Not to beat a very dead horse, But....
  Many have commented on the topic of epidurals and breastfeeding. Some have quoted from a few research articles, others have mentioned that we need to keep in mind the quality of studies and what specifically was studied (such as which medications are used, fentanyl vs lidocaine) Other important points have been made to remember studies that have linked epidurals with increased risk of operative, instrument assisted deliveries- (forceps/vacuum, episiotomy) and that logic would imply that these things would effect breastfeeding. I agree with these valid points!
   
  I’d also like to say a word about passion vs science. Breastfeeding is certainly more than the physiologically normal way for humans to feed their offspring. It is a blessed part of mothering for many lucky mothers(and babes.) I didn’t need any reminding of this as I nursed my daughter to sleep this evening.
   
  As passionate as I am about breastfeeding, I also love the scientific method and statistics and empirical evidence and this interesting search for truth we call research. Because of that I have found the conflicting results in the research on epidurals quite interesting. 
   
  As I have stated in earlier posts my interest was first peaked when I attended a Principles of Lacation course where Dr. Pamela Berens, MD, IBCLC. gave a presentation on Pharmacology and Breastfeeding. She covered much material, far too much for me to include here. In her lecture, she gave an overview of studies on epidural use and their effect on breastfeeding. After reviewing several studies in detail, it was clear that the results are mixed and contradicting, indicating a need for further research in this area. An over-view or meta-analysis, or a review of the literature(whatever you want to call it) on this topic did not indicate that epidurals adversely affect breastfeeding rates or duration. Quoting 1, 2 or even 3-4 studies does not prove that epidurals adversely effect breastfeeding, unless one is quoting the only studies that have ever been done on the subject. The fact remains that there are at least 4 studies that offer contradictory results in that there was not a
 statistically significant difference in breastfeeding rates at either 24 hours post partum and/or 6 weeks(Baumgarder, Radzyminksi, Halpern, Riordan J et al). I am not specifically addressing whether they got supplements, but whether these women continued breastfeeding to 6 weeks)
  Am I going to go out and advertise for epidurals?? Certainly not! There are many good sensible reasons not to have an epidural. But, as I see it, the studies right now are conflicting and certainly more research should be done, especially if we could establish that lidocaine only epidurals are better for moms/babies. Why not appreciate that this is significant and concede that this topic deserves further attention? Most women delivering in America today choose epidural anesthesia over other pain control methods. They deserve to know that the research overall is conflicting and overall has not clearly established any adverse effects on breastfeeding duration/rates, regardless of any one individual’s opinion in the subject.
   
  The only Cochrane review of the literature on epidural use does not mention breastfeeding at all but concluded:
  "Epidural analgesia appears to be effective in reducing pain during labour. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia on women in labour and long-term neonatal outcomes."
   
  Mary Herrington RN
  Labor & Delivery
  St. Lukes CMC
  The Woodlands, Texas
   

			
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