I write this as someone who years ago, used to be very opposed to epidurals and pro-natural childbirth. I admit to having had a knee-jerk reaction against all things epidural in the past. However,I'm trying to be more open minded about the issue and look at the research in an unbiased manner. It's not about my personal experience, it's about what the research shows. And in case you think I'm a pro-epidural person making this argument, I've never had an epidural myself. I had three natural childbirths. But when we take inconclusive research and present it to the medical community as proof that epidurals have a negative impact on breastfeeding, it undermines our credibility with healthcare providers.

So I think we need to be very careful about not going beyond what the research is saying.  First of all, one of the problems is that there is not enough research into women's health issues overall. I have been consistently encountering this lately among many issues related to childbirth and lactation. Many systemic reviews say the same thing, not enough research, inconclusive, more research needed. The ABM protocol about analgesia and Nancy Mohrbacher's book, Breastfeeding Answers Made Easy, state the same thing, it's inconclusive and more research is needed. Billions of dollars per year are spent researching cancer and heart disease, and very little is spent research childbirth and lactation, which I think is evidence of the continuing health care disparity between men and women in our society. 

I think we should be very cautious about how we present this information. Rather than stating that research shows that epidurals interfere with breastfeeding success, a more accurate view of the research would probably be that research shows that women who do not have an epidural during labor are more likely to successfully breastfeed, but we do not know if this relationship is causal. Women who choose natural childbirth may be more motivated to breastfeed. The studies we have are small, and there are many confounding variables that are not always accounted for. There is slightly more evidence that when fentanyl is used in an epidural that it may interfere with breastfeeding success. However, more research is needed in this area to determine if breastfeeding is impacted by an epidural.

Do epidurals increase risk of OP position?

"Their results, however, aren’t sufficient to convict epidurals because we can’t tell whether having an epidural led to persistent OP or more painful and prolonged OP labor led to having an epidural."


Cheng, Y. W., Shaffer, B. L., & Caughey, A. B. (2006). Associated factors and outcomes of persistent occiput posterior position: A retrospective cohort study from 1976 to 2001. Journal of Maternal Fetal and Neonatal Medicine, 19(9), 563-568.
Fitzpatrick, M., McQuillan, K., & O’Herlihy, C. (2001). Influence of persistent occiput posterior position on delivery outcome. Obstetrics and Gynecology, 98(6), 1027-1031.
Lieberman, E., Davidson, K., Lee-Parritz, A., & Shearer, E. (2005). Changes in fetal position during labor and their association with epidural analgesia. Obstetrics and Gynecology, 105(5 Pt 1), 974-982.

In researching the suggestion of Anne Marie Widstrom's research, I was not able to find anything specific on epidurals, mostly her research was about the importance of early skin to skin contact. But I did find these studies cited by her in her research.

Baumgarder DJ, Muehl P, Fischer M, Pribbenow B: Effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally.J Am Board Fam Pract 2003, 16:7-13.

"Labor epidural anesthesia had a negative impact on breast-feeding in the first 24 hours of life even though it did not inhibit the percentage of breast-feeding attempts in the first hour. Further studies are needed to elucidate the exact nature of this association."



Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA: Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J 2006, 1:24.

"Women in this cohort who had epidurals were less likely to fully breastfeed their infant in the few days after birth and more likely to stop breastfeeding in the first 24 weeks. Although this relationship may not be causal, it is important that women at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support."


Wiklund I, Norman M, Uvnäs-Moberg K, Ransjö-Arvidson AB, Andolf E: Epidural analgesia: breast-feeding success and related factors. Midwifery 2009, 25:31-38.

The study shows that EDA is associated with impaired spontaneous breast feeding including breast feeding at discharge from the hospital. Further studies are needed on the effects of EDA on short- and long-term breast-feeding outcomes.



I'm not pro-epidural, but I'm just advising caution here. We are already having to fight for respect, if we go beyond what the research is saying, we are risking undermining our credibility. Another problem is that I have had patients who have been told that having an epidural reduces their chances of being able to successfully breastfeed, then they have a difficult and prolonged labor and end up getting an epidural. They often feel like failures because they "gave in" and got the epidural. Then they will sometimes have the mistaken idea that they won't be successful at breastfeeding because they had an epidural. Anyway, as with many of areas of women's healthcare, we need more research here.

Tricia Shamblin, RN, IBCLC 

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