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Subject:
From:
Pamela Mazzella Di Bosco <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 19 Feb 2006 16:23:51 EST
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In a message dated 2/18/2006 9:50:19 A.M. Eastern Standard Time,  
[log in to unmask] writes:

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)



While Mary is sharing information she has heard and read, and I agree that  
it is exactly as she has said, the point is completely being missed by those  
doing the research and those using it to encouraget the choice of epidural as  
having no impact---- the measurement itself is not necessarily an  acceptable 
measurement of impact on breastfeeding.  ONE bottle makes a  difference.  ANY 
supplementing makes a difference.  If the comparison  is only to other 
medicated births, there is no comparison.  Unless the  research is done comparing 
epidurals to a normal birth, we are talking the  comparison of red apples to 
yellow apples.  In that case, sure the  epidural is better than a dose of demoral 
or nubain in the last stages of  labor.  However, I do not want to compare 
types of apples!  I  want to compare apples to carrots...not even both fruit! And 
that is  huge difference. The physiological/biological norm of the newborn 
and  postpartum mother needs to be the standard of comparison just as the 
exclusively  breastfed baby needs to be the standard of comparison. 
 
Honestly, this is not about the presenter. I heard her speak and she is  
indeed breastfeeding supportive.  I don't think she was even coming from a  place 
of 'supporting epidurals' as her comments were more along the lines  of  how 
this is the reality of the situation and that it should not be an  issue for 
breastfeeding based on the research.  She was not endorsing  epidurals at all.  
She was stating the facts as they are interpreted, and  not only by her.  Her 
information is not incorrect, the facts are not even  incorrect. What is wrong 
is the method of measurement and the definition of  success being used to 
claim the facts as such 
 
 Unless research is being done with all things being comsidered  including 
separation of mother and baby, skin to skin, and the use of  supplementation we 
can't say there is no adverse affect.  Babies do receive  the drugs from 
epidurals, and for the most part mothers are told they do  not.  They do.  Is there 
long term effects?  How could we  know?  Especially as we do not have enough 
women for a control study!   How can we really know the long term consequences 
of interventions that were not  medically indicated if we cannot find enough 
women who did not receive them to  make the comparison? 
 
I know, it is difficult to discuss childbirth without someone becoming  
defensive, just as it is to discuss the choice to use formula instead of  
breastfeed.  Yet, that continues to be my point,  We cannot discuss  how breastfeeding 
can and should work well in the earliest of the experience  without teasing 
out what is interfering with the success of mothers and  babies.  And we cannot 
do that without acknowledging that birth impacts  breastfeeding, and we cannot 
do that without debating the impact (or even the  lack of one) on the 
breastfeeding dyad when mothers are given pain  meds--including the all favorite 
epidural.  When I take a history from  mothers I ask for all things related to her 
birth...including position of the  baby during labor if she remembers, how 
long she was pushing, how long her  transition was, etc. I also want to know 
where the baby was immediately  after the birth.  All this matters when trying to 
see if the baby just  needs time to heal and we need to focus on protecting 
her milk supply and being  patient, or if there is some other reason we need to 
investigate further so we  can find a solution.  Many times, a few more days 
and that clamping,  biting, chomping motion and tongue bunching in the back 
will stop and we can  move on.  And, maybe the fact that every single one of 
those women I have  worked with who had those specific issues also  had an 
epidural is just a  coincidence.  Not to say I don't see other issues with home 
birthed babes  and babes born with zero interventions too.  It is true, that even 
when all  is normal in birth, something can be off in breastfeeding.  But, we 
can't  just decide that based on the research it is not epidurals causing 
these  behaviors unless we more closely study what we are calling breastfeeding  
success.

As in all things related to health, we should be seeking to  first do no 
harm.  We should be seeing that which is the physiological  healthy normal 
experience as the norm for all research comparisons.  I  never cease to be amazed 
what medicine will do to women in the name of for  women's own good.  And, no I 
do not blame doctors as individuals, but they  are the gatekeepers and it would 
be nice if they found a way to hold true to  what I know they really want to 
do .... first do no harm... against all the odds  that force them to often go 
against even what they themselves know to be true,  thanks to a society that 
expects docs to create perfection in outcome and blames  the doctors when 
things go wrong even when it is outside their control and will  sue them silly for 
if they don't deliver.
 
I am not doubting the outcome of the studies, only the data being  analyzed.  
For me to agree that epdiduals have no affect on breastfeeding I  would have 
to see that defined as: Exclusive breastfeeding with zero  supplementation 
needed for any reason whatsoever and absolute pain free  breastfeeding.  Then 
compare that to women who have birthed at home with no  interventions of any kind 
whatsoever.  If the comparison between epidural  use and absolutely no 
interventions at all turn out to be non existent, then we  need to tease out why we 
are seeing babies with issues of suck and find out what  else may be causing 
this oral skill disruption....and fix it.
 
Sitting and saying no, no, there is no difference research or not, when we  
are seeing something totally different in our work every single day is not  
helping us find a solution.  If what is being seen is not matching the  research, 
maybe the research is flawed.  I am quite certain that physicians  would 
continue to question the research if after applying it day and day out  they saw 
the outcome was not as predicted.  Perhaps we need to explore  who did the 
research, who funded the research, etc. Perhaps we need new research  with more 
information.  Just because something seems to be proven by  research, does not 
mean it is so, and if we have learned nothing at all from the  pharmaceutical 
industry's fiasco of research ending up with meds recalled and an  upheaval and 
restructuring of how research must be presented, surely we have  learned to 
question the research.
 
Respectfully,
Pam MazzellaDiBosco, IBCLC, RLC
 
 

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