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From:
Julie Conaway <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 16 Oct 2007 13:58:47 -0400
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Hello all!

In searching the archives for info regarding the impact of epidurals on 
breastfeeding, I found a very interesting post by Carol Schlef from May 2005.  
I tried to e-mail her directly, but received an automated reply to follow a link 
to ensure my correspondence was not spam, and it was a broken link.  So, 
finding myself at this dead-end, I'm hoping this public post will be interesting 
to all.

Carol said:
"I share something Dr. Righard shared w/us here in St. Louis a few years ago, 
when he did Grand Rounds at one of our local hospitals. He had a theory about 
epidurals' impact on newborn behavior, but had not yet conducted clinical 
trials to verify it (and I tell my students this--that this is THEORY, not 
EVIDENCE--yet!).

His theory was that, when a mom gets a "good" epidural--that is, experiences 
no pain or discomfort for the last half of labor--she does not secrete 
endorphins, the body's natural response to pain. Endorphins have been found 
to not only reduce an individual's perception of pain, but also to energize the 
person--hence, the "runner's high".

Since endorphins flow freely across the placental barrier, babies born of an 
epidural birth do not have the benefits of maternal endorphins, to energize yet 
calm them. Hence, we have sleepy, disorganized babies. Whether or not the 
epidural meds get through to the baby, the nonexistent endorphins DON'T.

Makes sense to me, & to my students. So, I encourage them to employ as 
many non-medical comfort strategies as they can, and if they do opt for an 
epidural, to request the lowest possible dose at first, to "take the edge off" 
the pain rather than eliminate it completely."

Julie here again:
I find this theory very interesting and would like to hear more about it.  When I 
discuss epidurals with my colleagues at our hospital, they immediately reply 
that meds delivered via the epidural route don't enter mom's bloodstream and 
therefore cannot cross the placenta to make the baby sleepy.  (Which, 
according to one CRNA at our hospital, is not true.  His explanation is that 
narcotics delivered epidurally certainly do go into mom's bloodstream, but since 
the dose is 1/10 of what is administered IV, a much lower dose is passed to 
the baby.)  However, this 'endorphin theory' would completely bypass the 
suggestion that the epidural itself causes infant sleepiness and disorganization, 
but rather the lack of pain is the cause.  

Does anyone have any info to add to this theory?  Has Dr. Righard followed it 
up with a study?

I would also love to hear any info regarding which medications have the 
fewest negative effects on the baby, the efficacy of a local anesthetic alone 
without a narcotic, and the effects of an ultra-low dose of epidural meds to 
minimize pain rather than completely block pain.

I'm asking for a lot, I know.  I am planning to start compiling specific patient 
info at our hospital to try to track trends.

I have never done a research study.  I don't need anyone to help conduct this 
project, but if anyone would be willing to volunteer as a resource person just 
to ask procedural questions of, I would certainly appreciate it!

Julie Conaway, RN

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