Dear Friends:
    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." The 
authors also state that they didn't do any long term  follow-up.
    Halpern showed that Baby-Friendly style practice  did promote 
breastfeeding, and studied women out to 6 weeks, where 92% were  still breastfeeding, but 
not all exclusively.
    Baumgarder makes a lovely comment that "an  additional unexplored 
explanation for the apparent negative effects of epidural  exposure......is that 
mothers willing to accept one intervention (epidural) are  more willing to accept 
another (bottle supplementation).
    Sepkowski identified that newborns exposed to  epidurals were less alert. 
Riordan showed that breastfeeding assessment scores  (using the IBFAT scale) 
were statistically higher in unmedicated mothers.
    The Cochrane data base says that "Epidural  analgesia appears to be 
effective in reducing pain during labour. However, women  who use this form of pain 
relief are at increased risk of having an instrumental  delivery."
    I am also interested to know if this OB/GYN ignored  Matthiesson, 
Ransjo-Arvidson  and others that showed a negative impact on  breastfeeding when 
labor analgesia, including epidurals are used?
    True, studies of epidural use are difficult to  standardize: medications 
in the epidural vary, women may receive IV narcotics  before the epidural is 
given, epidurals are given at different times in labor.  Still, as epidurals do 
lead to increased chance of operative delivery, which  leads to maternal and 
infant injury and separation, we can't for one minute  accept that there is no 
connection between epidural use and  breastfeeding.    
    How was this lecturer discovered to be a  breastfeeding advocate? 
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct  Faculty Union Institute and University
Film Reviews Editor, Journal of Human  Lactation
www.breastfeedingalwaysbest.com

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