Christine:  There are a few areas of concern here.  The first issue would
be the older child's nursing at the time of the prenatal corrective
surgery.  I would imagine this could be handled as any other situation in
which a nursing mother undergoes a surgical procedure.

The next issue is that of the type of epidural and possible sucking
problems.  From all that I have read, it appears that the most profound
effects of epidurals on baby's sucking are from prolonged epidurals.  This
mom will likely just have the epidural for the C/section, so that in and
of itself is not likely to cause a problem.  Post-op, she may have the
option of keeping the epidural in for pain relief, and I don't know of any
data on the effects of that on bf behavior in the baby as compared with
traditional IM or oral meds (likely neither of these methods would affect
the baby much).  Let's remember that the baby will have possible medical
complications such as possible hydrocephalus or other neurological
problems which in and of themselves or due to medical interventions would
interfere with establishment of nursing.  Depending on the extent of the
spina bifida and the success of prenatal surgery, the baby may or may not
need further surgery, and may need to be immobilized, posing positioning
and other "technical" problems to the initiation of breastfeeding.

There is an excellent chapter in Riordan and Auerbach's "brown bible"
about breastfeeding babies with these conditions.  The mother will need a
lot of support for pumping and providing her milk by alternate feeding
methods to the baby until baby is physically ready to feed at breast.
Undoubtedly, if the older child is still nursing, there will be complex
issues to deal with such as tandem nursing (may be good for keeping up the
milk supply, but problematic if there are positioning difficulties with
the baby), jealousy and resentment in the older sib, etc etc.  Of course,
we all know that despite all these potential obstacles and problems,
breastfeeding will likely be much easier in the long run for this mother
than bottle-feeding.  She needs to know that and be reminded of it every
so often.  So do her support people (and her hcp's).

Hope this helps.  Alicia Dermer, MD, IBCLC.