The discussion regarding the observation of the relationship between Stadol
and poor breastfeeding behavior is a real one. Marie has identified yet again
what researchers reported on in 1994. In a study by Crowell, Hill, and
Humenick: Relationship between obstetric analgesia and time of effective
breastfeeding. J Nurse Midwifery 1994; 39:150-155, the authors looked at 48
healthy full term babies relative to the use of and timing of administration
of both Stadol and Nubain. They also looked at the timing of the first
breastfeeding following delivery.

They found that mother who initiated breastfeeding within an hour of birth
and had analgesia less than an hour prior to delivery had babies who took a
mean time of 6.4 hours to establish effective breastfeeding. The worse case
scenario was mothers who initiated breastfeeding greater than one hour after
delivery and had analgesia administered for longer than one hour prior to
birth. These babies took a mean time of 62.5 hours to establish effective
breastfeeding. Within the entire group of infants, female infants took a mean
time to effective breastfeeding of 28 hours and males took 56 hours. They
identified a subgroup of primiparous mothers of boys as having the most
difficulty after receiving labor medication.

We know that the longer a mother has any of the labor medications the more
the baby receives and sequesters into various body compartments. It can take
many days for a baby to detoxify and excrete these drugs which may account
for the slow start to breastfeeding and the sudden "learning" days after the
mother has been discharged.

Mothers who receive labor medications should be highly encouraged to remain
with their babies, skin to skin to take advantage of their baby's subtle
feeding cues. All labor medications, including epidural analgesia and
epidural anesthesia reach the fetus. Bupivacaine is measurable in the fetus
within 10 minutes of administration.

I submitted a paper to the Journal of Human Lactation entitled, "Do Labor
Medications Affect Breastfeeding?" It was accepted for publication and will
hopefully be out next March.