Contents lists available at ScienceDirect Journal of Clinical Anesthesia journal homepage: www.elsevier.com/locate/jclinane Original contribution Acute postcesarean pain is associated with in-hospital exclusive breastfeeding, length of stay and post-partum depression Rovnat Babazade a, ⁎ , Rakesh B. Vadhera b , Parthasarathy Krishnamurthy c,f , Ashwin Varma b , Gulshan Doulatram b , George R. Saade d , Alparslan Turan e a Department of Anesthesiology, University of Texas Medical Branch, Galveston Texas and Outcomes Research Consortium, Cleveland Clinic, OH, United States of America b Department of Anesthesiology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America c C. T. Bauer College of Business, University of Houston, United States of America d Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America e Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America f Baylor College of Medicine and The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America ARTICLE INFO Keywords: Postcesarean pain Exclusive breastfeeding Post-partum depression ABSTRACT Study objective: The primary aim of the proposed study was to determine the association between postoperative pain and breastfeeding after cesarean delivery during hospital stay. Design: Retrospective cohort study. Setting: Postoperative recovery area and operating room. Patients: Data was obtained on singleton pregnancies undergoing scheduled cesarean deliveries under spinal anesthesia between 2013 and 2016. Interventions: Determine the association between postoperative pain and breastfeeding after cesarean delivery. Measurements: Postoperative pain score, breastfeeding, LATCH score post-partum depression and length of stay values collected. Main results: The dataset consisted of electronic medical records from 5350 patients. We found that the pain score is negatively associated with the LATCH score; higher pain was associated with lower LATCH scores, -0.01 [-0.01,-0.00], p < .0402. Every one-point increase in average pain score was associated with a 21% reduction in the odds of in-hospital exclusive breast-feeding relative to exclusive formula-feeding, OR = 0.79 [0.70–0.90], p < .0002. We observed that the post-partum depression status was associated with the average postoperative pain score, F (1, 5347) = 41.51, p < .0001. We also found a significant positive association between the average pain score and the duration of hospital stay (p < .0001); every one-point increase in the average pain-score was associated with a 7.98 [6.28, 9.68] hour increase in length of stay. Conclusions: Our results demonstrate significant association between the increase in post-cesarean pain scores and deterioration of breastfeeding initiation while also exposing slight reductions in the quality of breastfeeding. Additionally, we found that increases in post-cesarean pain scores also positively associate with postpartum depression and duration of stay, with each increase in pain score resulted in an almost one-day increase in the length of stay. 1. Introduction The Centers for Disease Control and Prevention (CDC) recommends exclusive breastfeeding (EBF) for 6 months and in 2011, 79% of new- born infants were breastfed in the United States. Of infants born in 2011, 49% were breastfeeding at 6 months and only 27% at 12 months [1,2]. EBF is beneficial to the health and wellbeing of infants and mothers [3]. Children who are not breastfed exclusively for 6 months have a higher risk of gastrointestinal infections, respiratory illness, morbidity, and death [4–6], as well as atopic eczema [5,7], type II diabetes [8], leukemia [9], and obesity in later life [3] than EBF infants. EBF is estimated to prevent approximately one-tenth of child deaths [10–12]. Lack of breastfeeding is estimated to add $3 billion a year to mother and child medical costs [1,2]. Studies show that several factors, https://doi.org/10.1016/j.jclinane.2019.109697 Received 2 July 2019; Received in revised form 26 November 2019; Accepted 21 December 2019 ⁎ Corresponding author at: Department of Anesthesiology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States of America. E-mail address: rb@or.org (R. Babazade). Journal of Clinical Anesthesia xxx (xxxx) xxxx 0952-8180/ Published by Elsevier Inc. Please cite this article as: Rovnat Babazade, et al., Journal of Clinical Anesthesia, https://doi.org/10.1016/j.jclinane.2019.109697