Dear Friends:
    In the journal Birth, June 1999 there is an interesting article "Effect
of Labor Analgesia on Breastfeeding Success" where the authors (Halpern,
Levine, Wilson et al.)  looked at labor medications and breastfeeding at 6-8
weeks postpartum. Their conclusion: "In a hospital that strongly promotes
breastfeeding, epidural labor analgesia with local anesthetics and opioids
does not impede breastfeeding success. We recommend that hospitals that find
decreased lactation success in parturients receiving epidural analgesia
reexamine their postdelivery care policies." In this study, 72% of women were
breastfeeding exclusively at 6 weeks postpartum, and 20% were breastfeeding
partially.
    Very interesting and personally saddening. I hate when the evidence goes
against what I believe! However, at a breastfeeding training session where I
was teaching, several nurses from a Baby-Friendly hospital were saying the
same thing, that their epidural rates are high and so is their breastfeeding
initiation, which they ascribed to strong breastfeeding support postpartum.
    This article makes many interesting observations. They ascribed some
negative effects in other studies not to the epidural, but to the vacuum. Now
there is plenty of evidence is that epidural increases the chance of vacuum
use. And epidurals do add a lot to health care costs, as well as increasing
the risk of operative delivery. But as far as breastfeeding goes, we need to
rethink our position. The hospital where this study was done lacks a nursery;
all healthy babies room in. There is emphasis on skin-to-skin contact and
suckling. There are no formula discharge packs. Pacifiers are not given out,
and their use is discouraged.
    Warmly, Nikki Lee

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