I could not help commenting on the discussion regarding epidurals,
breastfeeding, and withholding information from mothers. I taught prepared
childbirth classes and prenatal breastfeeding classes for years and as a
nurse and certified lactation consultant have the duty of care towards the
patients I encounter. Laura wrote about having to read a statement written by
anesthesiologists that labor drugs have no effect on breastfeeding. I hope
that all of us on Lactnet resist the pressure from other disciplines to tell
us to withhold information from women, and place us in the position of
violating our standards of practice and/or state licensing by intentionally
omitting health information.
There is data on the effects of epidurals on breastfeeding - not much but
some.
1. Walker M. Do labor medications affect breastfeeding? JHL 1997; 13:131-137.
I did this review and found that much of the problem with epidurals centered
around motor and state control. Both of which are integral to breastfeeding.
A couple of older studies showed that babies had difficulty with these
behaviors for many weeks or months following birth.
2. Riordan J, et al. The effect of labor pain relief medication on neonatal
suckling and breastfeeding duration. JHL 2000; 16:7-12. Jan found that
epidurals diminished early suckling, with sucking scores from epidural babies
much lower than those from unmedicated babies. See also: Riordan J, Riordan
S. The effect of labor epidurals on breastfeeding. Unit 4/Lactation
Consultant Series Two, La Leche League, 2000
3. Ransjo-Arvidson A-B, et al. Maternal analgesia during labor disturbs
newborn behavior: effects on breastfeeding, temperature, and crying. Birth
2001; 28:5-12. Three groups of babies were observed for a number of
behaviors. In the group with epidural analgesia the median number of sucking
movements over the observation period of 2 hours was ZERO and none of the
infants remained attached to the breast.
Epidurals have side effects like raising the mother's temperature, forcing a
sepsis workup on the baby, separation, and antibiotics. Intrapartum fever,
even when not caused by infection was associated with a fourfold increase in
the risk of unexplained early-onset seizures in term infants. Then add the
use of vacuum extraction and the numbers of babies whose brain is damaged by
being sucked down a four tube. Mothers return for a patch when they
experience spinal headaches from a punctured dura, etc.
Epidurals are not benign and women have the right to know about the side
effects and outcomes of the use of this intervention.
Marsha Walker, RN, IBCLC
Weston, Massachusetts
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