November 12, 2010

A lot of the breastfeeding counseling that I do is for families who have had a hospital birth. It is rare that I work with mothers who choose to have their babies at home. I do not think this is a coincidence. I believe that most breastfeeding problems, like most birth issues are caused by high intervention births. I believe that many of these barriers can be easily remedied with preventative, holistic care.

Many mothers that I talk to prenatally are planning hospital births and they are often planning an epidural. Family & friends frequently encourage epidurals, joking with mothers as they doubt their abilities to handle labor. It is not supportive for people to question a mother’s ability to birth her baby. Although well-meaning family may believe that they are saving a woman from experiencing pain, it can often feel as though they are truly questioning her parenting abilities from the very beginning. After all, what better experience to prepare a woman to parent than birth. She will encounter lows, highs, love and the amazing empowerment that comes from thinking that she can’t go any further, then going there and becoming a mother.

The epidural is a domino effect consisting of a mother losing the empowering experience of a natural birth and often followed by difficulties with breastfeeding. Epidurals do lead to many interventions including cesarean sections. Epidurals affect a mother’s ability to be able to successfully breastfeed her child and shorten the duration of the breastfeeding relationship.

I do form my opinions from anecdotal experiences of hundreds of mothers that I have talked to concerning their birth and breastfeeding experience and I am also biased as I have experienced the wonder of birthing two of my babes at home. However, the effect of epidurals on women, babies, and their breastfeeding relationship is also well-documented.

In 2006, The International Breastfeeding Journal published a study which found that women who had epidurals were less likely to breastfeed in the first few days after birth and those who did were more likely to stop nursing within the first 6 months when compared to mothers who did not receive an epidural. Other studies have also shown a link between epidurals and an infant’s ability to organize suckling properly.

Cesareans typically create barriers to breastfeeding as well. Breastfeeding after a c-section will be another post topic. Cesareans often create challenges to successful breastfeeding due to separation of mom and babe, medication, delayed mature milk (which isn’t necessarily an issue, but will be in the hospital), difficulty with comfortable positioning for breastfeeding during recovery and a variety of other reasons. I am mentioning how a cesarean can affect breastfeeding in this post as epidurals can also lead to cesarean sections which I do not feel a lot of mothers are told in an open honest discussion with their caregiver about true informed choice.

In 1993 researchers began to study the effects of epidurals on first time mothers. However, this trial had to be ceased as the cesarean rate was so great, it was considered unethical to continue. Before discontinuing the study, they found increased rates of cesarean section to be 50% at 2cm, 33% at 3cm, and 26% at 4cm dilation. Risks do appear to lower as a mother reaches 5cm dilation. However, it is important to remember that the risk of cesarean is only lowered in correlation to the epidural, not overall.

I encourage mothers who plan to breastfeed their babies to research their birth options thoroughly. If you are expecting a baby and have any questions about how your birth plan might be related to your breastfeeding goals I would be happy to answer any that I can.


Midwifery and Childbirth in America by Judith Rooks
International Breastfeeding Journal


2 Responses to “Epidurals”

  1. Beth said

    I’ve had one epidural birth (first) and one non-epidural birth (second), and the difference in breastfeeding experiences were profound. Both were hospital births with supportive CNMs, both were long hard births, same gestational age, and I battled engorgement and latch issues both times and used the same lactation consultant, so the epidural and experience were the only real difference. My first baby was the epidural baby and came out sleepy and not interested in nursing. Same gestational age, but had a weak suck, didn’t want to open the mouth, fell asleep after just a few minutes of nursing, and seemed to take the first week to really “wake up.” As a result, weight gain was really poor, and if I hadn’t had a lot of support to make it through those first few weeks, I’m not sure if I would have persevered. I had no idea the alertness level difference until I had my second. While I don’t discount experience, the difference in the babies were readily apparent–my second was awake for hours after he was born, nursed for 30 minutes when latched on the first time. That baby was alert, enagaged, and interested in nursing. Sucked effectively and nursed efficiently even while I worked out the kinks of latch. Gained weight like a champ even though I had much of the same latch issues. Forgoing the epidural was the hardest thing I have ever done, but I *know* that it did make a huge difference in breastfeeding the second time.

  2. monex.com said

    As Leaders we believe that alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start. While it is well known that epidurals provide a high level of pain relief what women may not know is that one of the many side effects of epidurals is the possible interference with breastfeeding initiation and duration.

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