I am mostly a lurker here as I'm just beginning my practical experience
working with mothers.  However I have I question I would love some thoughts
on.

I've been tossing these thoughts around in my mind for about a month now and
would appreciate input from the wise minds of lactnet.  I teach childbirth
preparation at a local hospital among my other duties.  I've only been
teaching there for a short time.  This particular hospital has a 95%+
epidural rate.  Several of the prenatal instructors have taken to advising
women to start out w/ a dose (or half a does) of IV narcotic (Stadol or
Nubain) in an effort to get them to delay the epidural as long as possible
to avoid the first and second stage dystocia early epidurals can lead to.
The hospital has no policy re when epidurals can be given and will give them
to a mom at one or two centimeters or earlier (whole 'nother story) so it
really is up to the moms to make those determinations.

now the dilemma.  At our state LLL conference last month I was privileged to
here Jan Riordan speak on the effects of labor medication on infant feeding.
I was in and out of the room due to an active one yr old, but I gleaned the
results of her recent study as this:  women who had and epidural *or*
narcotics had infants who exhibit some breastfeeding problems (she used a
variety of measures) while those infants who were exposed to epidural *and*
narcotics had nearly twice as many problems as those whose mom received only
one type of medication.

So what to do?  Do we continue to encourage woman to use narcotics so that
they delay epidurals to 5 or 6 centimeters since we now that early epidurals
can lead to a variety of other interventions w/ there own set of problems
for moms and babies (including breastfeeding)?  Or do we not mention the
option because the double wamy of medication appears to really affect the
infants ability to breastfeed successfully?  With the type of epidural rate
that we have it is pretty much a given that *most* mom's will have one
eventually.

Any input would be greatly appreciated.

Jessica Mattingly  M.Ed., CCE
Kansas City metro

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