There are many problems with the way that most laboring women are treated in the USA. I agree with much of what Nikki has to say. Many interventions such as amniotomy and pitocin are overused in some hospitals. Having had natural childbirth and having worked in a hospital L&D environment, I think has given me a unique perspective to understand the good, the bad and the ugly of the modern OB environment. 

Nikki brings up an excellent point, "As many hospitals have epidurals rates at 80% and above, women don't get a chance to see how they would do with an unmedicated birth. I know plenty ofmothers who have been persistently asked, reminded and encouraged by hospital staff to consent to an epidural when it was not part of their original plan." 

I would go a step farther and call it bullying.

It's not always about the epidural itself necessarily, it's about the treatment of the mother by certain, well-intentioned but I believe, misinformed hospital personnel. In their viewpoint the epidural is liberating for the mother, she doesn't experience pain, it often makes their jobs easier when they are assigned multiple laboring patients (which is the reality in most hospitals) and they have not really been informed about or researched the complications associated with epidurals and other interventions. This is not all providers, I'm trying not to generalize here, but you are right I have seen what I would consider to be bullying of women into epidurals which is wrong. I have also seen the other side too, in which an epidural provides much needed pain relief and sleep after a prolonged labor, in which a mother is physically and emotionally exhausted and cannot go on any longer and really wants to give up and is requesting a c-section. 

My point is just that while epidurals are not without risk, and may possibly have a negative effect on breastfeeding, we shouldn't go beyond what the research is telling us. Otherwise we may lose credibility. I tell patients that it may affect the baby's ability to latch, but we don't know, we need more research. But in my opinion, I see many, many, many more problems with the IV meds. Those babies come out limp, groggy, needing to be resusitated, going to the nursery, and they feed poorly for days. I would much rather see a mom get an epidural than IV narcotic meds. Some of those meds have a half-life of 24 hours for the infant.

I agreed in my original post that there is more evidence that does show that when fentanyl is added to the epidural there may be more latch on problems, however, one study is not definitive proof. Each woman is unique and each labor experience is unique. Regional anesthesia has definitely been beneficial in the case of c-sections in the fact that now mothers can be awake for the birth of their infants. I recommend to pregnant women to prepare, read and plan, but also keep an open mind because sometimes these interventions are life saving and we never know what is going to happen in labor. But they need to have informed consent, they need to understand the cons of these procedures because they are widely overused and often they may only here the pros from those working in the hospital. Many OB's will tell you that they don't increase risk of c/s but I would tell you that my experience is that they do, especially when given during early labor.

It's very possible that epidurals could have a negative effect on breastfeeding. But it may be other things too. One problem persistent problem is that many mothers develop a low-grade fever after epidurals and then the infant is taken to the nursery for observation for infection unnecessarily. They draw blood on the baby, which makes them fussy, and they are separated from mom. All of this definitely interferes with breastfeeding. Working in a hospital that does have about 70 to 80% epidural rate, I actually have seen a huge decrease in latch on problems this past year since we went to a minimum of 1 hour of skin to skin contact and have delayed the newborns bath for 24 hours, which are also factors not accounted for in most epidural studies. Now I rarely see a baby having trouble latching, even with the high epidural rate. 

The main thing is that mothers need to be educated and their decisions supported. Both the mother and the providers need to know about pros and cons of interventions, because many only know the pros. But we also need to be careful not to push our views on the patient. I have seen the bullying go both ways too, with family members really trying to talk the mother out of getting an epidural when she really, really wants one. I have seen mothers of teen girls try to prevent them from getting an epidural as a way of punishing them for getting pregnant, or dads at the bedside saying, "But honey you said you didn't want the epidural." When she has clearly changed her mind. Women have a right to informed consent and then having their decisions respected and supported.

Tricia Shamblin, RN, IBCLC

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