Effects of Breast Feeding on Post-Cesarean and Post-Vaginal Delivery Pain
| Status: | Completed |
|---|---|
| Conditions: | Chronic Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - 40 |
| Updated: | 4/13/2015 |
| Start Date: | August 2011 |
| End Date: | May 2015 |
| Contact: | Brendan Carvalho |
| Email: | bcarvalho@stanford.edu |
| Phone: | (650) 861-8607 |
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.
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.
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.
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.
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
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