Getting an epidural may hinder breastfeeding

[Crunchymom]

Getting an epidural may hinder breastfeeding
http://www.msnbc.msn.com/id/16227311/

NEW YORK - Some women who get epidural anesthesia during childbirth may have difficulty with breastfeeding in the short- and long-term, a new study suggests.

Specifically, researchers found, women who received an epidural with the narcotic fentanyl seemed to have more problems with breastfeeding than women who went without an epidural.

They reported more difficulty with breastfeeding in the first week of their babies’ lives, and they were twice as likely to have given up breastfeeding by the time the baby was 6 months old.

Though it’s not clear that the epidurals were the reason, there is evidence from other research that fentanyl can hinder infants’ ability to suckle, Dr. Siranda Torvaldsen, the study’s lead author, told Reuters Health.

There’s no evidence, however, that other drugs used in epidurals interfere with breastfeeding, according to Torvaldsen, a researcher at the University of Sydney in Australia.

Moreover, the findings, which are published in the International Breastfeeding Journal, do not mean women should feel guilty about wanting an epidural.

“I think the most important message for pregnant women is to get good advice and help with breastfeeding,� Torvaldsen said. Lactation consultants, she noted, can help women learn how to best support breastfeeding and overcome any difficulties they may encounter.

“For many women, the benefits of epidural analgesia will outweigh the risks and it is important that women feel supported whatever decision they make,� Torvaldsen said.

Of the 1,260 women in the current study, one-third had an epidural during labor. All of the epidurals included fentanyl and an anesthetic called bupivacaine.

Overall, the study found, women who received an epidural were more likely than other mothers to be partially, rather than exclusively, breastfeeding in the week after the birth.

They were also twice as likely to report breastfeeding difficulties in the first week and to give up breastfeeding before the baby was 6 months old.

In general, experts recommend that babies be fed only breast milk for the first 6 months, and then continue breastfeeding after solid foods are introduced, for at least the first year of life.

Although it’s not certain that epidural drugs directly cause problems with breastfeeding, Torvaldsen said it’s important that women be aware of the possibility, so they can make “informed decisions� about analgesia, and seek advice on successful breastfeeding if they need it.

[MarisaSF]

I'm sorry that I had to laugh. I had every drug under the sun, it seemed. Just another case where my kid didn't get the memo. :P

[FiveLittleDucks]

My 5 kiddos didn't get the memo either, I guess. Especially my currently-nursing 17 mo.

[o_mom]

Well, I'm glad your kid was fine, but that doesn't change the fact that it can have an effect. There is nothing in this study that says it is an absolute that you will have problems BF if you have an epidural, just more likely. I had BF problems with both kids, but DS1 was much, much worse compared to DS2. I don't think it was a coincidence that with DS1 I was drugged up to the point of not being able to even move and that the epidural was topped off 3-4 times.

[pb&j]

My kid didn't get the memo either.

Association is one thing, causation is quite another. Epidurals may be associated with BF difficulties for any of a number of reasons. For instance, moms who choose to have medicated births may also be less likely to have planned to BF exclusively. It hasn't been shown here that having an epidural causes BFing problems.


-Ry,
mom to Max the one year old
and my girl in heaven

http://www.windsorpeak.com/dc/user_files/37124.gif

[KrisM]

I agree. Most people will say epidurals are great and they work fine. Well, they don't always work like they're supposed to and there are studies that show that. Do you then laugh at those people who tell you they didn't work for them?

I had an epidural for DS, had it topped off for the c-section and could move my legs. I then got a spinal. I felt the c-section cutting. Go ahead and laugh, since it probably worked well for you.

With DD, the epidural worked as it was supposed to.

[bunnisa]

I thought the epidural - weak suck connection was already known? I remember talking about it back in Bradley class 4 yrs ago.

...blessed wife and mama to two!

"And children are always a good thing, devoutly to be wished for and fiercely to be fought for."
-Justin Torres

[rlu]

I think this article is best used to promote the idea of getting help if BF is not going well. DS did not nurse well at first (is that due to the epidural or the fact neither of us had any idea what in the world we were doing?) and I had several different nurses helping me while in the hospital and my mom and MIL helping me at home. By the end of the first week DS was a champion nurser and nursed until 30 months.

[cstack]

Kris, I'm sorry you had a rough time. That sounds like a really horrible experience and I'm sorry you had to go through it. For me, the c-section was bad enough with only feeling the tugs, I can't even imagine feeling them cut.

At the risk os speaking for another person, though, I don't think they were "laughing" because it worked for them. I think it was the inside joke of "kid not getting the memo" that made them laugh. I don't think it was intended to offend anyone and I'm certain they didn't intend to laugh at what must have been a very unpleasant experience.

[o_mom]

Yes, this is just another piece of data. Here is a link to a review article published in the same journal issue that discusses all the research on the subject, including many well designed studies:

http://www.internationalbreastfeedingjournal.com/content/1/1/25

[goodnightmoon]

I agree. I'm another mom that was able to breastfed for over a year and I got an epidural (two in fact after the first came out).

Laura
DD Feb 2005

[octmom]

Add me to the list. I had an epidural and a C/S with DS. He latched on in the recovery room and nursed until he was 21.5 months and I was pregnant with DD. I had a spinal and a C/S with DD and she is still nursing at almost 11 months. My goal is a year, but we'll continue beyond that if it is still working for us.

Jerilyn
DS, 10/03
DD, 3/06

[Jo..]

I didn't get an epidural; and we've had nothing BUT trouble with breastfeeding. My stinkin' kid read the memo backwards. :D

[Moneypenny]

Interesting. Like a PP, I have to wonder if there were other factors at play here. I don't think my epidural had any negative impact on my nursing relationship (we're still nursing at almost 2.5 years), but then I had a DD who knew how to nurse from the get-go, a very supportive husband, and two on-call LCs at the hospital I delivered at (okay, that sentence should end "at the hospital at which I delivered" but that's a little cumbersome, no?).

Susan
mama to my cutie pie, Avery
http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif[/img][/url]

[Globetrotter]

It's the same thing with c-sections. Moms who get c/s are less likely to nurse, for various reasons: the trauma and pain of recovering from surgery, mom and baby being sleepy and drugged out, policies that separate mom and baby during the critical first few hours and days, milk coming in late, more chance of supplementing, and so on. Having gone through two c/s and working like a dog to establish nursing, I can vouch for that. Most people in my situation would have given up, and I can't say I would blame them! Of course there will be exceptions, but it doesn't take away from these facts.

I do wonder, though, if moms who take epidurals are also less likely to nurse?

Kris

[Globetrotter]

Oh, wow, I can't imagine that. It was bad enough afterwards, even with painkillers. HUGS.

Kris

[kijip]

>I do wonder, though, if moms who take epidurals are also less
>likely to nurse?

I see it as the reverse- those that avoid the epidural are perhaps also perhaps more likely to be intent on breastfeeding. Not that moms open to an epidural are uninterested in breastfeeding but if you are committed to no meds, you are usually also committed to breastfeeding. I have met lots of moms that are interested in breastfeeding and ok with an epidural but not any moms that are interested in natural childbirth but not also interested in breastfeeding.

[o_mom]

There are not a bunch of randomized trials, for obvious reasons. No IRB is going to approve a study which would deny women pain relief. However there are a few randomized trials out there.

The review article I posted in a response above had an interesting study that they cited. Women were randomized to either a midwife w/ natural birth intentions or an epidural group. They point out that people who felt strongly either way - either for natural birth or epidural - would be unlikely to even enter the study, so it can be assumed that the two groups were pretty much the same going in. They showed a similar effect on breastfeeding.

Also, there was a study were groups were randomized to three dose levels of narcotics in the epidural and the highest dose was correlated with trouble breastfeeding. So even among patients who choose epidural, the dose can affect breastfeeding.

[Octobermommy]

I had an epidural with my daughter and had problems with her latching on after her birth. My darn nipples were so flat, which according to the nurse she sees a lot of in women that had epidurals. But we got over that and nursed 15 months. I did not have the fentanyl though.

[cdlamis]

>I see it as the reverse- those that avoid the epidural are
>perhaps also perhaps more likely to be intent on
>breastfeeding. Not that moms open to an epidural are
>uninterested in breastfeeding but if you are committed to no
>meds, you are usually also committed to breastfeeding. I have
>met lots of moms that are interested in breastfeeding and ok
>with an epidural but not any moms that are interested in
>natural childbirth but not also interested in breastfeeding.

You said it perfectly. I was trying to figure out how to word my thoughts and you just did! :)

Daniella
Mom to Julia 6/02
and Bella 12/04
"http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif"

[SnuggleBuggles]

I would add mom having too many fluids (fluid overload) either with a vaginal birth and epidural or c-section. I can't remember why it can impact bf'ing. I just know I have read about it somewhere. :)

Beth

[MarisaSF]

>There is nothing in this
>study that says it is an absolute that you will have problems
>BF if you have an epidural, just more likely.

Oh really? Is that how scientific studies work? Thanks for filling me in!

ETA: I was making a JOKE about how hard it was to wean my daughter, which my friends here know very well (thank you, Ry). There are other reasons why I don't want an epidural with my next birthing.

[hez]

Payton followed your DS. He had no trouble sucking (little eel). His (our) trouble was latch position, which we figured out in the end, obviously.

Edited because my original post was a knee-jerk reaction.

I do like this part of the article for its positive message:

"“I think the most important message for pregnant women is to get good advice and help with breastfeeding,� Torvaldsen said. Lactation consultants, she noted, can help women learn how to best support breastfeeding and overcome any difficulties they may encounter.

“For many women, the benefits of epidural analgesia will outweigh the risks and it is important that women feel supported whatever decision they make,� Torvaldsen said."

I do have many IRL friends who successfully breastfed after having had epidurals. My personal experience is positive on that front.

[Marisa6826]

I'm not quite sure how an epidural can have an effect on a physiological structure like nipples. Either you have flat ones, or you don't. An epidural isn't going to change that.

Isn't it kind of like saying that an epidural will change your belly button from an innie to an outie? ;)

FTR, I've always had flat nipples. Sophie was never able to latch. Mia latched after some struggles, but never had a problem. MY problem was low production.

-m

[katiesmommy]

Yeah, well, I think weak sucking was a small price to pay for my life. I am 98% sure that if I hadn't had an epidural I would not have made it through DD's birth and would have died of exhaustion. Yes, my labor was that bad and that long.

[cstack]

> (okay, that
>sentence should end "at the hospital at which I delivered" but
>that's a little cumbersome, no?).


LOL, Susan, don't worry, I'm a teacher and I dangle my participles, too. Hmmm, now that just sounds *wrong*.

[jamsmu]

Chiming in. My epi had to be applied twice with DS1 and I bfed him for 13 months. Also had pitossin and staidol.

For DS2, epidural and immediate latch and suck. I hardly had a chance to see his blue eyes before he was eatting. 13 months later, he was still going full speed ahead, until I decided to wean him.

In my opinion (writing the words, so everyone knows this is JUST MY OPINION), this study **may** be trying to convince moms not to use epidural. You know what? Do what you feel comfortable with. Mommies and babies have an amazing ability to figure out what's best for them.

[o_mom]

If you post an inside joke that only your "friends" here know the background to, perhaps you should expect that not everyone will get it.

[o_mom]

The extra fluids required in an epidural can mean the breast tissue is more swollen. Combine that with a weak suck from the drugs and they are hard to latch onto and not drawn out well by the baby.

[psophia17]

I fail to see how Marisa's OP was an inside joke - her kid didn't get the memo, ha ha.

[psophia17]

...or upside down ;)

[KrisM]

I didn't realize it was a joke either. It reads really mean though. It sounds like you're making fun of anyone who might have had a problem breastfeeding after an epidural.

Maybe if you're talking about an inside joke, you can just e-mail the person/people directly, or add that to the post so the rest of us know that, too.

[KrisM]

It was an inside joke about her weaning. It reads as if her kid didn't get the memo to have a hard time initiating BFing because of the epidural.

[KrisM]

Well, afterwards was fine. The pain was there and then gone and nothing was lasting. But, boy was my c-section part of my birthplan long with DD! And when I ended up with one, the anesthesiologist and I had quite the chat! Fortunately, all was fine.

[KrisM]

Yeah, don't do it my way :). While it was bad, it was only a few minutes. I don't think I felt the full amount of cutting, but definitely had very sharp pains that hurt quite a bit. The beginning and end of the procedure was the tugging, as expected. So, I think the spinal was half there or so and helped, but didn't competely do it.

[o_mom]

It was an inside joke because you apparently had to know the details of her nursing and weaning relationship to get it.

I just felt that her OP, however much it was meant as a joke, was very dismissive of the many women who have had BF difficulties that may or may not have been contributed to by an epidural.

[goodnightmoon]

Wow, I totally read it differently and I'm far from one of the "cool" kids. If anything, I read it like she was playfully making fun of her own child, not of anyone else.

I don't know her history at all, and I think I read it like she meant it. I'm sure no offense was intended. It certainly can be a difficult and sad topic for many moms.

Laura
DD Feb 2005

[snowflake20]

This still isn't going to stop me from getting an epi with my next baby. I had a wonderful experience with it (except for the needle in my spine part..yuck!), 20 minutes of pushing and out the baby went. I had no problems Bfing, except soreness.

[KrisM]

That's good. I hope most read it that way instead.

[fortato]

Maybe he needed it translated.

[Bethann31]

My 4 either. Thank goodness.


Beth
mom to:

Josh 3/90
Mollie 4/92
Jeffrey 12/94
Katherine 6/03

[Bethann31]

I can't even imagine. How awful.


Beth
mom to:

Josh 3/90
Mollie 4/92
Jeffrey 12/94
Katherine 6/03

[squimp]

I hope they controlled for that! Seems like a serious confounding factor. One reason I do not envy social scientists.

[spanannie]

Nursed DS 19 mos, Nursed DD 28 mos....Had epidurals both times.

[Cristiana]

Just wanted to commiserate with you. I also felt cutting, and the anethesiologist didn't believe me. I kept insisting, and finally he put me completely under. He told me right before he did it that it was because I was too "excited". Wouldn't anybody be upset when they could feel the cutting? Sheesh...

Anyway, when I woke up, DD was already out of the room and I had to go to recovery and be monitored. I didn't see her for 3 hours. :( We did have some problems bfing at first and would have given up in the first week had it not been for my DH's support. DD was finally weaned at 18 months!

[shilo]

wow, i'd looovvveee to know more about that! fluid overload didn't begin to describe me. i left the hospital weighing more than when i entered it and had more edema in my feet and ankles in my first week PP than at the worst they ever were while preggo after long day's on my feet. i didn't read about the pitocin/pp edema correlation until after i delivered (here i think) and i'd definitely like to know more about that and the fluid overload/BF connection before i deliver next time. i'd love it if anyone has time to post anything on these topics!

also, thanks for the study with the correlates to dosages of epidurals with BF stats. i'm thinking my epidural had little to do with our troubles in the first few weeks, since i had a walking epidural, but you never know. my kiddo appears to have gotten the part of the memo about difficulty in the first week or two, but ignored the rest b/c he BF exclusively untill 6mos and then didn't wean until 14.5 :). and i totally agree with katie's point about women who are pro-natural childbirth also being likely to be committed to BF - exactly what i was thinking as i read the OP.

thanks, lori
Sam 5/19/05 How lucky I am that you chose me.

[niccig]

I would like to know what the access to help was, because I think professional help from a LC and supportive family have far more weight in keeping mother and child BF.

I'm Australian, a friend there had her DD 6 weeks before DS. She was having a very difficult time BF, I talked about LCs and the people I had at the hospital, the LC who works at our ped's office, and she said the nurses were of no help. She lives in one of the main cities - I don't know if she sought out help or not, or if the help just wasn't available. At 2 months she had cracked/bleeding nipples. I was seeing my LC to pick up more supplies and I mentioned this friend and she sold me the sticky pads that soothe your nipples. I sent her a pack and she said it worked wonders, helped her to heal and a friend with an older child gave her lots of help - they did keep BF. When her sister had the same problem 1 year later, they couldn't find the pads there and asked me to send a pack.

This is just my personal experience, but compared to friends living there, I had much more access to help. But maybe that's because I sought it out. I am a BBBer after all.

[Globetrotter]

"I see it as the reverse- those that avoid the epidural are perhaps also perhaps more likely to be intent on breastfeeding. "


Yes, exactly.

Kris

[C99]

As the OP posted it, it actually just says that there *may* be a correlation. Is that new information - I thought it had previously been documented that having an epidural may cause Bfing problems. So can having inverted nipples.

[Crunchymom]

I didn't read any of the responses yet, but don't forget that the research only pertained to epidurals that had fentanyl added to them. Epidurals without fentanyl didn't have any effect on breastfeeding. This makes sense since fentanyl is a NARCOTIC and it's widely known that narcotics can affect babies sucking, breathing, etc. So unless you know exactly what was in YOUR epidural it's hard to say what effect it had on your breastfeeding experience. Maybe everyone on here who said their epidural didn't effect their breastfeeding was because they DIDN'T have fentanyl in it, while maybe those who said it did have an effect had epidurals WITH fentanyl. You wouldn't know what kind of epidural you had unless you checked your medical records most likely.

[o_mom]

Actually, in the study and the associated review article which I posted later in the thread, they say that the benefits of epidurals will outweigh these risks for many women. They do say, however, that the medical professionals should be aware of this and provide extra support to mothers who have had epidurals, and especially to those who have had high doses in their epidurals.

[newnana]

Oh me too!!! My feet looked like footballs after coming home. Pregnancy swelling had nothing on that. Ouch!! That's definitely something I need to read more on.

Thankfully my DD didn't get the memo either and nursed like a champ even w/o DH being as supportive as I needed.

Michelle

[pb&j]

Actually, my anesthesiologist was very helpful, and DID explain to me exactly what medications were going into my epidural catheter, and yes, I had fentanyl. Yes, it's a narcotic, but it is not administered into the bloodstream, so usually has a very minimal effect systemically. It's not like it's a secret, he willingly volunteered the information as part of his SOP. Docctors aren't all evil scientists, hellbent on drugging women and destroying their BFing relationship with their newborns.

I'm not ignorant or uniformed, I just made different choices than you!

-Ry,
mom to Max the one year old
and my girl in heaven

http://www.windsorpeak.com/dc/user_files/37124.gif

[o_mom]

I don't think anyone is implying that it is a secret, just that when most women are getting an epidural, they aren't usually asking what is in it. Even if it is mentioned in passing, it is probably the last thing on their mind and not something that most people remember without going back and looking.

[octmom]

I had fentanyl with DS too, and as I posted above, DS latched on in the recovery room following my (gasp!) C-section. He kept latching on for another 21.5 months. Perhaps if my nipples had "gotten the memo" (to borrow a phrase) about being flat from getting an epidural (??) and having IV fluids, I wouldn't have had to wear nursing pads well after I stopped leaking just so that I wouldn't poke someone in the eye.

ETA: I know that I had fentanyl because I discussed it with my caregivers before it was administered.

Jerilyn
DS, 10/03
DD, 3/06

[pb&j]

In my case, it wasn't just mentioned in passing. It was discussed beforehand, long before I was in active labor. I can't be sure of the PP's intent, but to me, the implication was there that women choosing to have epidurals administered are somehow less involved in their care and not adequately informed about it. I'm not a representative sample, but that certainly wasn't the case for me. So I respectfully disagree with "Crunchymom"'s statement that I would need to check my medical record to know what was in my epidural.

-Ry,
mom to Max the one year old
and my girl in heaven

http://www.windsorpeak.com/dc/user_files/37124.gif

[C99]

I think your case is a perfect example of what is wrong with this study. The study only says that there MAY be a correlation and you MAY have had problems. To me, this study's conclusions illustrate only that the researchers' hypothesis was not particularly clear. Obviously, all of the stories on this thread are anecdotal evidence that does or does not support the study's findings (which really aren't that new or revealing, IMO).

[Moneypenny]

>I can't be sure of the PP's intent, but to me, the implication
>was there that women choosing to have epidurals administered
>are somehow less involved in their care and not adequately
>informed about it.

You know, I'm reading it that way, too. I don't personally know any woman who isn't aware that medicated pain relief during labor could have some side effects for mom and/or baby, although I'm sure there are many out there. I would posit that those women are then also not aware of the amount of work that goes into making a successful breastfeeding relationship. I hope the implication here isn't that women shouldn't get medicated pain relief during labor, but rather should be well informed about all aspects of pregnancy, birth and nursing (should they wish to nurse).

ETA: relationship doesn't usually have an "m" in it

Susan
mama to my cutie pie, Avery
http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif[/img][/url]

[Fairy]

Dude. There are no cool kids here. Now, me and the other popular girls have to go back to our lockers and talk about what happened last week on the OC, so gotta bail.

[missym]

This is how I took it as well. I like the new addition to the board rules: "Assume good intentions."

Missy, mom to Gwen 03/03 and Rebecca 09/05

** Want to discuss issues with other Conservative parents? Join us at
http://groups.yahoo.com/group/BBBConservatives/join **

[Piglet]

I usually stay out of these discussions, but I had to chime in...

Women need HELP to have a successful BF relationship. It doesn't matter what their delivery was like or whether they had an epidural (with or without fenatyl). The issue here is that hospitals, LCs, doctors, nurses, friends, and online message boards need to be supportive of new moms and give them the help they need to overcome barriers to BFing. Whether the barrier is psychological, physical, whatever... the bottom line is we need to give help and be open to receiving help from those around us.

Imagine a woman that had the most natural of natural deliveries and was then denied help from her doctors, nurses, friends, etc. She would have no hope for success if she had a rocky start (or middle or end) to BFing. Imagine a woman that had every imaginable drug, a baby admitted to NICU (so no chance to latch immediately), etc. She received immediate and continuous help from LCs, doctors, nurses, friends, online message boards, etc. Which of these women would have a greater chance of success? My money is on the second one even though studies might prove otherwise. The problem with studies is that it is easier to track physical issues and not so easy to track psychological issues. For example, it is easier to see the affect of drinking 2 cups fo coffee a day on a baby that it is to track the affect of the mother's mood on the baby. How do you conduct a sceintific study on how much help a woman received post-partum?

Just my 2 cents :)

[brittone2]

ITA, and beautifully said.

I do think it is important that women receive truly informed consent before consenting to an epidural (or other medical procedure(s)). If having an epidural does affect BFing or might potentially do so, I think it is important that women be aware of that before consenting. I do see value in these studies, but obviously it is hard to tease out the confounding variables.

[Fairy]

Very well-said, Marina. I also want to add that in any study, it's important to understand the study itself. Who sponsored the study,where was it conducted, what was the sample size, etc. We are always very quick to react to study results before first knowing the facts of the study to begin with. Not judging this particular study at all, as I have set opinions on pain management, but just in general, wanted to mention this (because I'm actually one of those who can be quick to react and forget to ask questions later).

[SnuggleBuggles]

I also think it is important to factor in other interventions that can come with an epidural before making any grand conclusions. Like induction meds as most can contribute to higher rates of newborn jaundice, fluid overload, possibly not being allowed to eat/ drink in labor... The interventions could have more of an impact on bf'ing than simply whether mom had one or not.

Those things, to me, need to be addressed for a definitive study.

But, I appreciate that this study distinguishes btw meds in the epidural.

Beth

[table4three]

I agree. I ended up with a cs under general anesthesia and didn't even get to hold DS for 3 days, then he was tube fed for 2 weeks. So, yes, BF was initially a big challenge, but with the help of a LC, we got it down during the 3rd week and went strong for a year.

So,I agree - this article definatley should be used to promote seeking out help if BF isn't working out well initially.

[SnuggleBuggles]

INTRAVENOUS FLUIDS (IV) given to women in labor (such as glucose) can keep the glucose levels in mom's and baby's blood abnormally high. The body compensates by making extra insulin. Suddenly the baby is born, it's glucose supply is cut off, and it has all that extra insulin. This could lead to neonatal hypoglycemia, which may mean a trip to the Neonatal Intensive Care Unit (NICU), which means separation from mom. Dr. Righard's studies have shown that separation from mother after the birth can have almost as dramatic effect on the baby's ability to latch on as maternal medications. Some women on IVs experience fluid overload. Extra fluids in the woman's body means perhaps worse engorgement, which can affect a baby's ability to latch on properly. Engorgement can lead to the death of the cells responsible for secreting milk, thus having an impact upon the mother's milk supply.

http://pregnancy.about.com/cs/breastfeeding1/l/blbfchoice.htm

From the AAP (long abstract, click on link to read the whole thing- it is good if you can muddle through it!)
It is possible that administration of IV fluids during labor, which is more common in women given labor pain medications, increases the hydration status of the newborn and leads to greater weight loss subsequently. However, this would not explain why we saw the association between labor pain medications and excess weight loss only in multiparas. Previous studies have focused on the relationship between labor medications and infant suckling behavior or breastfeeding duration, not infant weight loss. Some have shown an association,3,23,24 whereas others have not.25,26 Our data suggest that the association may not be evident among primiparas (who are at higher risk for early lactation difficulties regardless of labor medications), but may be significant among multiparas. Conflicting results may also be attributable to the potential indirect effects of labor medications on breastfeeding via their influence on duration of labor and the mode of delivery, which would not be evident when controlling for the latter variables. In a recent systematic review of unintended effects of epidural medications during labor, Lieberman and O’Donoghue27 concluded that epidurals increase the duration of labor and reduce the likelihood of a spontaneous vaginal delivery, particularly in primiparas.

"Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss "
http://pediatrics.aappublications.org/cgi/content/full/112/3/607


Some hospitals require that a mother have some form of narcotic pain relief before the epidural is started which further complicates the picture. Anesthesiologists may require infusion of two or more liters of I.V. fluids before the epidural and use further I.V. fluids throughout the labor. This leads to generalized edema in both the mother and the infant. Lactation consultants report a type of maternal areolar edema peculiar to epidurals that makes latch-on difficult, if not impossible. In addition, the infant's birth weight may be "inflated." When diuresis begins in the baby, weight loss may be more than allowable amounts. Formula supplementation may be required based upon weight loss alone. Moreover, mothers complain that epidural pain relief is not complete, is patchy or fluctuates. Over 69% of women report back problems for more than a year after having an epidural (Klaus, Kennell and Klaus 49).
http://www.lactationconsultant.info/hospdoula.html


I may not be searching the right phrases but that is what I pulled up on a first pass.

Beth

[lisams]

Agree!!

[spu]

I had so much epidural meds with the twins that I swore it delayed my milk coming in. and after having a natural labor with the big guy, my milk came in sooo much quicker... it took a good 7 days with the twins, and with #3, only 1.5 days... but with the twins, I went on to nurse for 3 years! though I did have lots of great support, and was determined to figure out what I was going...

susan

http://www.gynosaur.com/assets/ribbons/ribbon_amethyst_36m.gif
nursed for 3 years!
http://sunger2.home.comcast.net/superpower.gif

charlotte + else
+ cashew!

http://bd.lilypie.com/u2jym5.png
http://b4.lilypie.com/Bmr5m5.png

[newnana]

Thanks for the info!
Michelle

[bethie_73]

But I had an Epi, and 2 doses of narcotics (over 3 hrs of pushing, DS was stuck, a vacuum was used etc) And not only did DS latch right on but his suck was so hard my milk came in within 24hrs.

That said, DS and I did have latch issues, and if it hadn't been for the LCs, I do not think we would still be BF at almost 1 year.

Although I think it is a valid study, I believe that there are many external factors that have an effect, and would probably play some type of role as well as the Epi.

[StantonHyde]

Let's just say that "informed consent" is often a misnomer. I didn't go to medical school,, I don't have 10 years of practice under my belt--so I don't know every single thing that could or could not go wrong. Studies can give ideas and sometimes best practice, but professional judgement is pretty amazing stuff. There is absolutely nothing wrong with getting pain relief or not getting pain relief--as long as baby and mom are healthy.

There are so many things that make Bfing tough for people. Personally, I would have done meth and cocaine if it meant no pain while pushing (joking!). I was very happy to have my epidural with both children. My milk was late both times but both my children latched like champs and both nursed to a year when we gradually weaned. After the first month, it was the easiest thing in the world.

So say I assume complete causality--I'll take pain relief over a few days of late milk any day. In the end, I was ok and my kids are fine.

[bubbaray]

I had an epi with DD#1, milk came in on day 3 PP and BFd her for a year. The only BFg issue I had with her was she refused bottles completely, so I had no choice but to BF.

Had a spinal with DD#2, milk came in on day 2 PP. My BFg issue so far is huge oversupply and engorgement.

My kids and my boobs didn't get the memo either.


Melissa

DD#1: 04/2004

DD#2: 01/2007

[DrSally]

That's interesting. I had such a long labor and literally pees over 100cc's after I gave birth. DS was alert and sucked well, but it did take a long time for my milk to come in, so we got off to a rocky start.

[MarisaSF]

Don't insult my intelligence and I won't tell you that it doesn't take much to get the "joke." There was no "inside" to it, as everyone else who responded to this thread clearly gets.

[MarisaSF]

Thank you, Laura. You're definitely a cool kid. :)

[KrisM]

Just wanted to say I am sorry that I didn't get the joke, when I guess everyone else did. I've been around here a fairly long time, but just don't remember all the details that everyone posts here. There are just too many members. I guess that's my bad and why I didn't get the joke. Anyway, sorry about that. I am glad you had no problems with breastfeeding or the epidural.

[MarisaSF]

No problem, Kris. FTR, I *hated* the epidural and aim not to go down that route again. I have an issue with the study though... and the source... and people who ass ume I don't know how to evaluate either one.

[o_mom]

I'm sorry if my post insulted you - I was not trying to say that you did not know how to evaluate a study, but that your post seemed to dismiss the results because it didn't happen to you. When I read your OP, it seemed that you were laughing at people who might think there was a connection, as though it was not true because you didn't have that experience. If you cannot see that your post could be read that way, then fine, we disagree. Obviously I was not the only one who read it this way, as at least one other member has said so publically.

ET: clarify

[Eloise36]

I had pitocin and an epidural for both deliveries. I nursed DS for 14 months, and am still nursing DD at 8 months. Both kids had no problem latching on after delivery. I guess they didn't get the memo either :)