Which factor is NOT associated with increased afterpains?

• A. Bottle-feeding
• B. Diabetes
• C. Multiple gestation
• D. Primiparity

Answer: (A)

Afterpains are cramps caused by the uterus contracting as it involutes back to its pre-pregnancy size. The strength of these contractions is driven by oxytocin. Breastfeeding stimulates oxytocin release, which increases uterine contractions and, therefore, afterpains. Bottle-feeding avoids nipple stimulation, so oxytocin release is reduced and afterpains are not increased—often they’re milder. The other factors listed are associated with more intense involution and stronger contractions (for example, a uterus that has been more stretched in multiple gestation), so they tend to be linked with increased afterpains. Diabetes isn’t a primary driver of increased afterpains.