I have done a little looking at the literature regarding labor medications
and breastfeeding. I have submitted a paper on this topic which is currently
being reviewed for publication. A few goodies I found include:
1. no literature on epidurals use breastfeeding as a measurable outcome. What
is looked at is the score on neurobehavioral tests, and basically if the baby
is breathing he is fine
2. anesthesiologists see epidurals as therapy for the "pathology" of labor.
Each change in the status of the mother is thought to be deviant and cured by
an epidural
3. epidural medication such as bupivacaine reaches the fetus within ten
minutes of being administered. Telling mothers that labor medications do not
reach the baby is a lie
4. the half life of bupivacaine in an adult is 75 minutes. The half life in a
newborn is 18 hours. The longer a medication has been administered, the
longer it has to not only reach the baby but be stored in his tissues
5. there is a difference between epidural analgesia and epidural anesthesia,
mainly in the quantity of bupivacaine used and in the additives that replace
it
6. walking epidurals are epidural analgesia with the bupivacaine amount
greatly reduced and with a narcotic like fentanyl added to it
7. in a study by Loftus et al (Anesthesiology 1995; 83:300-308) it was shown
that in a group of babies whose mothers had epidurals with bupivacaine and
fentanyl, that at 24 hours their neurobehavioral test score was actually a
little lower than at birth. The conclusion was that the lower score in this
group may reflect the continued presence of fentanyl in the neonate.
"Fentanyl administration was associated with lower neurobehavioral test
scores at 24 hours of life." They remind everyone though that, "Despite our
findings, we do not believe that the differences in the NACS indicate
neurobehavioral depression with fentanyl that is of clinical concern." I
guess I view this a little differently! The inability of a newborn to latch
and feed at breast is a significant deviation from normal and should not be
dismissed as not of importance!
8. denial is everything! Maternal/child health care is one of the only areas
in the health service industry who practices in direct contradiction to its
own research. When ever many of these epidural researchers find that there is
some drawback or side effect to the medication is it deemed as not
significant, of no clinical importance, etc. Then instead of looking at ways
of reducing the need for this expensive procedure, they work harder at coming
up with different drug cocktails and continue to deny that epidurals have
side effects that are worth bothering with
All of these drugs get to the baby. It is not known which babies will have
problems and which ones will not. However, a blanket denial that there are no
problems cannot be documented in the literature.

When the anesthesiologist says there are no effects on breastfeeding ask him
for HIS references to document such a statement. I think we need to always
ask the other person for their references too!