Breastfeeding/Lactation Consultant

NO medication is risk free. Epidurals are by far the most common birth medication. The national epidural rate is up to about 60% of all births. Some hospitals have rates of 90 to 100%. I was just told by a physician that all the mothers in his hospital get epidurals unless they 'insist' otherwise. So epidurals are the 'norm' in many hospitals.

When you get an epidural you will need to be given IV fluids b/c they need to have your vein open in case they need to give other drugs related to dangerous side effects of the epidural such as a rapid drop in blood pressure. The most common side effect of the epidural is a rapid drop in blood pressure. They treatment for this drop in blood pressure is to provide a rapid and large infusion of IV fluids to keep the pressure up. This high dose of IV fluids also causes many mothers to have severe swelling of their extremities and of course their breasts. This extreme engorgement of the breasts not only hurts the mother, but makes it very difficult for the baby to latch. Imagine trying to put your mouth around a basketball! As the baby has latch difficulty s/he gets less than optimal nutrition which can lead to jaundice and/or too great a weight loss. This of course sets the stage for the need for supplemental formula feeding and many additional bf problems.

Another thing that occurs with epidurals is that many moms develop a fever with it and if a mom has a fever the doctors need to rule out any infection that may endanger the baby. There is no easy way to determine if the fever is due to a dangerous infection or if it is a side effect of the epidural. B/c infection can be so dangerous in the newborn this often leads to a separation of the mother and baby until it can be determined that there is no infection present. Of course the baby can't bf if mom and baby are separated.

Epidurals also lead to a higher rate of mechanically assisted births, both forceps and vacuum deliveries, as well as a higher rate of C-sections b/c the epidural can slow the labor down and pushing can be difficult with the epidural. When babies are delivered via mechanical devices they can have problems with compression of the nerves that go to the oral cavity. This compression of nerves can cause suckling and swallowing problems. The baby's head is pretty pliable in order to fit through the vaginal opening. Last night the speaker described it as being like a plastic bag full of jello with some card board pieces surrounding it. The jello being the brain, the bag being the sac around the brain, and the card board being the skull with separate pieces. (the skull is not fused in the fetus to allow passage throught the vagina). There are many nerves passing through small holes between and in the skull bones of the baby that go to the mouth and tongue. IF the skull is squeezed by forceps or misshapened by vacuum extraction it can compress these nerves that are vital for oral function.

Another birth intervention that impacts breastfeeding is vigorous suctioning of the baby's mouth and throat. This is almost routine with all births but even more vigorous with any medicated birth b/c the baby is a bit slower in respiratory function. BTW, any of the narcotics like Nardol and Stadol depress the baby's repiratory function. The baby's mouth is very sensitive but the minute it is born a bulb syringe is jammed in their mouth over and over. Is it any wonder so many don't want to open and latch? They are protecting a very sensitive part of their body. What in the world did cave women do without bulb syringes? How did their babies survive? One LC reported that she had seen a case were a baby had gotten a hole in the soft palate from vigorous use of the bulb syringe.

So, that epidural, or any birth medication, isn't as benign as you might be told and can lead to a 'slippery slope' of complications that negatively impact bf.

If you do have birth medications the way to help you and your baby heal from that is by almost constant skin to skin contact with the baby asap after the birth for the first few days. Hold the baby, in a diaper only, against your bare chest with a cover over both of you. Allow the baby to cuddle, and lick, and root for the breast. When the baby shows any interest help the baby to access the breast for a feeding. Very close and constant contact can help heal alot and get you off to a better start with bf.

There's oodles more on this topic and you should have no problem accessing the actual research articles. You can go on medline and do a search on epidurals and breastfeeing or medications and birth. Get back and let me know if you need more help on that.

HTH
Kathy