I realize that there is growing evidence demonstrating that epidurally-administered fentanyl in labor may affect breastfeeding (probably through a variety of mechanisms including direct effects on baby, residual narcotic affecting mom's behavior, the cascade of interventions that can result when anesthesia is given resulting in altered physiology in mom), but what I'm not sure about is if *post-partum* administration of narcotics and benzodiazepines may affect *milk production* if all other variables are excluded.  Especially when mom survived acute hypovolemic shock, is not conscious and baby is not directly nursing.  I'm just not sure how how exogenous stimulation/enhancement of opioid and GABA receptors would affect prolactin and oxytocin levels...  Would love to see if there is some research on this!

Sarah Reece-Stremtan M.D.
Pediatric anesthesiology fellow in Washington DC (off to spend the morning in the cath lab, which I can pretend to be excited about)

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