Nikki writes:

< Thank you Mary, for getting back to us about this  questionable finding,
that epidurals make little or no difference to  breastfeeding.
   I am perplexed at the lecturer's use of Baumgarder,  who found that
"epidural anesthesia during labor is negatively associated with  early
breast-feeding (sic) success despite not inhibiting early breast-feeding
 attempts."?

Epidurals routinely involve the use of crystalloid IV fluids in order to
keep the mother's blood pressure in a safe range while the epidural
medications are in effect. This is shown in anesthesiology research to have
the potential to produce relative overhydration. Pulmonary edema is one very
serious possible complication that can occur with overhydration,
and physicians are very aware of this risk, to avoid it for reasons of
litigation, if for no other reason.

However, as yet, I am not aware than any physicians have recognized that
overhydration almost always causes excess interstial fluid (edema) in the
breast, commonly superimposed on the normal physiological process of
engorgement at the onset of Lactogenesis II. This distorts the
nipple-areolar complex, making latching problematic. This gets milk transfer
off to a poor start with all its pediatric ramifications, let alone the
mother's frustration and discomfort. In addition, the potential for delayed
onset of milk production is increased due to dilution of raw materials and
their slower passage from the circulation to the alveoli. Many such problems
during the first two weeks of lactaton are enough to "nip it in the bud" for
many mothers. If moms don't make it through the first 2 weeks successfully,
then they very seldom appear in the statistics of longer term breast
feeding.

(The higher association of epidurals with subsequent operative deliveries of
course leads to the probability of the mother receiving yet even more
crystalloid IV fluids, increasing the numbers with the problems above.)

Jean
*********
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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