The recent article in Birth with the conclusion that epidurals had no effect
on breastfeeding begged for a letter to the editor, especially since my
artcile in the Journal of Human Lactation was cited and dismissed! Here is
what I wrote.
Marsha Walker, RN, IBCLC
Weston, MA
To the Editor:
I wish to comment on the Halpern, et al study regarding labor analgesia and
breastfeeding (Birth 1999; 26:83-88). This study looked at the use of
epidural analgesia and the outcome measure of breastfeeding duration,
concluding that epidurals had no effect on breastfeeding. However, the study
did not measure the effect of epidural medications on the actual
breastfeeding mechanics used by infants such as sucking or on infant state
control - both of which are known to be affected by labor medications. A
study by Riordan1 examined the effects of labor pain relief medication use on
neonatal sucking and breastfeeding duration. Infant feeding and sucking
behaviors were measured with the Infant Breastfeeding Assessment Tool (IBFAT)
which revealed significantly lower sucking scores in the first twelve hours
of life in infants whose mothers had epidurals compared to those using no
labor medications. As there was no unmedicated control group in the Halpern
study, it is difficult to know if the 31% of mothers who visited the
breastfeeding clinic and the 36% of mothers who had breastfeeding problems in
the hospital (sore nipples, difficult latch) represent any difference from
those women who had no labor medication.
The 72% of mothers breastfeeding exclusively at 6-8 weeks is an admirable
achievement. However, these types of outcomes occur when the mother's
intention and motivation are so strong that they override the side effects of
perinatal interventions and when breastfeeding support is intense and
sustained. In a hospital that routinely separates mothers and babies,
liberally uses pacifiers and bottles, gives away formula containing discharge
packs, and offers little to no follow up, breastfeeding is often an early
casualty. Epidurals in these hospitals (some with rates of 95% or higher)
contribute yet one more barrier to successful breastfeeding.
I certainly agree that hospitals with decreased lactation success should
reexamine their postdelivery care policies. However, I feel that reducing
epidural use will help eliminate a contributing factor to early breastfeeding
problems. If a hospital is minimally staffed and using outdated protocols,
how can it help babies to breastfeed whose sucking is depressed for the first
twelve hours and whose mothers receive little feedback from their sleepy
infant? The data that I presented in my review of labor medications and
breastfeeding2 was clear in that these drugs both reach the fetus and affect
the neurobehavior of the newborn. While this was dismissed as being
insignificant, it is certainly clinically relevant if an infant whose mother
received an epidural experiences depressed sucking for the first twelve hours
of life.
Wouldn't it make more sense to decrease the epidural rate, which would reduce
the resulting number of early breastfeeding problems, alleviate the need for
scarce intensive lactation support services, and simply avoid the problems to
begin with?
Thank you for your attention.
Sincerely,
Marsha Walker, RN, IBCLC
References
1. Riordan J. The effect of labor pain relief medication on neonatal suckling
and breastfeeding duration. 1999 (in press)
2. Walker M. Do labor medications affect breastfeeding? J Hum Lact 1997;
13:131-137
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