Dear all:

I'm not sure that a metaanalysis of whether or not women are nursing at six weeks is all the 
information I would look at to determine the impact of epidurals on breastfeeding.  Moreover, I 
would really pick over the "negative" studies.  As I've posted before, there are many reasons why a 
true biological effect can be washed out or obscured if one is not looking at all the details.  In the 
Schanler study  - simply having a drop in the NEC rates shifted the sample size that would have been 
necessary to detect what might have been an important physiological difference - but one that could 
not be picked up statistically because the calculations were based on a higher rate of NEC than what 
actually occurred in the study.  These types of considerations abound.  If anyone has a copy of the 
metaanalysis I would love to read it.

In terms of the nursing to six weeks - this may include huge differences in the quantity of formula 
that is being used.  I know many a token breastfeeding mom.  I cannot tell you how many mothers 
call me who are giving 3-4 ounces of formula after every single feeding and wondering why their 
breastfeeding isn't going better.  There could be HUGE differences that are buried in the "not 
breastfeeding at six weeks" criteria for a negative influence. 

Please send me a copy, I'm curious enough to want to pick over the details!

Best, Susan

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