Christine asks:
<If epidurals cause breastfeeding problems then why do most of these
babies
nurse well at the first feeding? Is the epidural not affecting them
within
the first hour? Or does it have more to do with the fact that babies
haven't been separated for very long in the first hour so the effects
don't
show up until later? Thanks. :-)
I am convinced that at least one reason is because epidurals are
accompanied by IV's. Plus pitocin, with antidiuretic properties,
depending on the dose, often goes before, or ongoing after delivery.
Depending on the volume of IV fluids a mom receives during the
intrapartum period, there is often a direct correlation with the amount
of edema that gradually forms in her tissues, the breast included, till
her kidneys can accomplish fluid balance, sometimes taking 10-14 days for
edema to resolve completely. So she starts out with little or no edema
and only a small amunt of colostrum in her breast at the first feeding.
Then the volume of "creeping edema" added to the growing glandular
engorgement with milk is continually changing the resistance of the
areola, thus effecting the baby's ability to latch on to it easily.
Park GE, Hauch MA, Curlin F, Datta S, Bader AM, The effects of varying
volumes of crystalloid administration before Cesarean delivery on
maternal hemodynamics and colloid osmotic pressure, Anesth Analg 1996;
83:299-303.
Hawthorne L, Slaymaker J, Bamber J, Dresner M, Effect of fluid preload on
maternal haemodynamics for low-dose epidural analgesia in labour,
International Journal of Obstetric Anesthesia 2001;10:312-315.
Jean
********
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA
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