It kind of astounds me that there are anesthesiologists who believe that epidurally administered medications remain in the epidural space and exert all their effects locally.  That is just plain wrong.

Anesthesiologists who state that epidural medications such as bupivacaine and fentanyl do not "affect the baby" are correct in that babies are not affected in a way that necessitates resuscitation after birth.  Generally when we think of negative effects of narcotics, we think about bradycardia or respiratory depression.  

I give narcotics to children for a living, often to neonates and infants, and certainly will see intermittent apnea intra-op related to the meds I give.  But healthy full-term infants being born to moms who had epidural infusions for a few hours are NOT being born with respiratory depression, lowered heart rates, or immediate drowsiness that makes anybody want to reach for naloxone to reverse the narcotics they received from mom.  

So from that perspective, yes, epidural medications given at current typical dosing for labor epidurals do not cause symptoms in babies that require immediate medical attention.  However, with measurable amounts of fentanyl and local anesthestics found in cord blood, it's clear that those medications DO reach the baby.  How much of an effect that will have on any given mother-baby dyad is difficult to predict, but I think it's irresponsible for anesthesiologists to blow off concerns about breastfeeding, as really that's a baby's sole responsibility after being born. 

I think that giving the OB anesthesiologists articles from their own literature that look at this connection would be a nice way to start, and acknowledge that these effects are subtle, but the research is emerging.

Happy to be doing epidurals in babies and kids now instead of in moms,
-Sarah Reece-Stremtan M.D. (pediatric anesthesiologist in Washington DC)

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