramping pain was significantly increased during, as compared with before or after breastfeeding in both the vaginal ( P < .001) and cesarean ( P < .001) delivery cohorts. Conclusions There was no analgesic effect on incisional pain during breastfeeding, indicating that endogenous oxytocin associated with breastfeeding may not play a significant role in postpartum cesarean wound pain modulation. Breastfeeding increased cramping pain after vaginal and cesarean delivery. The increase in cramping pain is most likely due to the breastfeeding-associated oxytocin surge increasing uterine tone.