I'm hoping some of you out there can help me by sharing your opinions and
experiences. At my institution we are currently embroiled in meetings and
discussions about what we teach in breastfeeding and childbirth classes about
the use of epidurals. The disagreement was started by an obstetrician and now
the anesthesiologists have joined in. They contend that we are biased against
epidurals and have no business teaching what we do because there is no good
scientific evidence that epidurals affect breastfeeding or have any
undesirable effects on mom or baby. The ACOG roundtable discussion audiotape
I just listened to states pretty much the same thing. What I teach in
breastfeeding class is that an unmedicated birth is a desirable goal and that
any medication given in labor, epidural or otherwise, does "get into" the
baby and MAY interfere with breastfeeding behavior. The childbirth
instructors seem to be very evenhanded when discussing pain control, but do
share the downside of the additional interventions inherent in epidural
anesthesia.

So, if you teach classes, what do you tell your clients? Do you all touch on
the possible effects of labor medications on breastfeeding? I know there
haven't been a lot of studies that directly address breastfeeding, and that
they are not the high-level studies that the contentious OB doc wants, but
that's all we have. It is my impression that virtually all of us who work
with breastfeeding moms believe that obstetric medications can adversely
affect breastfeeding, even if studies haven't PROVED it. Is that a correct
impression? I would really welcome input, and will assume that if you email
me directly that I can share your reply. Thanks so much.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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