Marsha Walker noted in her journal article, Do labor medications
affect breastfeeding, that many staff nurses and lactation consultants
have found many babies whose mothers receive labor analgesia, including
epidurals, have difficulty performing a cluster of behaviors necessary
for successfully initiating feedings at the breast.  They have difficulty
latching to the breast, are unable to sustain sucking once latched on,
have inefficient or uncoordinated sucking leading to little milk transfer
and low intake, have difficulty arousing or staying awake and exhibit
poor cueing to feed.  Thus these babies gain slowly or not at all and may
lose excessive amounts of weight during the first week following birth.
Additionally, mothers of these babies may present with sore nipples,
plugged milk ducts, and blocked areas of the breast (Walker,1997, p.
131).
        Although few babies exposed to epidural analgesia suffer from
respiratory depression, inability to latch and feed at the breast is a
significant deviation from normal.  It places the infant at a higher risk
for morbidity, alterations in biorhythms, and inappropriate brain
development, if breast milk is replaced by artificial milk and feeding at
the breast is replaced by bottles (Crawford, 1985, p. 1220).
        Taking all of this information into consideration, I am
interested to know if anyone has noticed in their practice a greater
incidence of breastfeeding difficulties in women who used epidurals
during labor and delivery?  Additionally, do any of you regularly inform
expectant moms of the risk for latching problems associated with epidural
use?  More importantly what have you done to alleviate latching
difficulties?  I would appreciate your thoughts on this issue and any
other comments or questions you may have.  Thank you Misty Jenko, College
Nursing Student (University of North Dakota). [log in to unmask]

        Walker, M.  (1997).  Do labor medications Affect Breastfeeding?
Journal of Human Lactation,(13)2, p. 131-137.

        Walker, M.  (1996).  Epidurals and breastfeeding. . . Epidural
analgesia in labor:  an evaluation of risks and benefits.  Birth: Issues
in Perinatal Care and Education, (23)4, p. 244-250.

        Crawford, JS.  (1985).  Some maternal complications of epidural
analgesia for labor.  Anesthesia,  (40), p. 1219-25.