I'm hoping some of you out there can help me by sharing your opinions and 
experiences.  At my institution we are currently embroiled in meetings and 
discussions about what we teach in breastfeeding and childbirth classes about 
the use of epidurals.  The disagreement was started by an obstetrician and 
now the anesthesiologists have joined in.  They contend that we are biased 
against epidurals and have no business teaching what we do because there is 
no good scientific evidence that epidurals affect breastfeeding or have any 
undesirable effects on mom or baby.  The ACOG roundtable discussion audiotape 
I just listened to states pretty much the same thing.  What I teach in 
breastfeeding class is that an unmedicated birth is a desirable goal and that 
any medication given in labor, epidural or otherwise, does "get into" the 
baby and MAY interfere with breastfeeding behavior.  The childbirth 
instructors seem to be very evenhanded when discussing pain control, but do 
share the downside of the additional interventions inherent in epidural 
anesthesia.

So, if you teach classes, what do you tell your clients?  Do you all touch on 
the possible effects of labor medications on breastfeeding?  I know there 
haven't been a lot of studies that directly address breastfeeding, and that 
they are not the high-level studies that the contentious OB doc wants, but 
that's all we have.  It is my impression that virtually all of us who work 
with breastfeeding moms believe that obstetric medications can adversely 
affect breastfeeding, even if studies haven't PROVED it.  Is that a correct 
impression?  I would really welcome input, and will assume that if you email 
me directly that I can share your reply.  Thanks so much.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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