Australian research published December 2006(1) suggests that epidurals given during childbirth can result in difficulty establishing breastfeeding. The results showed that of 1280 women, those who had had an epidural were less likely to fully breastfeed their infants in the few days following birth and they were more likely to stop breastfeeding in the first 24 weeks.
So why would this be? We all know that breastfeeding can be challenging for any new mother/baby duo – so what role do epidurals play in this process????
Before we begin this discussion, for those of you who have not read “Well Adjusted Babies”, let me clarify that as long as parents research their birth choices thoroughly and enter labour “self-informed” then I believe couples should choose a birthing style – (whatever that may be), that best supports their needs. As always, my concern is for mothers who do not physically and emotionally prepare for the gamut of birthing scenarios and end up being disempowered and resentful about birth in general.
Whether you choose an Elective caesarean, whether your baby wants to enter the world dramatically with an Emergency caesarean or whether your labour is free of complication, whatever happens – with the right knowledge and preparation all births can be a celebration and indeed are sacred.
As we all know sometimes things don’t always go to plan. For example we had an extremely long and complicated first birth, after thirty plus hours of labour and being placed onto a drip to replace my fluids, we were threatened with an impending caesarean section. However under the advice of our midwife, we were very fortunate to be able to speak with the anesthetist and arrange a low dosage epidural. This allowed my fatigued uterus time to rest and my body time to sleep.
After an hour’s rest, I awoke to excruciating pain and full dilation. I was frightened by the intensity of the contractions and desperately needed my husband and midwife to help me to re-focus. Whilst an epidural had not been a part of our birth plan, neither was a 36 hour vomiting spree, nor a start-stop labour, and the epidural did enable us to have a safe vaginal birth.
Back to the research at hand. The benefits of exclusively breastfeeding for at least six months are well documented and the World Health Organisation suggests continuing breastfeeding for as long as 12 -24months. So do epidurals play a role in compromising initial bonding between mother’s and babies and in turn result in an on-going spiral of breastfeeding challenges? This Australian research indicates that this may in fact be so.
It is well known that epidurals slow labour down and that other drugs are then often needed to keep contractions going. The muscles of the pelvic floor are also relaxed by the anaesthetic and as a result the baby’s head will not rotate so forceps are often needed. Numerous studies link epidurals with longer labours and an increased risk of instrumental deliveries and caesarean births.(2) Until now the impact of epidurals on breastfeeding are less clear and this is why such research is very useful.
The results of the above mentioned study showed that;
- In the first week, women who had an epidural were less likely to be fully breastfeeding their baby
- By the second week only 60% were continuing to breastfeed
- Of these women most had stopped breastfeeding within the first 24 weeks(3)
Two things to keep in mind;
1.With increased instrumentation there is a greater risk of separation of the mother and baby. With this separation the mother will not have the initial hormonal stimulation from her baby – normal stimulation initiates colostrum and milk let-down. Prolonged separation will inevitably continue to effect milk ‘demand and supply’. Most likely, some complementary formula feeds will be offered during this time, again decreasing the demand for the mother’s milk and therefore her production.
2. The baby will be affected by the drugs involved. The effects of these drugs will be intensified for the newborn considering their dose /body/ weight ratio. Most often a baby’s drowsiness or irritability post-birth will be due to this chemical sensitivity rather than mother/baby incompatibility.(4) Furthermore, no one knows as yet whether these drugs over-ride the mothers own hormonal capacity to produce milk.
So what’s the good news?????????????
The good news for women preparing for childbirth is that when we understand the effects of these drugs on our babies and our breastfeeding, then we can make feasible plans for each varied birth outcome.
Preplanning to have support with breastfeeding, additional guidance to that offered in hospitals, will help avoid bonding and feeding difficulties. If you want to breastfeed your baby then the right advice is critical. If you do not intend to have a private midwife then book a lactation consultant to visit you the day you give birth.
When I consider our first birth, I am completely aware that our private midwife protected the sacred space we needed to bond with our newborn. Had she not also stayed with us and built my confidence breastfeeding that first day, I would have been a “quivering mess”.
As discussed in “Well Adjusted Babies”, another important part of post birth planning is having your newborn’s nervous system assessed for any dysfunction which can arise from the birth process itself. When combined with instrumentation and drug toxicity, birth can be very stressful for a fragile, sensitive nervous system. A secret weapon post-birth is quite likely to be a gentle chiropractic adjustment. Having your baby checked by your chiropractor within a few hours or days post birth can make such a difference for those first few days.
Good luck and best wishes,
Dr Jennifer Barham-Floreani
2)Effect of epidural anaesthesia on clinician-applied force during vaginal delivery Original Research Article
American Journal of Obstetrics and Gynecology, Volume 191, Issue 3, September 2004, Pages 903-906
4)Linston A.W. Campbell AJ. Danger of Oxytocin inducedlabour to foetuses. BMJ. 1974;606-607.
Taylor RW. Misuse of Oxytocin in Labour. Letter to Lancet: February; 1998