Although Cesarean birth is identified as a persistent barrier to breastfeeding, operative delivery rates have risen at an alarming rate worldwide.Consequently, the importance of effective post-operative pain management and attention to early initiation of breastfeeding is imperative.Following IRB approval, a retrospective, comparative, correlational study of all Cesarean deliveries of at least 34 weeks gestation at a community teaching hospital in the northeast United States was conducted to assess patient controlled epidural analgesia (PCEA) vs.patient controlled analgesia (PCA) for post-Cesarean analgesia and to determine the impact of analgesic modality on breastfeeding in the first 24-hours postpartum.This sample of 621 singleton Cesarean deliveries consisted of primarily term, multigravidae women having a primary Cesarean.Overall, nearly 60% (n =370) had documented maternal and/or fetal complications, with the most common maternal complication being arrest of labor (32.7%) and the most common fetal complication being non-reassuring fetal heart tracing (19.3%).The average birth weight in grams was 3434.2 grams with average APGAR scores at one and five minutes showing appropriate adjustment to extra-uterine life.More than one-half the total sample breastfed, with an average time of 4.2 hours to initiation of breastfeeding.Women with PCEA reported significantly less average pain (p =.000) and required significantly less analgesic adjuvant medication doses (p =.038) compared to women with PCA.Statistically significant negative correlations were found for average total pain score with number of breastfeeding sessions (p =.023).Controlling for confounders, women with PCEA had 2.2 times the odds of mild pain compared to PCA (p =.03).Women with mild pain (aOR =2.4, p =.03), term neonate (aOR =3.2;p =.006),breastfeeding within 2 hours (aOR =3.2, p =.000) and no supplemental feedings (aOR =6.9;p =.002) had significantly greater odds of breastfeeding 6+ times in the first 24 hours.PCEA confers greater pain control post-Cesarean than PCA.Women with greater pain are less likely to breastfeed six or more times within the first 24 hours.This could potentially impact duration ofbreastfeeding.Measures to improve pain management are warranted.