Epidurals and Breastfeeding
Many women have epidurals for pain relief during labor. Like every other medical treatment, there are risks and benefits to epidurals. The effect of epidural medications on breastfeeding success is something that is still being studied, and which is not totally understood at this time. Many professionals believe that breastfeeding support after birth can overcome any effects that epidurals may have on the infant, and therefore, contacting an IBCLC professional for ongoing support is the best way to ensure success with breastfeeding, no matter what the course of birth and medication may be. Doses of medications, combinations of medications, administration of IV medication at the same time as epidural medication, baby’s gestational age, baby’s weight, and timing of medication administration are all factors that may affect the course of early breastfeeding. Epidurals can slow down labor and result in an instrument -assisted delivery, and this can add to breastfeeding problems a baby may experience. Epidurals, however, are preferable, according to some studies, in instances where anesthesia is required during birth. Consensus shows that early and ongoing breastfeeding support, and careful clinical management of breastfeeding does give mothers and babies the best chance of getting breastfeeding off to a wonderful start.
In order to breastfeed easily and well right from the start, the baby should spend a good amount of uninterrupted time with mother, skin to skin, right after birth. Babies breastfeed best if they are put to breast within the first half hour after birth. Babies whose mothers had both intravenous pain control medicines and epidurals had the most trouble breastfeeding. 2 Short-term studies showed no difference in the duration of breastfeeding among mothers who had epidurals. 3 Longer-term studies showed that mothers who had epidurals were less likely to be breastfeeding when their babies were 6 months old. 4
Some professionals feel that epidural medication during labor may make labor longer and make it difficult to push the baby out vaginally (Lieberman 2002). This means that forceps or a vacuum extractor may be needed to help the baby be born vaginally. The baby may have pain or a headache after this type of birth, which can make breastfeeding more difficult for the first few days or weeks. Some studies show that mothers who have epidurals are more likely to have fevers after the birth 5, and this can cause delays in mother-baby contact in some hospitals that have protocols regarding mothers with fevers holding their infants. Babies whose mothers have epidurals may be more likely to have fevers 6, more likely to require evaluation for sepsis 7 and more likely to receive bottle supplements in hospital. 8 If these difficulties occur, they can cause a delay in breastfeeding “early and often,” which is best for both mother and baby.
If mother and baby are separated after birth, the mother can express colostrum by hand, then immediately use a hospital grade electric breast pump such as the Symphony or Lactina. She should pump at least 8 times a day until the baby can breastfeed often and effectively well. Having guidance from a professional lactation support person (LINK TO BNN and www.ilca.org) can really help during the early postpartum weeks.
Mothers who give birth by Cesarean surgery need pain relief during and after the birth. For these mothers, epidurals are a better choice than general anesthesia. 9. Epidurals during Cesarean birth make the baby far less sleepy than general anesthesia 9 and result in earlier initiation of breastfeeding 9. After the operation, mothers who get epidurals for continued pain relief in the early days are able to breastfeed more comfortably, and their babies gain more weight than mothers who get intravenous medicines or narcotic (sleep-inducing) medicines. 10 Babies are more alert and feed better when mother has an epidural after Cesarean rather than intravenous pain medicine. 11 One epidural medicine (buprenorpine) decreases weight gain in breastfeeding babies 12. Make sure the anesthesiologist knows you plan to breastfeed so buprenorphine can be avoided.
The final concern that mothers may have about epidural medicines after birth is whether or not the medicine will reach the baby. The medicines in epidurals get into the milk in only tiny amounts, and drug safety experts do not expect them to affect the baby. 13
Mothers who take pain medicine during or after birth may need to be more patient while baby learns to breastfeed, and will benefit from professional breastfeeding support from an IBCLC professional. If breastfeeding seems frustrating for you or your baby, or if the baby seems very sleepy, a lactation consultant (IBCLC) and La Leche League can help. Find a lactation consultant in the registry at www.ilca.org. La Leche League is at http://www.laleche.org.
References:
1, 8 Baumgarder DJ, Muehl P, Fischer M, Pribbenow B. Effect of labor epidural anesthesia on breast-feeding of healthy full-term newborns delivered vaginally. J Am Board Fam Pract. 2003 Jan-Feb;16(1):7-13.
3 Halpern SH, Levine T, Wilson DB, MacDonell J, Katsiris SE, Leighton BL. Effect of labor analgesia on breastfeeding success. Birth. 1999 Jun;26(2):83-8.
4 Henderson JJ, Dickinson JE, Evans SF, McDonald SJ, Paech MJ. Impact of intrapartum epidural analgesia on breast-feeding duration. Aust N Z J Obstet Gynaecol. 2003 Oct;43(5):372-7.
Hirose M, Hosokawa T, Tanaka Y. Extradural buprenorphine suppresses breast feeding after caesarean section. Br J Anaesth. 1997 Jul;79(1):120-1.
10, 12 Hirose M, Hara Y, Hosokawa T, Tanaka Y. The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain. Anesth Analg. 1996 Jun;82(6):1166-9.
13 Kanto J. Risk-benefit assessment of anaesthetic agents in the puerperium. Drug Saf. 1991 Jul-Aug;6(4):285-301.
4 Kiehl EM, Anderson GC, Wilson ME, Fosson L. Social status, mother-infant time together, and breastfeeding duration. J Hum Lact. 1996 Sep;12(3):201-6.
9 Lie B, Juul J. Effect of epidural vs. general anesthesia on breastfeeding. Acta Obstet Gynecol Scand. 1988;67(3):207-9.
5, 7 Lieberman E, O'donoghue C. Unintended effects of epidural analgesia during labor: a systematic review. Am J Obstet Gynecol. 2002 May;186 (5 Suppl Nature):S31-68.
13 Ortega D, Viviand X, Lorec AM, Gamerre M, Martin C, Bruguerolle B. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand 1999 Apr;43(4):394-7.
5, 6 Ransjo-Arvidson AB, Matthiesen AS, Lilja G, Nissen E, Widstrom AM, Uvnas-Moberg K. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth. 2001 Mar;28(1):5-12.
1, 2, 3 Riordan J, Gross A, Angeron J, Krumwiede B, Melin J. The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. J Hum Lact. 2000 Feb;16(1):7-12.
9 Sener EB, Guldogus F, Karakaya D, Baris S, Kocamanoglu S, Tur A. Comparison of neonatal effects of epidural and general anesthesia for cesarean section. Gynecol Obstet Invest. 2003;55(1):41-5.
1 Sepkoski CM, Lester BM, Ostheimer GW, Brazelton TB. The effects of maternal epidural anesthesia on neonatal behavior during the first month. Dev Med Child Neurol. 1992 Dec;34(12):1072-80.
Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA.
Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int. Breastfeed J. 2006 Dec 11; 1;24.
4 Volmanen P, Valanne J, Alahuhta S. Breast-feeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and breast-feeding practices. Int J Obstet Anesth. 2004 Jan;13(1):25-9.
2, 11 Wittels B, Glosten B, Faure EA, Moawad AH, Ismail M, Hibbard J, Senal JA, Cox SM, Blackman SC, Karl L, Thisted RA. Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. Anesth Analg. 1997 Sep;85(3):600-6.
Author/Editors:
Kelly Bonyata, BS, IBCLC
Kathleen Bruce, RN, IBCLC
Mary V. Bibb IBCLC
