Saturday, December 16, 2006

Epidurals and breastfeeding

There is more and more evidence that breastfeeding is affected by birth practices, particularly the epidurals mothers receive during labor.

Epidural use is not all that common in Japanese hospitals, but if there was a survey done on the non-Japanese mothers' use of epidurals, the rates would definitely be higher than for the local mothers.

This video gives an interesting discussion of the situation being seen in North American hospitals where epidural use is much more common. The doctor describes how babies born to mothers who have had epidurals during labor are having more difficulties getting breastfeeding started. Their behaviour is affected by the medications. They are usually sleepier, may have disorganised sucking patterns and are often subject to other kinds of interventions, as are their mothers.

One thing to note is that the comments she makes about the medications passing into the mother's colostrum are not supported by the evidence. Dr Thomas Hale who specialises in pharmacology and lactation, reports that the fentanyl transfer from epidural anesthesia during labor into mother's milk is poor and probably clinically unimportant. The milk is not the concern: more important is the effect of the epidural on the baby during labor, and the different breastfeeding behaviours being observed when compared with babies whose mothers had unmedicated births.

I think what this all means is that all mothers should be informed of the potential risks of epidurals and other birth interventions, and if possible you should take childbirth classes here or in your local area to learn about resources for coping with labor. Read some good birth books and ask lots of questions.

Ideally, staff in the hospital or clinic should be well versed in how to help mothers and babies get breastfeeding off to the best possible start...lots of skin to skin contact with baby on mum's chest, keep mother and baby together at all times, give baby time to come to the breast, if baby is having trouble, you might need to express some of your colostrum and feed it by syringe or spoon, very sleepy babies may need to be woken for feeds and gently encouraged to continue feeding for long enough and so on. Unfortunately, we cannot control what level of skill the staff have, nor how supportive the hospital or clinic will be of breastfeeding.

The best idea then, is to learn as much as possible about breastfeeding during pregnancy. Mothers-to-be can attend La Leche League meetings, both parents can take classes here if they are available in your area, so everyone knows what to expect with normal breastfeeding, and can recognise if things are going well or not after your baby arrives.

For a more technical review of epidurals and breastfeeding see here where the author states "There is evidence to show that epidural anesthesia probably does diminish the neonate's early ability to suckle. " A recent breastfeeding journal article concludes "women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour."

Make sure you get the support you and your baby need.