Betsy is correct, we need to remember also what good we are doing and how great it is that we are there to be sure breastfeeding happens. I am sure we all know we cannot undo that which has been done. However, understanding the impact of what has happened in birth does in fact help us as professionals when we are determining the best course of action or what other interventions may now be necessary. And, to make informed decisions and provide an accurate care plan and to understand what needs to be done to solve the problem, it makes sense to understand why the problem exists. It is not that we are not aware we cannot change things, we are acutely aware. It is like any other health situation---understanding the cause is part of the solution. And, yes, Heather, I do know we are talking about completely different scenarios including the women themselves. Yet I know many women entering a hospital for birth extremely determined and educated about breastfeeding. I am certain the research could have information about desire to breastfeed as part of the criteria...including education about breastfeeding, help, etc. I do know that the very birth itself when in a hospital setting will have a different set of postpartum policies, but like I said, that too can be controlled for. My desire is to see normal as the control group, not the interventions. Anyway, we already know the epidural is better than the iv meds for pain. I totally accept that fact. Your final comment is that in areas where epidurals are common we do not see breastfeeding problems. Well, where I live epidurals are so common that if you don't want one, stay home. The rate of epidural use is so high I have been told that my subgroup of clients seeking an unmedicated birth in the hospital setting are statistically insignificant. That still leaves me with the question of the definition of "problem free breastfeeding" and the measurement used to determine that conclusion. From what I understand, that measurement is not as I describe: pain free, good milk transfer, no need for supplementation and exclusive for 6 month duration. I am not attacking those who have had epidurals, heck, I had two epdidurals and a spinal for my c. But to say that epidurals do not do anything at all to the baby and do not make any difference no matter how subtle to the outcome of breastfeeding is not something I see that the research has proven because the definition of no impact on breastfeeding has still not been completely defined. Just as it has not proven that it is 100% safe for mother or baby. Is it better than iv meds? Yep. Is it better than a general for ceserean? Oh, yes and I am so glad we have the epidural! Also, knowing if there is an impact and knowing exactly how it impacts and especially how long that impact may last is not somethng we should ignore and make believe doesn't exist so moms don't feel guilty for having an epidural. But, knowing there is a reason, having a time frame of reference, knowing there is a solution may be what helps mothers continue trying when breastfeeding difficulties arise. And if we do find that for some women there is indeed more difficulties breastfeeding in the early days or weeks due to the baby's difficulty with oral motor skills we should let her know so she knows it will pass. I doubt that the knowledge will make a hoot of difference to the anesthesia income as I do not see women opting to avoid an epidural to avoid difficulties breastfeeding....they won't even avoid the formula and they are not even in pain then. This is not about telling women they cannot have an epidural and breastfeed, of course they can! This is about understanding the impact of every event within the birth experience that may impact breastfeeding capability for the newborn and how we can help the dyad overcome that issue as lactation consultants. Take care, Pam MazzellaDiBosco, IBCLC, RLC *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html