Becky Krumwiede had asked for opinions on what we see as the impact of
medications in labor, especially epidurals.

I am not sure this will satisfy the OB you are dealing with but I have
observed and many LC friends have agreed that one major impact of the
epidural is the effect of the IV fluids that are given to counter the drop in
BP seen when the epidural is administered.     As the rate of epidurals
increases (it is above 90% in one area hospital) I am seeing more and more
mothers with moderate to severe edema.  Of course the edema frequently
contributes to severe engorgement which then leads to latch difficulties.  In
severe cases the edema can limit mom's movement and overall comfort, making
it difficult to achieve a comfortable position because of the swelling in the
hands, feet, and perineum.   Additionally, the use of forceps and vacuum
extraction which has increased with the use of epidurals increases the
likelihood of a very large repair and very tender bottom that inhibits mom's
ability to get comfortable enough to sit and feed her baby.

In the last week I saw one women whose edema was so severe that she was
hypertensive, having urinary hesitancy from the swelling,  and having heart
palpatations.  Besides her extreme discomfort sitting and breast engorgement,
all of this necessitated an extra trip to the doctors to be examined and trip
to the lab for blood and urine tests.   Even these trips for medical care
interrupted and negatively impacted the breastfeeding.    Everything turned
out to be normal and strictly an effect of fluid overload.   Thankfully as
the swelling subsided she was able to breastfeed effectively.

Another mom this last week told me on arrival about her sore nipples, it
seems she was having trouble latching because she was standing to breastfeed
due to a very large perineal repair.   She told me the doctor was pulling so
hard on the baby's head with the vacuum while pushing with his foot on the
end of the labor bed that  when the vacuum became disengaged accidentally
from the baby's head the doctor fell backwards against the wall.     We
worked for quite awhile just to achieve a sitting position she was
comfortable in.  (we couldn't use side lying because she ended up having a
c/s and was uncomfortable in side lying as well.)   Just FYI, the position
that finally worked was in a large somewhat firm lounge chair with her feet
up on a nursing stool and a pillow under just the thighs so she was tilted
back on her coccyx and off the wound.

Becky I hope you are able to make some headway and please get back to us and
let us know if you find an effective way to help with this issue.

Kathy Kuhn
RN BSN IBCLC
ParentsPlace.com LC
Private Practice LC
Eastern PA

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