Epidural anesthesia brings with it a host of medical interventions into normal labor. The epidural rate in most U.S. Hospitals is in excess of 85%. This resurgence in medicated deliveries raises various concerns regarding epidural use and feeding problems.  The available studies reviewing the drug content of the epidural conclude that the drug(s) do not pass to the infant. Thus, anesthesiologists consider the epidural to be the ideal method of pain control during labor (Cohen).  "Much of the anesthesiology literature dismisses early behavioral effects on infants as insignificant . . .   inability to latch and feed at the breast is a significant deviation from normal Walker 131)."  No study to date has looked at the effects of the epidural itself on the ability breastfeed.  Lactation Consultants and hospital staff have noted that these babies are lethargic and have uncoordinated suck-swallow patterns for days after birth resulting in poor milk transfer leading to excessive neonatal weight loss.  Mothers exhibit problems secondary to poor latch on and suckling difficulties: sore nipples, engorgement, low milk supply, plugged ducts and mastitis.  (Walker 131)

It appears that when a mother has epidural anesthesia she may be "setup" for a series of other medical interventions (Liberman 1, 2 et al) .  When a mother receives epidural anesthesia, her labor may slow down.  Consequently, the labor may require pitocin augmentation.   Once the epidural is started, the mother is confined to bed and cannot turn or change positions easily.  The epidural relaxes pelvic muscle tone. The mother lacks the normal bodily reflexes that turn the head into the optimal position for delivery. The normal descent of the baby's head is inhibited.  The pushing phase may be prolonged, resulting in the need for vacuum extraction, forceps and/or cesarean delivery. When an epidural is used for any length of time, the mothers temperature begins to rise. If this fact is not recognized, the presence of maternal fever could lead to unnecessary tests for neonatal sepsis and costly antibiotic regimens for the mother (Liberman 1, 2 et al).  The elevation in maternal temperature causes the baby's heart rate to increase and can mimic fetal distress.  The incidence of cesarean section for fetal distress in these cases has not been studied.  (Klaus, Kennell and Klaus 46-51)

Some hospitals require that a mother have some form of narcotic pain relief before the epidural is started which further complicates the picture. Anesthesiologists may require infusion of two or more liters of I.V.  fluids before the epidural and use further I.V. fluids throughout the labor.  This leads to generalized edema in both the mother and the infant. Lactation consultants report a type of maternal areolar edema peculiar to epidurals that makes latch-on difficult, if not impossible.  In addition, the infant's birth weight may be "inflated."  When diuresis begins in the baby, weight loss may be more than allowable amounts. Formula supplementation may be required based upon weight loss alone.  Moreover, mothers complain that epidural pain relief is not complete, is patchy or fluctuates. Over 69% of women report back problems for more than a year after having an epidural (Klaus, Kennell and Klaus 49).

Childbirth educators must again encourage "natural childbirth" in their classes. They should provide their class with ALL the potential risks of epidurals. Properly used childbirth techniques, changing the mother's position frequently in labor, walking, squatting, allowing nutritious clear liquids in labor (rather than ice chips) may all assist in reducing and/or eliminating medicated births.

The need for medication in labor is not in question.  Surely, many women benefit from its use.  It is the routine use of medication at the first complaint or request that should be under scrutiny.  Other comfort and coping measures should be tried first.

Copyright Marie Davis, RN, IBCLC 1999 
[see also doula support in labor]
[References]
[Index]

Last reviewed: Wed, Nov 8, 2006