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Epidurals and Newborn Feeding  


The effect of epidural anesthesia on breasfeeding is highly controversial. For years, La Leche League leaders, lactation consultants and educators reported that mothers had epidurals have problems suckling at the breast. These difficulties include inability to find the nipple, inability to self-latch and inability to suck properly. Difficulties in suckling occur because "caine" anesthetics enter the mother's circulation and cross the placenta. The newborn's liver is too immature to break down the medication, so the effects linger. A thorough review (Walker, M. Do labor medications affect breastfeeding? Journal of Human Lactation, 1997, Vol 13, No2, Pgs 131-7) of the effect of epidurals and narcotics on subsequent breastfeeding found that epidural drugs are present in the laboring mother's bloodstream, cross the placenta to the fetus and affect the baby's later behavior, often causing difficulty with latching on and "inefficient" sucking. These 'sleepy' babies may need more time to 'acquire efficient breastfeeding skills.


At the 1999 International La Leche League Conference, Jan Riordan, RN, MSN, EdD, IBCLC, and La Leche League Leader noted that babies seem to be having more trouble with early suckling, latching on to the breast, disorganized suckling, and sleepiness in the first days of life. Riordan's presentation looked at several studies showing the effects of medicated births on mother and baby. The effects included a drop in some mothers' blood pressure, head or backaches after delivery, prolonged second stage of labor, increased rate of cesareans births, more instrument-assisted deliveries, and more common fetal distress. Mothers also develop fevers after birth that may be mistaken for infection and lead to separation of mother and baby. Most of the research didn't study problems with breastfeeding associated with epidurals, so Riordan developed a study to focus on epidural anesthesia 's effect on the baby's suckling and the duration of breastfeeding. She explained the methodology of her study and its results. It clearly showed that medication during birth did negatively affect babies' suckling during the first 12 hours, and that combining medications increased the effect. Demerol was especially harmful to the baby's suckling ability. The duration of breastfeeding was not shown to be affected.

According to Suzanne Arms, "an astounding 96% of all women who get a fever in labor have had an epidural. A tragic 86% of newborns who are put on full-spectrum antibiotics, and have full septic workups while in the ICU have been born to mothers who had epidurals in labor. "Nurses and breastfeeding consultants have observed that babies born following epidurals often seem to be numb around the mouth. This may be the reason why so many babies have difficulty getting breastfeeding started. The domino effect of this one intervention is broad, yet the full information about its adverse effects is seldom given to parents."

However, this information IS available to expectant women in The Thinking Woman's Guide to a Better Birth. Author Henci Goer found that "researchers compared newborn behavioral abilities at 12 hours and 3 days of age in women receiving Demerol and women having no drugs in labor. Demerol clearly adversely affected newborn behavioral competency. A study companing fentanyl to Demerol found they had similar neurobehavioral effects on the newborn. In another study, researchers observed 72 newborns left on their mothers' abdomen at birth. Of the newborns whose mothers had no narcotic (pethidine), 72% spontaneously crawled up on their mother's trunk, latched on, and suckled correctly versus 20% of the newborns whose mothers had had pethidine during labor."

Information from Sarah Buckley, MD of Brisbane, Australia: excerpts from her paper on Epidurals and Newborns

Although the drugs used in epidurals are injected around the spinal cord, substantial amounts enter the mother's blood stream, and pass through the placenta into the baby's circulation. Most of the side effects of epidurals are due to these "systemic", or whole-body effects.

There is a noticeable lack of research and information about the effects of epidurals on babies.(24) Drugs used in epidurals can reach levels at least as high as those in the mother(25), and because of the baby's immature liver, these drugs take a long time- sometimes days- to be cleared from the baby's body.(26) Although findings are not consistent, possible problems, such as rapid breathing in the first few hours(27) and vulnerability to low blood sugar(28) suggest that these drugs have measurable effects on the newborn baby.

As well as these effects, babies can suffer from the interventions associated with epidural use; for example babies born by caesarean section have a higher risk of breathing difficulties.(29) When monitoring of the heart rate by CTG is difficult, babies may have a small electrode screwed into their scalp, which may not only be unpleasant, but occasionally can lead to infection.

There are also suggestions that babies born after epidurals may have difficulties with breastfeeding(30,31) which may be a drug effect, or may relate to more subtle changes. Studies suggest that epidurals interfere with the release of oxytocin(32) which, as well as causing the let-down effect in breastfeeding, encourages bonding between a mother and her young(33).

Epidural research, much of it conducted by the anaesthetists who administer epidurals, has unfortunately focussed more on the pro's and con's of different drug combinations than on possible serious side-effects(34). There have been, for example, no rigorous studies showing whether epidurals affect the successful establishment of breastfeeding(35).

Several studies have found subtle but definite changes in the behaviour of newborn babies after epidural(36,37,38) with one study showing that behavioural abnormalities persisted for at least six weeks(39). Other studies have shown that, after an epidural, mothers spent less time with their newborn babies(40), and described their babies at one month as more difficult to care for.(41)

While an epidural is certainly the most effective form of pain relief available, it is worth considering that ultimate satisfaction with the experience of giving birth may not be related to lack of pain. In fact, a UK survey which asked about satisfaction a year after the birth found that despite having the lowest self-rating for pain in labour (29 points out of 100), women who had given birth with an epidural were the most likely to be dissatisfied with their experience a year later.(42)

Some of this dissatisfaction was linked to long labours and forceps births, both of which may be a consequence of having an epidural. Women who had no pain relief reported the most pain (70 points out of 100) but had high rates of satisfaction.

Pain in childbirth is real, but epidural pain relief may not be the best solution. Talk about other options with your care-givers and friends. With good support, and the use of movement, breathing and sound, most women can give themselves, and their babies, the gift of a birth without drugs.

Buckley's References:

24) Howell CJ, Chalmers I. A review of prospectively controlled comparisons of epidural with non-epidural forms of pain relief during labour. Int J Obstet Anaesth 1992;1:93-110

25) Fernando R, Bonello E et al. Placental and maternal plasma concentrations of fentanyl and bupivicaine after ambulatory combined spinal epidural (CSE) analgesia during labour. Int J Obstet Anaesth 1995;4:178-179

26) Caldwell J, Wakile LA, Notarianni LJ et al. Maternal and neonatal disposition of pethidine in child birth- a study using quantitative gas chromatography-mass spectrometry. Lif Sci 1978;22:589-96

27) Bratteby LE, Andersson L, Swanstrom S. Effect of obstetrical regional analgesia on the change in respiratory frequency in the newborn. Br J Anaesth 1979; 51:41S-45S

28) Swanstrom S, Bratteby LE. Metabolic effects of obstetric regional analgesia and of asphyxia in the newborn infant during the first two hours after birth I. Arterial blood glucose concentrations. Acta Paediatr Scand 1981; 70:791-800

29) Enkin M, Keirse M, Renfrew M, Neilson J. A Guide to Effective Care in Pregnancy and Childbirth. P 287 Oxford University Press 1995

30) Smith A. Pilot study investigating the effect of pethidine epidurals on breastfeeding. Breastfeeding Review, Nursing Mothers Association of Australia. V5 no1 May 1997.

31) Walker M. Do labor medications affect breastfeeding? J Human Lactation 1997;13(2) 131-137

32) Goodfellow CF, Hull MGR, Swaab DF et al. Oxytocin deficiency at delivery with epidural analgesia. Br J Obstet Gynaecol 1983; 90:214-219

33) Insel TR, Shapiro LE. Oxytocin receptors and maternal behavior. In Oxytocin in Maternal Sexual and Social Behaviors. Annals of the New York Academy of Sciences, 1992 Vol 652. Ed CA Pedersen, JD Caldwell, GF Jirikowski and TR Insel pp 122-141 New York, New York Academy of Science

34) Howell CJ, Chalmers I A review of prospectively controlled comparisons of epidural with non-epidural forms of pain relief during labour. Int J Obstet Anaesth 1992 1: 93-110

35) See 31

36) Scanlon JW, Brown WU, Weiss JB Alper MD. Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology, 1974; 40: 121-128

37) Morikawa S, Ishikawa I, Kamatsuki H, et al. Neurobehavior and mental development of newborn infants delivered under epidural analgesia with bupivicaine. Nippon Sanka 1990; 42: 1495-1502

38) Lester BM, Heidelise A, Brazelton TB. Regional obstetric anesthesia and newborn behavior: a synthesis toward synergistic effects.Child Dev 1982; 53;687-692

39) Rosenblatt DB, Belsey EM, Lieberman BA et al. The influence of maternal analgesia on neonatal behaviour II epidural bupivicaine. Br J Obstet Gynecol 1981 24;649-670

40) Seposki C, Lester B, Ostenheimer GW, Brazelton, TB. The effects of maternal epidural anesthesia on neonatal behavior during the first month. Dev Med Child Neurol 1992:34;1072-1080

41) Murray AD, Dolby RM, Nation RL, Thomas DB.Effects of epidural anesthesia on newborns and their mothers. Child Dev 1981; 82:71-82

42) Morgan BM, Bulpitt CJ, Clifton P, Lewis PJ. Analgesia and satisfaction in childbirth (the Queen Charlotte's 1000 mother survey) Lancet 1982; 2 (Oct 9) 808-810

 

Additional References:

Ransjo-Arvidson A et al. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth 28(1):5-12.

The Nursing Mother's Companion by Kathleen Huggins RN, MS.

Obstetric Myths Versus Research Realities: A Guide to Medical Literature by Henci Goer.

The Thinking Woman's Guide to a Better Birth by Henci Goer.

The Ultimate Breastfeeding Book of Answers : The Most Comprehensive Problem-Solution Guide to Breastfeeding from the Foremost Expert in North America
by Jack Newman, Teresa Pitman

The Womanly Art of Breastfeeding by Gwen Gotsch, Judy Torgus

The Breastfeeding Book: Everything You Need to Know About Nursing Your Child from Birth Through Weaning by Martha Sears R.N., William Sears M.D.




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