All of us who work as prenatal teachers as well as bfcs must have noted the correlation between the use of epidural during birth and subsequent bf problems
The new studies showing the effects of the drugs themselves give some of the answers but I still am convinced that when epidurals are given inappropriately  the process sets off a cycle of intervention which interferes with the first contact between mother and baby and the first bf experience.
For example, while it is established that epidurals should not be given before active stage of labour and that the pelvic station should be no higher than -2, the fact is that if a women is vocal in her demand, she will probably get her pain relief earlier than this.
Then labour often slows down, induction drugs are given, the baby`s head does not descend and we  see situations where there is full dilatation but the baby is stuck  at -2 resulting in a CS.

At the other end of the window of opportunity, epidurals are often given so late that their full effect is during second stage.  Even when the epidural is given at the appropriate time, it effects the expulsion effort and the strength of the pelvic floor.  But whatever the reason, effects on pushing result in more vacuum births and episiotomies.

So with all these interventions, the opportunity for the mother to receive her baby for an interrupted period immediately after birth, skin-to-skin, and to breastfeed is reduced.

Once the baby is based in the nursery there is a greater tendency to offer bottles.  If a woman is recovering from a CS or vacuum birth or has episiotomy pain, she is less likely to opt for rooming in and again with the baby spending more time in the nursery, out come the bottles.

Babies also suffer more trauma during such interventive births and may be more reluctant to feed.  If they get bottles they get conditioned to that method of feeding  and preferring  the easy way of getting their milk, reject the breast.

As Jack Newman said in his lecture in Israel last month: Babies put hunger over bonding.  If they get their milk easier and quicker from a bottle before they have the opportunity to breastfeed adequately, they do not yet understand the benefits of skin-to-skin contact with their mothers.

Since as a prenatal teacher I am convinced that women have rights to make their own choices about their births I am not about to start to advise women that epidurals are nasty and unnecessary.  I can only give information about the advantages and disadvantages, the timing and the effects on labour and breastfeeding.
For some women, epidurals may make the difference between a good birth experience or a trauma that lasts so long they can`t contemplate another pregnancy.
But for many, the epidural is accepted because of fear of pain, ("if you don`t have your epidural now, you can`t have it later"), pressure from the staff and/or given at the inappropriate time.
For those women, the perineal pain or painful recovery from CS or vacuum birth, the separation from the baby, the bf problems may seem a high price for the pain relief during those hours of labour.

Most childbirth preparation courses that are given within the health system do not deal with these issues so the majority of women are not aware that when they make choices they need the maximum of information.

All we can do is to support those choices and how many hours have I spent helping frustrated and exhausted mothers breastfeed babies who are restless and out of tune with themselves because of all the interventions during the birth and in the neonatal nursery.

Wendy Blumfield
NCT Tutor Prenatal Teacher/bfc
Israel Childbirth Education Centre

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