New Medical Study Shows Epidurals Inhibit Nursing Instincts

A new study published in the International Breastfeeding Journal, a peer-reviewed medical journal, confirms what many have been saying for years; that epidurals can have a negative effect on infants, specifically impacting their ability to nurse properly.

Spearheaded by Siranda Torvaldsen the study followed 1,280 women, the largest sample of any study of this type. The results were surprising and have led some to call for action. In fact, Dr. Sue Jordan, senior lecturer in applied therapeutics at Swansea University called for more long-term research into the effects of epidural opioid medication on newborn babies. She also said the evidence from this research warrants breastfeeding difficulties being added to the list of "adverse drug reactions" even though it isn't a reaction by the mother, but rather an adverse reaction to the baby.

The Study: 1,280 women who had given birth were studied. Of those 416 received epidural pain relief during their labor. This was a cohort, observational study meaning that the women were not assigned to specific medication vs non-medication groups, but rather were allowed to act on their own and the results followed to determine the effects. (Authors note: British women have a 40% epidural rate; in America the percentage of laboring mothers receiving epidurals is much higher, giving this even a higher impact on children in the States)

The Results: While 93 percent of women attempted breast feeding in the first week, those who had received epidural medications during labor has more difficulty establishing a good breast feeding routine in the critical first few days.

At the 24-week mark 72% of the women who did not receive epidurals were still breast feeding but only 53% of the women who received epidurals were still breast feeding at all. The number one reason given for no longer breast feeding was that the baby simply "refused to nurse". Over a third of the mothers no longer breast feeding gave up within the first week and 55% quit nursing their infants within the first month and a half.

Discussion: Epidurals have long been known to have adverse effects on maternal health; including a drop in maternal blood pressure, longer labor time especially in the pushing stage, and a dramatic increase in the number of assisted births via forceps or vacuum extraction. This is the first study to examine on a large scale the negative neurological and physical effects on the infant and more research should be done to determine the extent and variability of this effect. Does timing of epidural or dosing change the effects? In what way? These questions need further research.

Ramifications: The conclusion that the drugs administered to the mother during labor can and DOES cross over through the placenta to the baby goes against long-held myths. Women used to hear "Oh, this doesn't affect the baby at all" yet studies, beginning in the 1970's, continue to show otherwise. This study, being the largest scale study yet, paves the way for further research.

While no one would suggest that this is the only factor impacting breast feeding success the study is clear that epidural use does indeed continue to have an impact on infant tone and coordination for up to six weeks after birth.

Hopefully this study will pave the way for extra breast feeding support for mothers who have been given epidurals. It seems that many mothers found trying to nurse their baby frustrating because the fentanyl, the opioid drug in epidurals, impairs the muscular coordination of the infant. This makes latching on more difficult for the baby, and breast feeding very frustrating for the mother. Most mothers felt like they failed at breast feeding so using a bottle was easier. Hopefully, with the results of this study now published, health care professionals can take appropriate steps to support mothers and their babies.

As one expert said "extra support [should] be offered to the most vulnerable women, to ensure that their infants are not disadvantaged by this hidden, but far-reaching, adverse drug reaction."

"Mothers should receive detailed information while pregnant about the potential side-effects of different types of epidural and local anesthetic, and should receive extra support when starting to breast-feed if they have received opioid pain relief during labor." says Rosie Dodds of the National Childbirth Trust.

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