Hi Alicia,

How exciting that you are going to discuss these issues -- (epidurals, short
stay).  As you noted, the literature is VERY scanty on the effect of
epidurals on bf.  There is an article (1992) that discusses the effect of
epidurals on babies, but doesn't address bf specifically.  It is by
Sepkowski, and is in May, '92 issue of Neurology and Child Development or
something like that.  Eegads, I can't find it right now - maybe someone else
has the direct reference, or I'll have it tomorrow.  The important statement
is that bipivucaine has been found in the cord blood, and that motor skills
are delayed for up to one month.

In the birthing center where there was no intervention in birth and moms went
home in <24 hrs, there were no problems bf.  I still see a direct correlation
between interventions in birth and probs. with bf.  Then couple that with
early d/c and lack of good followup and you can have MAJOR problems.

Many home health nurses are sent out that aren't lactation trained, and the
insurance companies (that employ some of them) don't want to pay for either
the lactation training or hire IBCLCs to do the prn work.  One insurance co
in this area wanted to pay IBCLCs $35 to do home visits all over the city on
a prn basis for those moms who were found to be having problems.  They
couldn't understand why the visit might take as much as 2 hours, and it
simply wasn't cost effective for the IBCLC; particularly if she was an RN and
also expected to do the entire mother-baby followup.  So, they are sending
out non-lactation trained nurses as just part of the routine followup and
hoping for the best.  Perhaps something else will transpire....