Pregnancy and Birth

Epidurals and Breastfeeding

Epidurals May Affect a Mom's Ability to Breastfeed

INTERNATIONAL BREASTFEEDING JOURNAL
 

A new study of more than 1,200 women suggests that those who receive epidural anesthesia during childbirth with the narcotic fentanyl may have trouble breastfeeding. Women who got a fentanyl epidural reported more difficulty with breastfeeding during the first week, and they were also twice as likely to give up breastfeeding within the first six months.
Evidence from other research suggests that fentanyl can interfere with infants' ability to suckle.

International Breastfeeding Journal - December 11, 2006
MSNBC - December 15, 2006

The report published in the International Breastfeeding Journal, detailed finding that Mothers-to-be might want to reconsider having epidurals in order to relieve labor pains.

A similar study of women at Toronto University, Canada, found that 177 were less likely to breast-feed were they to be given an an epidural with fentanyl.

Do Epidurals affect breastfeeding?

Researchers in Sydney studied 1280 women who had babies between March and October in 1997.

416 women had epidurals. 172 of those women had Caesarean sections with pain-killing medication.

It was found that mothers that choose an epidural to relieve labor pains had a greater chance of problems in the first week after birth making it more likely that they would stop breastfeeding their babies sooner.

They are also now of the opinion that the chemicals, bupivacaine and fentanyl, which is an opioid, present in epidurals may have an adverse affect on the unborn babies. They suggest that some of the drugs used enter the bloodstream and cross into the placenta to reach the fetus. They can affect the unborn infants' brains and make them over sleepy and less disposed towards breast-feeding.

The following abstracts are outlined in the research:


Background
Anecdotal reports suggest that the addition of fentanyl (an opioid) to epidural analgesia for women during childbirth results in difficulty establishing breastfeeding. The aim of this paper is to determine any association between epidural analgesia and 1) breastfeeding in the first week postpartum and 2) breastfeeding cessation during the first 24 weeks postpartum.

Methods
A prospective cohort study of 1280 women aged ≥ 16 years, who gave birth to a single live infant in the Australian Capital Territory in 1997 was conducted. Women completed questionnaires at weeks 1, 8, 16 and 24 postpartum. Breastfeeding information was collected in each of the four surveys and women were categorised as either fully breastfeeding, partially breastfeeding or not breastfeeding at all. Women who had stopped breastfeeding since the previous survey were asked when they stopped.

Results
In the first week postpartum, 93% of women were either fully or partially breastfeeding their baby and 60% were continuing to breastfeed at 24 weeks. Intrapartum analgesia and type of birth were associated with partial breastfeeding and breastfeeding difficulties in the first postpartum week (p < 0.0001). Analgesia, maternal age and education were associated with breastfeeding cessation in the first 24 weeks (p < 0.0001), with women who had epidurals being more likely to stop breastfeeding than women who used non-pharmacological methods of pain relief (adjusted hazard ratio 2.02, 95% CI

Conclusion
Women in this cohort who had epidurals were less likely to fully breastfeed their infant in the few days after birth and more likely to stop breastfeeding in the first 24 weeks. Although this relationship may not be causal, it is important that women at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support.

To view the full study:
 http://www.internationalbreastfeedingjournal.com/content/1/1/24

Excerpted with permission by:
© 2006 Torvaldsen et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.