Heather cites my posts on how everyone expects to BF here, and epidurals are
not considered a major hindrance.
But our rates are not high, although they are rising dramatically and there
is a rapid spread of the so-called ambulatory epidural, with fentanyl and
bupivacaine.  The majority of women don't have them, but I think it is not
an overwhelming majority.

I haven't been spending much time in hospital the last 18 months, and things
may be different (worse) there now.  When I was there last, our rate was
about 15%, and we wanted to keep it there or lower.  Epidurals and their
effects on BF are something I intend to look at more closely when I go back
to clinical work shortly.

Another factor is the length of time women have an epidural before the baby
is born.  Here it is very unusual to have one sited more than a couple of
hours before birth.  I understand that in the USA, at least, it is not
unheard of for women to have epidurals sited almost before we would consider
labor to have begun, and they and their babies are exposed for a much longer
time, sometimes 24 hours or more.  That would not happen here, if for no
other reason than that we don't have space in our units for women to be
there, anesthetized, but not in labor, nor do we have a surplus of
anesthesiologists.

Heather's astute comments on the setting in which birth takes place should
be taken to heart.  I agree that epidurals and low commitment to
breastfeeding can be markers for the same problems, and may not be the root
of the problem themselves.
Epidurals are a blessing to have when you need one.  Otherwise, they are a
nuisance and an obstacle to normal birth.  The goal of keeping birth normal
(the mandate of midwifery) is entirely consistent with promoting
breastfeeding.  Our more challenging job is to see to it that those
experiencing complications FOR WHATEVER REASON, iatrogenic or organic, also
can breastfeed successfully.

Rachel Myr (midwife, IBCLC)
Kristiansand, Norway

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