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Epidurals and Breastfeeding...

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Tuesday, December 12, 2006

There's a new study making the rounds of the blog world this week that talks about the possible effect of epidurals on breastfeeding. In fact, my friends Andi and Angela have already shared their take on the subject. The study, featured in an article over at BBC News titled "Epidurals 'Hamper Breastfeeding'" speculates that there may be several factors in play that cause moms who have epidurals to have lower breastfeeding rates.

From the article:

The researchers, led by Dr Siranda Torvaldsen, say: "There is a growing body of evidence that the fentanyl component of epidurals may be associated with sleepy infants and difficult establishing breastfeeding."

They add: "Whatever the underlying mechanism, it is important that women who are at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support, both in the initial postpartum period [just after birth] and the following few months."

Pat O'Brien, a spokesman for the Royal College of Obstetricians and Gynecologists, said it was possible that fentanyl had an effect on the baby.

But he added: "There are other factors which may explain this link, including that if a woman chooses not to have an epidural, she may also be more motivated to persevere with breastfeeding.

I've actually been having this same discussion with both my midwife and a friend that's a lactation consultant. While I fully believe that there's a tie-in here, I don't necessarily think that it's a direct result of the epidural medication that's causing the problem.

Personally, I think the issue is two-fold.

1.) There's an obvious "belief-system" that can vary between moms that choose to get epidural pain relief and moms that choose to have an unmedicated birth and there's a good chance that those personal beliefs influence the success and duration of breastfeeding. A reality of having a successful unmedicated birth is that moms must put a LOT of time and effort toward preparation. Natural childbirth classes like those offered by Hypnobabies and Bradley take a LOT of time and effort. Unmedicated childbirth is hard work, at least in terms of preparation. Thus, it can pretty easily be argued that women who are willing to consciously plan for and work toward an unmedicated birth may be more likely to "stick it out" when breastfeeding gets tough. (NOTE: I am NOT saying that epidural moms are bad, that unmedicated moms get medals, blah blah blah...I've HAD an epidural, believe me, I get it. LOL...My point is simply that there's a tie in between the "work" associated with preparing for an NCB and the work associated with nursing. There are plenty of epidural moms out there that breastfeed just fine.)

2.) The BIGGER factor, in my mind is IV fluids. See, the moms that I know that had epidurals and had an easy time breastfeeding where those that didn't have their epidurals for HOURS (or days) on end. Without the epidural, it's unlikely that they had bag after bag of IV fluids. See, there's a tie-in between massive fluid overloads and difficulty breastfeeding and I personally believe that it's the massive fluid overdose that causes the problems, not the medicine in the epidural. Here's why...

First, when mom has a MASSIVE amount of fluid in her system, things tend to swell...especially low-hanging areas. Think of how the feet, the hands and yes, the breasts, tend to collect fluid when mom is having edema problems. That swelling that takes place in the breasts mimics extreme engorgement and makes it very difficult for baby to get a good latch. Anyone that has tried to nurse knows that breastfeeding a baby with a bad latch is painful, VERY painful and frustrating for the baby. In fact, unresolved bad latch is what pushed me to switch to pumping with Elnora. (And yes, I did have an epidural and IV fluids with her.)

The second problem is that when mom is overflowing with excess fluids, the body works very hard to return to its natural state. That means that mom's body is working hard to flush that excess fluid out of the system. Obviously the process of making breast milk means adding MORE fluid to the equation. A new body of research is starting to look into the possibility that women's bodies actually fight the production of breast milk in moms that have massive fluid overloads. Basically, the body says "nope! you have too much fluid already...we're not letting you add any more!"

That's why I tell moms that it's just peachy to have an epidural if you want one. After all, despite having a wonderful experience with an unmedicated home birth for my second child, I get that some moms simply have no interest in the "full" experience of labor and birth. There's absolutely nothing wrong with that. The availability of pain relief to laboring mothers is a fantastic invention! However...it's a good idea to hold off as long as you can and to avoid that IV until it's time to get the epidural so that you can avoid that fluid problem that can come with the epi. In fact, I have two friends that had so much IV fluid during their labors that their feet literally squished when they walked for up to a week after the birth. One was unable to breastfeed and gave up after a few days of frustration, the other is still fighting her way through.

That said, I'll be interested to see more research as this comes out. It's certainly possible that the medication itself is what's causing problems, but we all know that the narcotics in the epidural leave the system pretty quickly and many babies don't get the hang of nursing for a few days. Thus, I really do think it's something else (the fluid) that's contributing to the problems that many "medical mamas" have with getting breastfeeding established.

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  1. Anonymous Anonymous | 9:23 AM |  

    My legs swelled from all the extra fluid from the IVs. When I got home from the hospital I had to rest with my legs up on the arms of the couch just to get comfortable. I cannot STAND the IV. The IV itself is uncomfortable and the side effects are even worse!

  2. Anonymous Anonymous | 7:27 AM |  

    That's really interesting info. I had epis with both kids. With my first my water broke and off to the hospital I went. Unfortunately no labor and my substitute dr. waiting 24 hrs before inducing but insisted on fluids the whole time. Then with the epi the rapid infused another bag. All in all I was on an IV for over 40 hours before delivery.

    I did have some latch issues with my daughter and she was very sleepy. At the time I attributed it to the IV meds (never again!). But we eventually got it and nursed for 15 months. I had to be very stubborn though b/c the nurses kept trying to convince my husband to sneak the baby a bottle. Grrr!

    With my son, I had an IV for about 15 hours before delivery. For both they made me keep it 24 hours after delivery b/c of the epidural. My son latched on immediately and my milk came in so fast and hard I would have made adult movie stars envious. He has been going for 13 months and will probably choose to continue for quiet awhile longer.

    All in all I still believe it is the determination of the mother. I had very little support and my mother and her mother never breastfed. I'm darm stubborn and am a perfectionist so I never give up, especially when it comes to the well being of my children.

    It would have been nice to have an easier delivery the first time and easier breastfeeding start, but I would never have given up the epi.

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