Greetings from S.E. Montana:

Just to give you some perspective - I am located in an isolated setting of
8500 population with next larger city 150 miles away and lots of wide, open
spaces in between.  Sometimes I'm not sure what the rest of the world is up
to.  Lactnet has been a very helpful reality check.  My background is OB
rather than LC although I am nursing my fifth out of five children at
present and am a strong advocate.

I would like to offer discussion in two areas regarding the actions taken
in labor and delivery and the implications for breastfeeding.  I have been
following the controvery of especially long use of Pitocin in labor lending
to nipple edema and a poor latch for the nursing infant.  We have become
accustomed to using Prepidel gel to the cervix the night prior to Pitocin
induction. This is meant to soften the cervix and allow it to dilate more
easily and therefore shortening the length of induction or to even
eliminate use of Pitocin if the Prepidel succeeds in initiating labor.  If
the length if time on Pitocin is shortened, does this Prepidel protocal
offer a better outcome regarding nipple edema?  Are there problems
suspected or seen by the maternal exposure to Prepidel as related to
breastfeeding?


The second issue is in regard to use of intrathecal anesthesia instead of
epidural.  (Intrathecal isn't exactly used as interchangable but rather as
a different approach to pain relief.)  There is no IV bolus required.
Mother is not confined to bed.  Relief is limited to 8 hours and offered
one time only.  Generally, the drug dosage is Fentanyl 25 micrograms and
Morphine .5mg.  How might this method of medicating a laboring mother
affect the breastfeeding experience?

Our first approach is to support the most natural process possible.  But
when intervention does become necessary would these protocals be more
helpful or not?

Noelle Rice, RN, BSN