Epidural Babies Can't Get a Grip on What's "Breast" - Page 2

[Ammaarah]

I had an epidural as a last-ditch attempt at avoiding a c-section (it didn't help) and my daughter was OK with nursing right away. However, we had some pretty big breastfeeding issues in the following days and I'll never know if the epidural had anything to do with it. I won't get one again without trying everything under the sun first.

[~Mamaterra~]

All of those in the "had an epi and baby nursed with no problems" are fortunate but should not ignore what physiologically happens to the baby when an opiate or narcotic is passed into their blood stream.

As the epidural is given in the spinal column, the mother experiences localized effects from the narcotics. Unfortunately for the baby, these drugs pass through the placenta and are circulated causing a "systemic effect" meaning that it affects all of their systems. One notable side effect is depressed breathing in the baby, hence the rationalization Electronic Fetal Monitoring.

The babys' immature liver cannot metabolize these narcotics as readily as the mothers liver. As a result, these drugs take a long time- sometimes days-to be cleared from the baby's body.

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. 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

Again, anything that we ingest, inject, breathe or expose ourselves to as pregnant women, we pass on to our babies. Whether you think it has an effect or not, is irrelevant!!! You may not recognize the effect as you have nothing to compare how the child would have normally behaved without the narcotic in their system.

[skueppers]

Originally Posted by cdnmom

Whether you think it has an effect or not, is irrelevant!!! You may not recognize the effect as you have nothing to compare how the child would have normally behaved without the narcotic in their system.

I totally agree with you that anecdotal comments (such as my own) about successful nursing after epidural anesthesia are not scientifically valid -- and certainly don't indicate whether the anesthesia had some effect on the baby, merely that the effect was not sufficient to negatively impact breastfeeding. However, I do think it's relevant that many babies have no difficulty breastfeeding after the mother had epidural anesthesia.

I also think it's worth noting that the type of study referenced at the beginning of this thread cannot distinguish between breastfeeding outcomes that are the result of the epidural, and breastfeeding outcomes that are the result of the mother's attitude. According to the news stories, what this study shows is a correlation between epidural anesthesia and breastfeeding problems, which may or may not be a causal relationship.

Personally, epidural anesthesia was the only type of pharmaceutical pain relief I was willing to consider during labor -- my own research at the time indicated that of all the options, it was the least likely to have a negative effect on the baby. (Even though I thought it was the scariest for me!)

There are at least two studies I am aware of in which no effect on breastfeeding was noted after epidural anesthesia:

Chang & Heaman, "Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding." Journal of Human Lactation, August 2005, 21(3):305-14.

Radzyminski, "The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors." Journal of Obstetric, Gynecologic, and Neonatal Nursing, May-June 2003, 32(3):322-31.

There is also an interesting and seemingly well-designed study which did show a negative impact:

Baumgarder, Muehl, Fischer, and Pribbenow, "Effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally." Journal of the American Board of Family Practice, January-February 2003, 16(1):7-13.

http://www.jabfm.org/cgi/content/full/16/1/7

This study showed that 70% of babies born to mothers who had an epidural nursed successfully twice in the first 24 hours of life, compared with 81% when the mother had not received an epidural. Thus, it's not surprising that the majority of mothers who received an epidural would say that they didn't experience breastfeeding problems as a result.

[OnTheFence]

Originally Posted by ndunn

Just watch the doctumentary "Delivery Self Attachment" by Dr. Lennart Righard. Whether you believe the "research" or not, the evidence is right there on the screen.

Actually I have seen his video.

I think he wants us to see what he wants to portray. I am sure there is some merit to it, but I seriously have doubts when there are so many variables when it comes to whether a baby or mother have a successful nursing relationship.

[BugMacGee]

Couldn't what's seen in the video be considered "anecdotal"? Granted I haven't seen it so I'm probably just speaking from my rear.

[crazy_eights]

Originally Posted by BugMacGee

Couldn't what's seen in the video be considered "anecdotal"? Granted I haven't seen it so I'm probably just speaking from my rear.

Well, except that what's seen on the video is just illustrating what was observed as part of a study done in Sweden.

[mamaverdi]

Just because there is no affect on breastfeeding initially, doesn't mean there is no affect on the child. I think the biggest message of this study is the drugs get to and affect the baby.

[~Mamaterra~]

:

FINALLY, somebody who gets it!!!!

Argue back and forth all you want posting all of the ancedotal info and whathaveyou about this study and that...the point is that it gets passed onto your baby...PERIOD!!!

[mamabearing]

great point

Originally Posted by skueppers

According to news coverage mentioned in a separate thread:

http://www.mothering.com/discussions...d.php?t=574845

The researchers weren't sure whether the epidural affected the babies' ability to nurse, or whether mothers who opted not to have an epidural were more likely to be persistent about breastfeeding.

Too bad it's impossible to design a double-blind study on this subject!

I have never been sure how much credence to give this sort of research because you can't design a study ethically that would eliminate other variables. In my experience the moms who are most likely to really work to give birth without drugs are also the ones who are very commited to breastfeeding. Converesely, the moms who really would prefer not to breastfeed but feel social pressure to do so are pretty likely to be the ones who choose an epidural. I haven't seen any research that takes out the variables enough to convince me. I think I am convinced epidurals do slightly increase C/S and assisted delivery rates, longer second stage and all these things can make breastfeeding harder...C/S...or sore head on baby from vacuum or forceps or just bruising from prolonged labor. So I would buy that being a reason more than I would buy the very small amounts of Fentanyl or sensorcaine in the bloodstream ( the amount is so very small that I just have a hard time believing it...rings of what people WANT to believe...it must be bad because it is not natural...vs...what is ). But I am sure there is an association just not sure of causation.

[FreeThinkinMama]

The amount varies too though right? Some women have "walking epidurals" that are basically just a lower dose. Others get epidurals very early in labor so it stands to reason doesn't it that the longer the baby is exposed to the drugs, the more likely it would be to cause some problems? I noticed a lot of the people on the thread who said they had the epi's and their babies nursed just fine had it towards the end of their labors. I had my epi early on at 4cm, it was on for about 5 1/2 hours I guess and when I was 9cm they also upped the dose because it was wearing off. Like I said I'm not sure if that caused our breastfeeding problems or not. My dd could have been tongue tied, maybe the nurses gave her a bottle when she was out of my sight, I don't know. But it's possible the epi contributed. Even if it didn't there are plenty of other reasons to
try and avoid getting an epi.

[Smalls181]

I had my daughter through natural childbirth at a hospital birth center assisted by a midwife and a very sweet, knowledgable nurse. After dd was born she nursed like a champ and that sweet nurse mentioned that babies born w/out meds tended to nurse better. She hadnt done any scientific research, just years of observation.

[lifescholar]

My son was another baby who had no visible effects from the epidural. I got it about 5 hours before I gave birth (for exhaustion after 49 hours of labour and no sleep).

My son had to be seen by the NICU team right after birth, so it was probably about 5 minutes before I held him.

I started nursing him about 1/2 an hour after he was born, and he latched on perfectly the first time, and nursed for about 45 minutes.

He definitely was NOT sleepy....lol. I swear, it was like he NEVER slept, although looking back, he definitely did sleep, just not as much as other newborns I had seen....And he gained more than 4 pounds in his first month, so obviously nursing was not a problem! lol

I definitely am NOT in a hurry to have another epidural. While many of the risks are slim, it's not a risk that I take lightly!! I don't regret having an epidural at all, because it was the right thing to do in my situation, but I'm certainly not going to go in to my next birth and say "Oh, the epidural worked last time, I'll just get one of those, please!"

Oh, and my anesthesiologist went over ALL the risks, for both my baby and me, before giving me the epidural. Of course, I was in too much PAIN to really listen, which is exactly why I did all my research before hand!! I went into the hospital knowing that I was aiming for a natural birth, but also knowing EXACTLY what pain medications I was willing, and unwilling, to use. For me, nitrous oxide and an epidural were the ONLY options I was comfortable with, and an epidural was only SLIGHTLY ahead of having a c-section. IMO, any and all drugs should be avoided like the plague during a birth!

[wifeandmom]

Originally Posted by cdnmom

:

FINALLY, somebody who gets it!!!!

Argue back and forth all you want posting all of the ancedotal info and whathaveyou about this study and that...the point is that it gets passed onto your baby...PERIOD!!!

So be it, regardless of the effect on the baby's ability to nurse.

Cause, well, to be honest, having a c-section *without* the drugs simply wasn't on my agenda.

Really though, it amazes me that anyone would believe that NONE of the drugs pass to the fetus anyhow. I mean, really, even taking a Tylenol during pg means the fetus is exposed to some amount of medication. Why on earth would anyone truly believe that an epidural or spinal would be different?

FWIW, I *am* glad I had scheduled sections where the meds were given and babies were born within a matter of minutes compared to women who get an epidural HOURS prior to birth. Seems like whatever effect the meds happen to have would be lessened if said meds were administered a matter of minutes before birth vs. hours.

[WinterBaby]

Originally Posted by skueppers

According to the news stories, what this study shows is a correlation between epidural anesthesia and breastfeeding problems, which may or may not be a causal relationship.

Yes, that... I think the correlation is interesting, noteworthy, and worth talking about, studying further, but it certainly doesn't prove a cause and effect even if seems like a logical conclusion. FWIW, ancedotally, I had a 33 hour labor (at home,) and if hospitalized, would certainly have had an epidural. My daughter was born alert and healthy, but failed to latch on the first 3 days. She never really latched til my milk came in, but I didn't sweat it, and from that point on we had a fine, straightforward nursing relationship. If I had been in that hospital with the epidural, I'm sure we'd have experienced that same thing, and I'd have likely blamed the epidural. Further, I'd have found myself under a great deal of pressure from her failure to latch, and perhaps had our entire breastfeeding effort undermined and derailed. Then I'd have found myself in the bad end of these bfing/epidural numbers. So it would have correlated, and I'd have thought it the obvious conclusion, but really not cause and effect at all. So I guess my point is, anecdotally illustrated, that we can't read more into numbers like these than they actually say, even if it seems to make the most sense. But it sure is thought provoking to speculate

[mamaverdi]

Originally Posted by wifeandmom

Really though, it amazes me that anyone would believe that NONE of the drugs pass to the fetus anyhow. I mean, really, even taking a Tylenol during pg means the fetus is exposed to some amount of medication. Why on earth would anyone truly believe that an epidural or spinal would be different?

I think you're married to an anesthesiologist, and he sounds like an ethical guy. But I cannot count the number of times I have heard that THIS drug won't affect the baby. No really. All the claims are for a different drug.

Like the time I heard someone say she would never get nubain because that went to the baby, but an epidural didn't. This was a well-read-on-birth woman.... It. is. odd.

Originally Posted by wifeandmom

Seems like whatever effect the meds happen to have would be lessened if said meds were administered a matter of minutes before birth vs. hours.

I agree with this. The less exposure the better.

(OT, but for my babies though each with an undetected metabolic disorder that causes them not to be able to process many different kinds of pharmaceuticals, they would have been in deep crisis immediately.)

[crazy_eights]

L&D nurse chiming in to say that I can't even count the number of times I have heard OB's AND anesthesia staff say OUTRIGHT that the beauty of an epidural is that the meds don't get to the baby. They write off any heart rate changes seen minutes after the epidural (NOT a drop in HR, but the loss of variability/reactivity) as BP related. Uh-huh.