Currently I am a nursing student from the University of North Dakota whose 
working with a mother in her second trimester of pregnancy and is interested 
in breastfeeding.  The mother has ankylosing spondolytis which is causing a 
great strain on her back.  It has been determined that there is a strong 
possibility of utilizing pain medication during delivery and she may also be 
a candidate for a cesarean delivery.

The mother is concerned that using pain medication during delivery will have 
a negative effect. She is concerned that the effects of the drug on the 
newborn will leave the infant to drowsy to have an interest in 
breastfeeding.  The mother is also concerned that she may have less interest 
in breastfeeding especially if she has a cesarean section.

In reviewing studies, there were concrete findings that breastfeeding is a 
complex, coordinated task and it is imperative that breastfeeding be 
initiated immediately after delivery.  According to one study (Henderson, 
Dickinson, Evans, McDonald, & Peach, 2003) no major adverse effects have 
been demonstrated by the neonate from epidural analgesics but subtle 
neurobehavioral depression had been seen.  The study suggests that these 
mild effects are sufficient enough to impede the successful initiation of 
breastfeeding.

Jorden, Emery, Bradshaw, Watkins & Friswell (2005) stated that the analgesia 
is rapidly eliminated from both the mother and neonate leaving no long term 
effects, but can cross the placenta and enter the colostrum leaving subtle 
effects on both the infant and mother and therefore hinder initiation of 
breastfeeding.

A study by Halpern et al. (1999) stated that women receiving general 
anesthesia for cesarean delivery will also usually receive postoperative 
opioid analgesia.  The study showed there were lower rates of breastfeeding 
initiation than those women who received epidural anesthesia.  Also, the 
infants of women, three and four days after cesarean delivery who received 
meperidine by PCA, as opposed to those who received intravenous morphine, 
showed lower neurobehavioral scores, therefore impeding initiation of 
breastfeeding.  The findings in this study were similar to the study by 
Ransjo-Arvidson et al. (2001) which showed that analgesics  received during 
labor had an adverse effect on breastfeeding by the infant having a slower 
response to touching and massaging the breast as well as a proper latch to 
provide sufficient sucking. These movements are known to be essential in 
successful breastfeeding.  It is the massaging of the infants hands and 
mouth movements that stimulate the erection of the nipple and areola making 
it easier for the infant to attach properly to the breast and enhance milk 
flow.

Clearly from the studies that I have researched, it shows a direct 
correlation between analgesics and hindrance in breastfeeding.  The question 
I am posing is what techniques can be done to assist the mother and infant 
in having a successful initiation of breastfeeding and ultimately continue 
to breastfeed after receiving any form of analgesics or opioids?

Teresa Romero, SN


REFERENCES

Henderson, J., Dickinson, J., Evans, S., McDonald, S., & Paech M. (2003). 
Impact of
intrapartum epidural analgesia on breast-feeding duration. Australian and 
New Zealand Journal of Obstetrics and Gynecology, 43, 372-377.

Halpern, S., Levine, T., Wilson, D., MacDonell, J., Katsiris, S., & 
Leighton, B. (1999).
Effect of Labor Analgesia on Breastfeeding Success. Birth, 26, 83-89.

Jordan, S., Emery, S., Bradshaw, C., Watkins, A., & Friswell, W. (2005). The 
impact of
intrapartum analgesia on infant feeding.  BJOG: an International Journal of
Obstetrics and Gynecology, 112, 927-934.

Ransjo-Arvidson, A., Matthiesen, A., Lilja, G., Nissen, E., Widstrom, A., & 
Moberg, K.
(2001). Maternal Analgesia During Labor Disturbs Newborn Behavior: Effects 
on
Breastfeeding, Temperature and Crying. Birth, 28:1, 5-12

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