Nikki and Jan have referred to a study published in Birth last year that
concluded that epidurals did not affect breastfeeding. The authors referred
to and dismissed my work as insignificant. It's a good thing I have thick
skin and an extensive collection of articles on the side effects of
epidurals. My letter to the editor appears below. Like Linda, I have
presented lectures for years that address the affects that birthing
interventions have on breastfeeding. Some days the concrete blocks tied to
our ankles threaten to sink breastfeeding in a sea of inadequate, incorrect,
outdated, and conflicting information. The side effects and interventions
that epidurals require are frightening. The biggest concrete block we have is
the lack of good data on these issues. I bet if those of us on Lactnet who
have access to hospital pateients and charts could come up with some dandy
data on epidural rates, what drugs were used, how far dilated was the mother,
how many times was the epidural topped off, how much IV fluid did the mother
receive, how many minutes and hours of lactation consultant time were
required to facilitate breastfeeding, how much was the baby supplemented, how
much time did the mother spend with her baby, etc. Any researcher here
willing to take on some organized data collection? The reaction to
challenging epidurals is strikingly similar to the reaction to the topic of
the hazards of infant formula. I have been writing and lecturing on this for
years. The latest Ross data shows that exclusive breastfeeding rates in the
US have been falling since 1995. Could this be related to not only the
crushing commercial pressure on breastfeeding women to supplement but also
the epidural baby unable to suckle at breast?
Marsha Walker, RN, IBCLC
Weston, MA
To the Editor:
I wish to comment on the Halpern, et al study regarding labor analgesia and
breastfeeding (Birth 1999; 26:83-88).This study looked at the use of epidural
analgesia and the outcome measure of breastfeeding duration, concluding that
epidurals had no effect on breastfeeding. However, the study did not measure
the effect of epidural medications on the actual breastfeeding mechanics used
by infants such as sucking or on infant state control – both of which are
known to be affected by labor medications. A study by Riordan(1) examined the
effects of labor pain relief medication use on neonatal sucking and
breastfeeding duration.Infant feeding and sucking behaviors were measured
with the Infant Breastfeeding Assessment Tool (IBFAT) which revealed
significantly lower sucking scores in infants whose mothers had epidurals
compared to those using no labor medications. As there was no unmedicated
control group in the Halpern study, it is difficult to know if the 31% of
mothers who visited the breastfeeding clinic and the 36% of mothers who had
breastfeeding problems in the hospital (sore nipples, difficult latch)
represent any difference from those women who had no labor medication.
The 72% of mothers breastfeeding exclusively at 6-8 weeks is an admirable
achievement. However, these types of outcomes occur when the mother’s
intention and motivation are so strong that they override the side effects of
perinatal interventions and when breastfeeding support is intense and
sustained. Mothers and infants may experience numerous side effects of
epidural use that can affect breastfeeding which were not mentioned in the
Halpern study. In a hospital that routinely separates mothers and babies,
liberally uses pacifiers and bottles, gives away formula containing discharge
packs, and offers little to no follow up, breastfeeding is often an early
casualty. Epidurals in these hospitals (some with rates of 95% or higher)
contribute yet one more barrier to successful breastfeeding.
I certainly agree that hospitals with decreased lactation success should
reexamine their post delivery care policies. However, I feel that reducing
epidural use will help eliminate a contributing factor to early breastfeeding
problems. If a hospital is minimally staffed and using outdated protocols,
how can it help babies to breastfeed whose sucking is depressed during the
early postpartum period and whose mothers receive little feedback from their
sleepy infant? The data that I presented in my review of labor medications
and breastfeeding(2) was clear in that these drugs both reach the fetus and
affect the neurobehavior of the newborn. While this was dismissed as being
insignificant, it is certainly clinically relevant if an infant whose mother
received an epidural experiences diminished early sucking ability.
Wouldn’t it make more sense to decrease the epidural rate, which would reduce
the resulting number of early breastfeeding problems, alleviate the need for
scarce intensive lactation support services, and simply avoid the problems to
begin with?
Thank you for your attention.
Sincerely,
MarshaWalker, RN, IBCLC
References
1. Riordan J, Gross A, Angeron J, Krumwiede B, Melin J. The effect of
labor pain relief medication on neonatal suckling and breastfeeding duration.
J Hum Lact 2000; 16:7-12
2. Walker M. Do labor medications affect breastfeeding? J Hum Lact
1997;13:131-137
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