by Anne Eglash MD, IBCLC, FABM
What are the effects of epidural anesthesia and breastfeeding? A recent systematic review analyzed published research studies on epidural anesthesia and breastfeeding. They included 23 articles, all of which were written in English, did not include subjects undergoing cesarean births, reported effects of epidural analgesia during labor, and included breastfeeding outcomes.
According to the authors, previous research has shown that epidural anesthesia is a risk factor for prolonged second stage of labor, instrumentation during labor, use of oxytocin during labor, lower maternal blood pressure, and maternal fever, among others.
On the other hand, epidural anesthesia reduces pain during labor, which reduces mother’s physiologic stress.
What do you think the authors concluded regarding the effect of epidural anesthesia and breastfeeding?
- A. Infants of mothers who received epidural anesthesia are less likely to initiate breastfeeding in the first hour.
- B. Women who receive epidural anesthesia are more likely to report breastfeeding problems at 6 weeks postpartum.
- C. Infants of mothers who received epidural anesthesia have poorer latch and feeding skills at the time of hospital discharge.
- D. A, B and C
- E. No conclusions could be reached
See the Answer
Abstract
J Hum Lact. 2016 Aug;32(3):507-20. doi: 10.1177/0890334415623779. Epub 2016 Apr 27.
Labor Epidural Analgesia and Breastfeeding: A Systematic Review.
French CA1, Cong X2, Chung KS3
Abstract
Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers’ intention to breastfeed, social support, siblings, or the mother’s need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively.
© The Author(s) 2016.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
There are many medical interventions whose effects on breastfeeding have not been thoroughly evaluated for several reasons. Besides epidural anesthesia, good examples include intrapartum IV fluids, postpartum contraceptive hormones, and medications during pregnancy.
The biggest problems in reviewing the research on epidurals and coming to any conclusions is the lack of similarity between these studies, and lack of controlling other factors that play a role in breastfeeding initiation and duration. Most of the studies employed different methods, had subjects who received varying doses of epidural medication, and used different measures of breastfeeding success. For example, some of the studies sent out surveys to determine breastfeeding rates at 4-6 weeks, some looked at the epidural medication levels in the infant, others measured neurological activity in the infant immediately postpartum. Several of the studies showed some degree of negative impact of epidurals on breastfeeding, but several showed no impact.
So how can this research help us? Well, first of all we cannot say that epidural anesthesia is a terrible problem for breastfeeding. But, it is a good idea to use the shortest acting, lowest dose medication for epidural anesthesia to minimize harm. In addition, trying to avoid additional IV pain medications may be helpful, since some of the studies showed a negative impact of the combination of epidurals and IV pain medication. And of course employing Baby Friendly Hospital Initiative strategies for optimal breastfeeding success with an emphasis on skin-to-skin early and often, and ensuring a safety net of breastfeeding support after hospital discharge.