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From:
Rachel e-mail <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 22 Sep 1999 13:26:08 +0200
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On 21 Sep, K. Jean Cotterman writes: 
"Any study of "epidurals" and their effects on breastfeeding would seem to
be comparing oranges and apples if one particular set of drugs is used by
one anesthesiologist and another combination by someone else."
YES!
Epidurals vary in content, strength, placement and duration, and they are given for varying indications.  All these things need to be taken into account when the time comes for the baby to meet the breast.  "... mothers who receive IV's in labor for any reason often seem
to retain fluid. Sometimes pitting edema is noticeable for as many as
10-14 days postpartum. At least part of this fluid overload collects in
the breast..."
K. Jean Cotterman relates this to Pitocin infusion as well, with good reason.  Pitocin opposes diuresis, and if you think about it, it is perfectly logical.  Fluid shouldn't go down the toilet, it should be channeled through the breasts as milk for the baby.
(Pitocin and epidurals).".. are frequently being administered simultaneously, and the use of one often seems to increase the use of the other."
How very true.  This reasoning makes sense to me!

This is yet another occasion to demonstrate the three prime virtues of any good midwife (speaking as a midwife, which is the capacity in which I facilitate first breastfeedings), namely 
1. Patience 
2. Patience 
3. Patience 
to let mother and baby have abundant skin contact without pressure to perform, to let baby get alert and interested enough to start rooting clearly enough that helpers can determine readiness to start feeding, to let mother and baby sort it out themselves.
Note:  It is not virtuous to be patient with institutions whose practices impede breastfeeding, or with societies which devalue mother-baby relationships, or with anyone who engages in unethical promotion of products which can threaten breastfeeding.  


If we want to promote BF, and I am assuming we Lactnuts all do, we need to be knowledgeable about the effects of epidurals so we can support mothers and babies in an appropriate way.  In cases where epidural has been part of a bad experience, BF can be a vital and unique part of recovery.  I have experienced two labors from the inside and hundreds from ringside, and would never ever ever presume to know another woman's motivation for the choices she makes about analgesia.  My job is to be with woman.  The battles about appropriate use of medical technology, including epidurals for childbirth, are not to be fought with individual women as enemies, or as weapons, or as battlefields.  We have other places to do our fighting on behalf of Women, Birth, and Breastfeeding (capitals intended), and believe me, I am suited up in full armor on my horse regularly.  The reality is that the benefits of BF are not limited to those women whose choices in labor match our own personal biases, and all women and babies deserve competent help with BF.

Rachel Myr
Chronically battling windmills in Kristiansand

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