In a message dated 2/18/2006 9:50:19 A.M. Eastern Standard Time,
[log in to unmask] writes:
Quoting 1, 2 or even 3-4 studies does not prove that epidurals adversely
effect breastfeeding, unless one is quoting the only studies that have ever been
done on the subject. The fact remains that there are at least 4 studies that
offer contradictory results in that there was not a
statistically significant difference in breastfeeding rates at either 24
hours post partum and/or 6 weeks(Baumgarder, Radzyminksi, Halpern, Riordan J et
al). I am not specifically addressing whether they got supplements, but
whether these women continued breastfeeding to 6 weeks)
While Mary is sharing information she has heard and read, and I agree that
it is exactly as she has said, the point is completely being missed by those
doing the research and those using it to encouraget the choice of epidural as
having no impact---- the measurement itself is not necessarily an acceptable
measurement of impact on breastfeeding. ONE bottle makes a difference. ANY
supplementing makes a difference. If the comparison is only to other
medicated births, there is no comparison. Unless the research is done comparing
epidurals to a normal birth, we are talking the comparison of red apples to
yellow apples. In that case, sure the epidural is better than a dose of demoral
or nubain in the last stages of labor. However, I do not want to compare
types of apples! I want to compare apples to carrots...not even both fruit! And
that is huge difference. The physiological/biological norm of the newborn
and postpartum mother needs to be the standard of comparison just as the
exclusively breastfed baby needs to be the standard of comparison.
Honestly, this is not about the presenter. I heard her speak and she is
indeed breastfeeding supportive. I don't think she was even coming from a place
of 'supporting epidurals' as her comments were more along the lines of how
this is the reality of the situation and that it should not be an issue for
breastfeeding based on the research. She was not endorsing epidurals at all.
She was stating the facts as they are interpreted, and not only by her. Her
information is not incorrect, the facts are not even incorrect. What is wrong
is the method of measurement and the definition of success being used to
claim the facts as such
Unless research is being done with all things being comsidered including
separation of mother and baby, skin to skin, and the use of supplementation we
can't say there is no adverse affect. Babies do receive the drugs from
epidurals, and for the most part mothers are told they do not. They do. Is there
long term effects? How could we know? Especially as we do not have enough
women for a control study! How can we really know the long term consequences
of interventions that were not medically indicated if we cannot find enough
women who did not receive them to make the comparison?
I know, it is difficult to discuss childbirth without someone becoming
defensive, just as it is to discuss the choice to use formula instead of
breastfeed. Yet, that continues to be my point, We cannot discuss how breastfeeding
can and should work well in the earliest of the experience without teasing
out what is interfering with the success of mothers and babies. And we cannot
do that without acknowledging that birth impacts breastfeeding, and we cannot
do that without debating the impact (or even the lack of one) on the
breastfeeding dyad when mothers are given pain meds--including the all favorite
epidural. When I take a history from mothers I ask for all things related to her
birth...including position of the baby during labor if she remembers, how
long she was pushing, how long her transition was, etc. I also want to know
where the baby was immediately after the birth. All this matters when trying to
see if the baby just needs time to heal and we need to focus on protecting
her milk supply and being patient, or if there is some other reason we need to
investigate further so we can find a solution. Many times, a few more days
and that clamping, biting, chomping motion and tongue bunching in the back
will stop and we can move on. And, maybe the fact that every single one of
those women I have worked with who had those specific issues also had an
epidural is just a coincidence. Not to say I don't see other issues with home
birthed babes and babes born with zero interventions too. It is true, that even
when all is normal in birth, something can be off in breastfeeding. But, we
can't just decide that based on the research it is not epidurals causing
these behaviors unless we more closely study what we are calling breastfeeding
success.
As in all things related to health, we should be seeking to first do no
harm. We should be seeing that which is the physiological healthy normal
experience as the norm for all research comparisons. I never cease to be amazed
what medicine will do to women in the name of for women's own good. And, no I
do not blame doctors as individuals, but they are the gatekeepers and it would
be nice if they found a way to hold true to what I know they really want to
do .... first do no harm... against all the odds that force them to often go
against even what they themselves know to be true, thanks to a society that
expects docs to create perfection in outcome and blames the doctors when
things go wrong even when it is outside their control and will sue them silly for
if they don't deliver.
I am not doubting the outcome of the studies, only the data being analyzed.
For me to agree that epdiduals have no affect on breastfeeding I would have
to see that defined as: Exclusive breastfeeding with zero supplementation
needed for any reason whatsoever and absolute pain free breastfeeding. Then
compare that to women who have birthed at home with no interventions of any kind
whatsoever. If the comparison between epidural use and absolutely no
interventions at all turn out to be non existent, then we need to tease out why we
are seeing babies with issues of suck and find out what else may be causing
this oral skill disruption....and fix it.
Sitting and saying no, no, there is no difference research or not, when we
are seeing something totally different in our work every single day is not
helping us find a solution. If what is being seen is not matching the research,
maybe the research is flawed. I am quite certain that physicians would
continue to question the research if after applying it day and day out they saw
the outcome was not as predicted. Perhaps we need to explore who did the
research, who funded the research, etc. Perhaps we need new research with more
information. Just because something seems to be proven by research, does not
mean it is so, and if we have learned nothing at all from the pharmaceutical
industry's fiasco of research ending up with meds recalled and an upheaval and
restructuring of how research must be presented, surely we have learned to
question the research.
Respectfully,
Pam MazzellaDiBosco, IBCLC, RLC
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