In a message dated 96-03-04 17:02:01 EST, you write:

>-
>
>Date:    Mon, 4 Mar 1996 15:09:20 -0500
>From:    Deena Zimmerman <[log in to unmask]>
>Subject: Re: LACTNET Digest - 4 Mar 1996 - Special issueEPIDURALS
>
>I was asked for some help in a study to be done soon at our institution
about
>epidurals and their possible effect on the newborn.  I know this has been a
>hot topic of conversation here on lactnet and I am trying to be sure that we
>really assess the effects on the breastfeeding baby.  The original protocol
>was only going to measure the amount in the breastmilk. Now they are
>considering assessing sucking with a guage (described in an article - more
>details to those interested).  I would like to included a clinical
assessment
>of breastfeeding success as well.  Any suggestion for eastily done
>reproducible scores and there references.
>
>Just as an aside, there are many different contails that are given
epidurally
>for anesthesia.  It would be of interest if those nurses/LCs who are seeing
>problems could find out what drungs are being given this way as their may be
>a difference based on drungs given. "Epidural" afterall only refers to the
>route. It is like saying "IV'. Obviously a women receiving IV saline will
>have different effects than one receiving IV morphine
>--
>*******************************

Dear Deena:
I am very interested in your study on epidurals.  I am presently working as
an LC at a large hospital with a very high epidural rate, a high induction
and augmentation rate, and a high breastfeeding initiation rate.  We see many
problems with establishing breastfeeding.  I have done no formal studies, but
I do try to note in a haphazard way, the drugs used in the epidurals, how
long the epidural was in place, if there were any problems with the
insertion, when the last redose was relative to the delivery.  I came to this
hospital from another high epidural rate hospital where I saw problems, but
not the same problems.  That hospital used a different drug mix in its
epidurals.
The problems we see presently fall into two main categories--tongue or
sucking problems (baby sucking tongue, pushing nipple out of mouth, or
extreme tension in the jaw) and lack of responsiveness problems (baby awake-
not rooting, or with a disorganized rooting response ;baby sleepy;or baby
latching on, but not sucking).  Then there are babies with a combination of
problems.  We send many babies home who are not nursing yet.  These babies
sometimes are very poor bottle feeders, also.  This is getting scary.
The drugs used at my present hospital are mainly Bupivicaine contiuous drips,
with  varying amounts of doses of Lidocaine and Fentanyl.  Another variable
is the use of epinephrine.  Almost all mothers  have some oxytocin, and some
have large amounts.
The drugs that were used at the first hospital were opiates--mainly
meperidine.  They were usually given in separate doses and mothers were not
redosed for pushing.  This hospital also had a high induction and
augmentation rate.  I saw very few cases of babies sucking their tongues (I
can't remember any) and fewer disorganized sucks, but there were a lot of
sleepy babies, and nonreponsive awake babies.
I would like details on the sucking gauge that you are using and any
information you gather.
Thank you for doing this study--we are very frustrated and need some more
evidence to share with the MD's.
Christine Lundberg, BSN, IBCLC
INDIANAPOLIS, INDIANA