I think Elisheva has hit upon just the right approach for a response to this
anesthesiologist. My experience with caring for Moms who have had "walking
epidurals" has been fairly positive on the breastfeeding aspect. And as has
been mentioned here before, these Moms seem to get out of bed and recover
far more quickly than those who've had "traditional" epidurals. Most have
had perhaps a half liter of fluid prior to the epidural and the IV and
epidural are discontinued right after delivery, even in the case of a
C-section most times!  C-sections get a small dose of epidural morphine
before the catheter is removed, which seems to provide a longer duration of
pain relief and enables the Moms to get up and about sooner. And remember
what Dr. Jack says; only a small amount of any drug the Mom receives is
going to make it into the milk.

One reason we may have problems getting babies to breast successfully in the
first 24 hours in the hospital is the " 1st Day Sleep Patterns of Infants
Born in Hospital" researched and referenced in Auerbach and Riordan. It's
that "awake the 1st two hours, then light and deep sleep for 20+ hours" that
most of us see in hospital. I do see some flattened nipples, but don't know
if that's from epidural or just pregnancy/anatomy related. I just work
around it and help Moms figure out a way to get enough of the nipple-areolar
complex in the baby's mouth. Moms with flat and inverted nipples have nursed
through the ages.  Anybody seen that slide of Jack's with the inverted
nipple before the feeding (inverted) and after the feeding (still inverted),
but the baby was eating and gaining well? Very revealing!

Anyway, back to the anesthesiologist. Maybe he sees mostly "walking
epidurals" and therefore doesn't understand the implications of the
traditional epidural. (?) Given references, he really might become a convert
on the breastfeeding side and be willing to help with the research. Doctors
do like to get published, you know. TIC! :>) I'm very grateful for OUR
published MD's!

Jean Macomber, RN, IBCLC
Lactation Consultant
The Family Birth Place
St. Luke's Hospital
296-5212

> ----------
>
        <However, the best advice I could give myself, if I were replying to
this guy,
> would be to try to imagine that I were Barbara Wilson Clay.  Her tone is
> just
> the right one for this guy, I think.    Something like,
>
> 1. "Glad you read my site.   I see you aren't acquainted with the IBCLC
> credential.  Here it is, here's what it involves, here are other sources
> (IBCLE, etc - you'll know better than I will, Marie) for you to learn
> about
> it. "  -- Note -- the key here is that even though his tone has been
> abusive,
> yours is welcoming and not what he deserves.  Your taking the stance that
> if
> he only understood he'd be on your side.  Probably this is wishful
> thinking,
> but occasionally one really does make a convert this way.
>
> 2." I was only writing about epidurals in childbirth, of course many other
> terrific uses.   And we're all grateful that they exist even for
> childbirth
> -- couldn't have emergency c-sections w/o some anesthesia, etc.  But like
> all
> med procedures, some upsides and some downsides, and its always important
> for
> us to remember that every intervention is a tradeoff."
>
> 3.  "Here's what there is in the peer reviewed literature.  You're right,
> it's limited, and peer review really is the gold standard" -- Marie,
> imagine
> you are Marie Biancuzzo writing now! -- "And in fact it does seem that in
> hospitals with really top-notch breastfeeding support, such as Evergreen,
> etc, there is no negative association between bf success and epidural
> anesthesia in labor.  But very few US hospitals have that quality of bf
> support, and, in light of that, the many anecdotal reports from
> experienced
> lactation clinicians have suggested that the physiological effects of
> epidural anesthesia on bf will be a fruitful area for further more formal
> studies.   Some of those are now taking place" (is this true? anybody out
> there?)  and when their results are in you can be sure that I will be
> updating my website in light of them.
>
> 4.  Meanwhile, I would never say -- and don't say -- that nobody should
> ever
> have an epidural.   But it is responsible to make clear that there are
> reported adverse effects, so that laboring women can make informed
> choices.
>
>
> In fact, I'd go further -- ask him if he would like to help your study by
> reporting on the subsequent breastfeeding success of his epidural
> patients!
> Probably he's never thought of this before in his life.   And while it is
> hugely unlikely that he'll really be in touch with you about them, if it
> prompts him, some time, to talk to his local LC about this, or even to
> look
> in on his patients postpartum and ask them how their bf is going, this is
> a
> pure gain for the world.
>
> Good luck lighting this recalcitrant candle --
>
> Elisheva>
>
> ------------------------------
>
> Date:    Wed, 3 Jan 2001 15:31:04 -0000
> From:    Alexis Martin Neely <[log in to unmask]>
> Subject: New member
>
> Hi. I am new to Lactnet. I am an attorney in Los Angeles and I have become
> interested in lactivism as a result of breastfeeding my daughter for the
> past 14 months and for the foreseeable future.  I am looking for ways to
> use
> my legal skills to advocate for breastfeeding. Please let me know what
> ideas
> you have in this regard.  I am going to be attending a breastfeeding task
> force LA meeting January 12, so that is a start.
>
> Also, I am in the process of drafting a letter to a pediatrician I saw
> yesterday who professes to support breastfeeding and yet stated to me that
> I
> must feed my daughter iron-fortified cereal, vitamin D supplements, and
> was
> about to recommend I supplement her with formula while I am at work before
> remembering that she is 14 months old.  Also, she measured my daughter on
> the standard growth chart and expressed great concern that she was only
> 10%
> for height and 37% for weight; neither issue concerned me.  I would like
> to
> create a document that addresses common misconceptions that pediatricians
> who profess to support breastfeeding continue to espouse and support.  If
> you have any resources that address breastfed babies and growth charts I
> could use them.  Also, I would be interested to hear some of the most
> common
> misinformation you hear being given and try to correct.
>
> Thank you,
>
> Alexis Neely
> Attorney and Mom to Kaia (11/2/99)
> _________________________________________________________________
> Get your FREE download of MSN Explorer at http://explorer.msn.com
>
> ------------------------------
>
> Date:    Wed, 3 Jan 2001 18:09:51 +0200
> From:    The Curries <[log in to unmask]>
> Subject: Breast refusal.
>
> Hi everyone.
>       Please can you help me?   I have a 21 year-old mother who had a baby
> girl born on 27th December, 00.   She had 24 hours of labour and then had
> a
> C/S under general.   Apgar was 9 and 10 and birthweight 4055g.   From the
> start the baby refused the breast.   The mother said that there were many
> nurses pushing and prodding the baby onto the breast.
> The baby just arched it back and screamed!     I saw the mother at home on
> the 30th December and after calming the baby down, tried the baby at the
> breast - she arched her back and screamed!   I taught the mother and
> father
> finger-feeding and they fed the baby in this manner for about 48 hours - I
> saw the baby on the 1st Jan.   I put the baby to the breast and she took
> it
> like a dream.   The mother managed another 2 feeds like this and then the
> baby refused the breast again.   Saw the baby on the 2nd and once again
> took
> the breast like a dream - today, the 3rd - the baby has once again refused
> the breast.   A friend came in and offered to wet-nurse and the baby took
> the breast well but when put near the mother refused!   The baby does not
> have a dummy (pacifier) and to my knowledge has not had a bottle (but who
> knows what happens at night in the ward)   The tube used for
> finger-feeding
> is the thinnest one - the baby refuses to take the breast so its difficult
> to supplement her at the breast.   I find it puzzling that she takes the
> breast when I put her on and 2-3 after that and then back to the same old
> story.   Mother has been encouraged to do skin-to-skin.   She has a good
> support system - her own mother fed 2 adopted babies for over 2 years!!
> Am
> I missing something?   Mother, being young is getting discouraged.   I
> have
> gone through the list looking for reasons but I am sure it has to do with
> treatment in hospital.
> Thanks for any suggestions.
> Happy New Year to you all.
> Barbie Currie. IBCLC. White River, Mpumalanga, South Africa.
>
> ------------------------------
>
> Date:    Wed, 3 Jan 2001 09:09:09 -0700
> From:    LC Mama <[log in to unmask]>
> Subject: Re: Boiling Mad over epidural comments
>
> Ok, without even going to your site (which I will in a minute) I can tell
> you that you are right in your assessments!  From personal experience, I
> have had one epidural birth and one natural birth.  The epidural birth was
> my first and I will NEVER put myself or my children through that again.
> My
> son took DAYS to latch on, my milk didn't come in for 5 days, I had to
> supplement with formula... and I couldn't walk for almost 6 hours after
> the
> drip stopped!  I do have an article somewhere, I will try to find it that
> states children born to moms using an epidural usually don't recover fully
> until about one year!  Their motor skills are not as refined as children
> born drug free.  Compare that to my second birth... my second son latched
> on
> and nursed in the delivery room for more than 30 minutes, I never had sore
> nipples with him, formula has never crossed his lips.  I intend to repeat
> that this time (if she ever decides to come!).
>
> While I have a LOT of respect for the medical community as a whole,
> sometimes I feel like they get defensive over what they do.  Of course an
> L&D anesthesiologist wouldn't have a job if all the women in the world
> went
> into birth totally natural now would they??  While an epidural in
> generally
> safe, I would opt for it in an appendectomy, not child birth!  Unless of
> course I was having a c-section.  Also, just like any drug there can be
> long
> lasting effects of the epidural on the patient, a client of mine still has
> a
> numb spot on her hip 5 years after her son was born!
>
> Cheers to you!  I would be boiling mad too!
>
> Melisa
> ~*~*~*~*~*~*~*~*
> Did you hear? Breast is Best!
> Certified Lactation Counselor
> IBCLC Exam Candidate
> Homeopathic Counselor in training
> www.nurturingmama.com
>
> ------------------------------
>
> End of LACTNET Digest - 2 Jan 2001 to 3 Jan 2001 - Special issue (#2001-8)
> **************************************************************************
>

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