Objective  To investigate the impact of intrapartum analgesia on infant feeding at hospital discharge.

Design  Retrospective cohort.

Setting  Maternity unit of a UK district general hospital.

Population  A random sample of 425 healthy primiparae delivering healthy singleton babies at term in 2000.

Methods  A random sample of primiparae delivering term neonates was identified from the birth register. We retrieved and analysed the corresponding joint midwifery/obstetric case notes.

Main outcome measure  Infant feeding method at discharge from hospital.

Results  Women [190/424 (45%)] were exclusively bottle feeding their babies at discharge from hospital. No one commenced breastfeeding after hospital discharge. Regression analysis revealed that the main determinants of bottle feeding were as follows: maternal age [odds ratio (OR) 0.90, 95% confidence interval [CI] 0.85–0.95 per year]; occupation (OR 0.63, 95% CI 0.40–0.99 for each category, unemployed, manual, non-manual); antenatal feeding intentions (OR 0.12, 95% CI 0.080–0.19 for each category, bottle feeding, undecided, breastfeeding); caesarean section (OR 0.25, 95% CI 0.13–0.47, caesarean or vaginal delivery); and dose of fentanyl administered intrapartum (OR 1.004, 95% CI 1.000–1.008, 90% CI 1.001–1.007 for each microgram administered, range 8–500 μg).

Conclusions  A dose–response relationship between fentanyl and artificial feeding has not been reported elsewhere. When well-established determinants of infant feeding are accounted for, intrapartum fentanyl may impede establishment of breastfeeding, particularly at higher doses.