Epidural anesthesia is certainly associated with many side effects that can interfere with breastfeeding, such as elevated maternal and infant temperatures, increased instrument deliveries, increased duration of labor, sleepy babies, increased cesareans, poor state control, decreased O2 saturation, disturbance in initial prefeeding sequence of behaviors, delay in effective feeding, and insufficient milk. Babies whose mothers have had epidurals are more likely to receive bottle supplements, especially if they have not fed within an hour of birth. Maybe that's why the supplementation rates are so high. Susceptibility to bottle-feeding is also influenced by the dose of fentanyl in the epidurals. Mothers receiving epidurals are 33% more likely to not be exclusively breastfeeding at 6 months. But epidurals?often do not occur in isolation. Other narcotics are given before the epidural such as nalbuphine (Nubain). The FDA issued an advisory on this drug being used during labor,?warning of infant respiratory depression and hypotonia, both of which can make breastfeeding difficult. 1/860 babies can experience an intracranial hemorrhage from vacuum extraction, often used in conjunction with epidurals. Vacuum extraction can affect infant feeding skills. Multiple interventions can have a cumulative effects on early breastfeeding. Add in 7 liters of IV fluid, prenatal SSRIs, and separation, and the recipe for breastfeeding disaster is just about complete.

When I lecture on the effects of birth interventions and?labor medications on breastfeeding, I often see eyes rolled into the back of heads by labor and delivery and staff nurses. Yet all of these interventions have evidence to support their deleterious effects on breastfeeding. You can bet that parents know nothing of this. In a breastfeeding class, I once had a mother tell me that her childbirth educator said that there was a wall between the epidural space?and the bloodstream so that none of the medication could ever reach the baby!?After I corrected this little fairy tail I received a call from our department head telling me that?I was not to scare patients by saying that labor medications could reach the baby! We had a?small discussion about evidence-based practice and the ethics of lying to patients.

While we may not be able to influence mothers to refuse epidurals, they still have the right to know about the side effects of this intervention?on breastfeeding. I always used a handout on how to compensate or offset these effects, i.e. what to do about a sleepy baby or a non-latching infant. Sometines I wonder how any mother and baby can actually leave a hospital exclusively breastfeeding anymore.?Should we be educating nurses and physicians or concentrate on mothers?

Marsha Walker, RN, IBCLC
Weston, MA
? 




________________________________________________________________________
Email and AIM finally together. You've gotta check out free AOL Mail! - http://mail.aol.com

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome