Betsy is correct, we need to remember also what good we are doing and how
great it is that we are there to be sure breastfeeding happens. I am sure we
all know we cannot undo that which has been done. However, understanding the
impact of what has happened in birth does in fact help us as professionals
when we are determining the best course of action or what other interventions
may now be necessary. And, to make informed decisions and provide an accurate
care plan and to understand what needs to be done to solve the problem, it
makes sense to understand why the problem exists. It is not that we are not
aware we cannot change things, we are acutely aware. It is like any other
health situation---understanding the cause is part of the solution.
And, yes, Heather, I do know we are talking about completely different
scenarios including the women themselves. Yet I know many women entering a
hospital for birth extremely determined and educated about breastfeeding. I am
certain the research could have information about desire to breastfeed as part of
the criteria...including education about breastfeeding, help, etc. I do know
that the very birth itself when in a hospital setting will have a different
set of postpartum policies, but like I said, that too can be controlled for.
My desire is to see normal as the control group, not the interventions.
Anyway, we already know the epidural is better than the iv meds for pain. I
totally accept that fact. Your final comment is that in areas where epidurals
are common we do not see breastfeeding problems. Well, where I live epidurals
are so common that if you don't want one, stay home. The rate of epidural use
is so high I have been told that my subgroup of clients seeking an
unmedicated birth in the hospital setting are statistically insignificant. That still
leaves me with the question of the definition of "problem free
breastfeeding" and the measurement used to determine that conclusion. From what I
understand, that measurement is not as I describe:
pain free, good milk transfer, no need for supplementation and exclusive for
6 month duration.
I am not attacking those who have had epidurals, heck, I had two epdidurals
and a spinal for my c. But to say that epidurals do not do anything at all
to the baby and do not make any difference no matter how subtle to the outcome
of breastfeeding is not something I see that the research has proven because
the definition of no impact on breastfeeding has still not been completely
defined. Just as it has not proven that it is 100% safe for mother or baby.
Is it better than iv meds? Yep. Is it better than a general for ceserean?
Oh, yes and I am so glad we have the epidural!
Also, knowing if there is an impact and knowing exactly how it impacts and
especially how long that impact may last is not somethng we should ignore and
make believe doesn't exist so moms don't feel guilty for having an epidural.
But, knowing there is a reason, having a time frame of reference, knowing
there is a solution may be what helps mothers continue trying when
breastfeeding difficulties arise. And if we do find that for some women there is indeed
more difficulties breastfeeding in the early days or weeks due to the baby's
difficulty with oral motor skills we should let her know so she knows it
will pass. I doubt that the knowledge will make a hoot of difference to the
anesthesia income as I do not see women opting to avoid an epidural to avoid
difficulties breastfeeding....they won't even avoid the formula and they are not
even in pain then. This is not about telling women they cannot have an
epidural and breastfeed, of course they can! This is about understanding the
impact of every event within the birth experience that may impact breastfeeding
capability for the newborn and how we can help the dyad overcome that issue
as lactation consultants.
Take care,
Pam MazzellaDiBosco, IBCLC, RLC
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