Misty, What great timing. We had an inservice yesterday on epidurals and
one of the statements our CRNA made was that there is no affect on
breastfeeding. I gently challenged him and said I would obtain the
references that counter his. Your posting has saved me time and I thank
you. As the only lactation nurse in our little hospital I'm pretty busy. In
response to your question: short term epidurals (under 2-3 hours) don't
seem to have as much effect on breastfeeding as the longer ones or the
epidurals with 1 or 2 boluses. Our small hospital (average 380 births/year)
is low intervention and the nurses are determined to avoid any unnecessary
interference with a normal birth. Fortunately we have an excellent working
relationship with most of the docs and they tend to follow our lead in
allowing the parents to manage their labor and birth with guidance from us.
As a result our epidural rate is lower than most hospitals, and most are
short term. The biggest problem I've seen with prolonged epidurals in
relation to breastfeeding is a disorganized suck; the baby wants to nurse,
is giving all the right cues, goes to the breast and then can't seem to
make his tongue and mouth work right. Usually patience, reassurance to the
mother, and monitoring of the baby is all that's needed. Most resolve in
about 12 hours. The baby's are given no supplements (unless medically
indicated, and then by cup or gavage) and if things don't turn around by 12
hours we start the mother pumping and cup feed her milk to the baby.
This is longer than I intended, but did want to add what a pleasure it is
getting these questions, insights, references, and enthusiasm from you
N.Dak. students. Hope it continues for a while. As an LC in the making (am
preparing to take the exam in July) your input is invaluable. Warm thanks,
Mary Anne B.

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> From: Misty A Jenko <[log in to unmask]>
> To:
> Subject: Epidurals and breastfeeding
> Date: Tuesday, October 21, 1997 12:29 PM
>
>         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.
>