Effects of Breast Feeding on Post-Cesarean and Post-Vaginal Delivery Pain

Oxytocin is a hormone that is released in response to distension of the cervix and uterus during labor, and after breast feeding as a result of nipple stimulation. In addition to oxytocin facilitating birth and breastfeeding, oxytocin has a number of effects on maternal behavior including bonding, social recognition, anxiolysis, sexual arousal.

The role of oxytocin in pain modulation has recently been highlighted. Intranasal or intrathecal (spinal) administration has been found to impact pain modulation. The administration of intravenous oxytocin has not provided effective analgesia because oxytocin is unable to pass to your brain. The role of breastfeeding on analgesia is poorly investigated, which is why we are carrying out this study.

Study Overview

• Status: Completed
• Conditions: Pain

Detailed Description

Patients will be recruited by a member of the research team when the patient is admitted to labor or delivery and when they are in the post-natal floor.

Patients will be divided into two groups initially depending on mode of delivery, vaginal vs. cesarean. The vaginal delivery group will be randomized into three groups. One group will be told that we are investigating the effect of oxytocin on pain intensity, the second group will be told that it reduces pain intensity, the third group will be told that it increases pain intensity.

The cesarean group are not going to be randomized, they will be told we are investigating the effect of oxytocin on pain intensity.

Demographic and obstetric will be collected by patient questioning as well as from the medical record on Day 1 post delivery. Analgesia data from the medical record will also be collected on days 1 and 2 post-delivery.

The primary outcome measure will be change in pain scores (0=no pain, 10=worse pain imaginable) during and after breastfeeding compared to pain before. We will examine both vaginal, cramping and surgical pain as appropriate.

The patients will be given a breastfeeding diary to complete, which will record the average pain scores (0-10) before, during and after each breastfeed.

Secondary outcome measure will include: Depression, PTDS, and other outcome measures. Patients will also be asked to complete pain intensity and depression (The Edinburgh Depression Scale) and a PTSD questionnaires. We will also determine pain preferences as relating to pain intensity and duration by another questionnaire.

At 6 weeks post-delivery, a member of the research team will call the participant to ask questions regarding current pain scores, success of breastfeeding and weight of the baby.

The study end-point is 6 weeks post-delivery. We will debrief participants who had deception at completion of the whole study.

• Study Type: Observational
• Enrollment (Anticipated): 130

Contacts and Locations

Study Locations

• United States
  • California
    • Stanford, California, United States, 94305
      • Stanford University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 40 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

30 patients posy cesarean delivery. 100 patients post vaginal delivery.

Description

Inclusion Criteria:

1. Age 18 - 40 yrs
2. ASA 1 or 2
3. Singleton gestation
4. Greater or equal to 37 weeks gestation
5. Vaginal delivery
6. Scheduled cesarean delivery with a Pfannenstiel incision

Exclusion Criteria:

1. Chronic pain
2. Patients prescribed regular analgesia medication ante-natally
3. Substance abuse
4. Classical cesarean incision
5. Emergency cesarean delivery
6. Patients not planning to breastfeed
7. Psychiatric or cognitive disorder, including anxiety or depression
8. Physicians, labor and delivery nurses, midwives

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Nocebo; Told breastfeeding may worsen pain
No treatment; Told nothing
Placebo; Told will improve pain

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain in relation to breastfeeding	The primary outcome measure will be change in pain scores (0=no pain, 10=worse pain imaginable) during and after breastfeeding compared to pain before. We will examine both vaginal, cramping and surgical pain as appropriate. The patients will be given a breastfeeding diary to complete, which will record the average pain scores (0-10) before, during and after each breastfeed.	6 weeks post-delivery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To determine the effects of suggestion and mood on pain	Secondary outcome measure will include: Depression, PTDS, and other outcome measures. Patients will also be asked to complete pain intensity and depression (The Edinburgh Depression Scale) and a PTSD questionnaires. We will determine the effects of suggestion (placebo vs. nocebo) on the pain experience. At 6 weeks post-delivery, a member of the research team will call the participant to ask questions regarding current pain scores, success of breastfeeding and weight of the baby. The study end-point is 6 weeks post-delivery.	6wks
To understand patients' preference for duration versus intensity of pain	We will also determine pain preferences as relating to pain intensity and duration by another questionnaire we have developed.	48 h

Collaborators and Investigators

• Sponsor: Stanford University
• Investigators: Principal Investigator: Brendan Carvalho, Stanford University

Study record dates

Study Major Dates

• Study Start: August 1, 2011
• Primary Completion (Actual): December 1, 2014
• Study Completion (Actual): December 1, 2014

Study Registration Dates

• First Submitted: August 11, 2011
• First Submitted That Met QC Criteria: August 12, 2011
• First Posted (Estimate): August 16, 2011

Study Record Updates

• Last Update Posted (Estimate): April 14, 2015
• Last Update Submitted That Met QC Criteria: April 10, 2015
• Last Verified: April 1, 2015

More Information

Terms related to this study

• Other Study ID Numbers: SU-08092011-8247; IRB 22053