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Subject:
From:
Alicia Dermer <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 3 Jul 1996 22:23:55 -0400
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Hi, everyone:  Just a couple of thoughts on the epidural issue.  I think
it's clear that there is no literature on the actual effects of epidurals
on breastfeeding behaviors, because that has just not been used as an
outcome so far.  I agree that we need good studies confirming the
anecdotal evidence.  As for the data we currently have, it seems that the
effects of labor medication are well documented.  However, the true
effect of epidurals may not be in the absorption of the medications and
their transfer to the baby, but  rather from the effects of epidurals
(especially when begun before true active labor is established) on the
subsequent course of labor.  Some examples are the need for intravenous
fluids to counteract the low blood pressure from the epidural; the
slowing of labor requiring pitocin augmentation, hence continuous
monitoring, often requiring the mother to continue her labor lying flat
on her back; interference with the urge to push, possibly leading to more
instrumented births with forceps or vacuum extractions, which in
themselves may affect the baby's ability or willingness to suck.  I'm not
sure of data regarding these possible mechanisms, but I did find two
interesting articles which point to documented effects of epidurals on
labor:  Morton SC, Williams MS, Keeler EB, et al.  Effect of epidural
analgesia for labor on the caesarean delivery rate.  Obstet Gynecol
1994;83:1045-52.  (we have all seen delays in establishment of
breastfeeding after caesarean births, so this increased rate due to
epidurals may be a factor in some breastfeeding outcomes, wouldn't you
think?); Newton ER, Schroeder BC, Knape KG and Bennett HBL.  Epidural
analgesia and uterine function.  Obstet Gynecol 1995;85:749-55.
It is now up to us to take these findings further and look for the
correlation with breastfeeding outcomes that so many of us have
observed.  Alicia.  [log in to unmask]

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