The effects of opioids during labour on breastfeeding : midwives' views and experiences

Abstract

Opioid use during labour and the early postpartum period may affect the initiation and establishment of breastfeeding due to opioids’ side effects (Lim et al., 2018). The aim of this study is to explore the views and experiences of midwives on the effects of opioids on breastfeeding following their use during labour and the early postpartum period. The objectives of this study are to explore midwives' views on the effects of opioids on breastfeeding in the early postpartum; to seek midwives' experiences of breastfeeding when the mother has received opioids during labour and in the early postpartum; and to identify midwives' management of breastfeeding in the presence of opioid side effects. A qualitative approach was adopted for the study, using faceto-face, semi-structured interviews. A target population of eight midwives, working at the obstetric wards in the local general hospital, were chosen by convenience sampling. A response rate of 100% was achieved. The interview recordings were transcribed via verbatim transcription and data was analysed using the Braun and Clarke (2006) thematic content analysis framework. The findings in this study demonstrated that midwives are faced with several maternal and neonatal problems due to opioid use during labour and the early postpartum period; such as maternal fatigue and sleepy babies. The type of opioid used and the time when the opioids were administered, played an important part in the severity of problems with breastfeeding, but were usually resolved within 24 hours. However, participants claimed that the mother’s sheer will to breastfeed supersedes the ill effects of opioids. Participants identified skin-to-skin contact, providing the mother with adequate support, assisting with different breastfeeding positions, and finger feeding, as methods that help in initiating breastfeeding. In comprised situations, a gastric washout and an opioid antidote are strategies used to initiate and establish breastfeeding. Ongoing care for the breastfeeding mother may also be needed through referral to the paediatrician and the breastfeeding clinic. Several recommendations for practice, education, and further research were presented, namely; educating mothers on opioid effects on breastfeeding, and further education for midwives on the challenges and strategies to establish breastfeeding. More in-depth larger scale research is also recommended.