Charlotte's Web

Blogging my world since 2006

How Epidurals Affect Breast-Feeding

23 Comments

I read in the press yesterday about the link an Australian research team has made between women receiving epidural pain relief at birth and their subsequent difficulty with breast-feeding, and a loud click sounded in my brain. According to The Sunday Times’ article,

The research suggests that some of the drugs used in epidurals make their way into babies’ bloodstreams, subtly affecting their brains and development for weeks afterwards — including making them less willing to breast-feed.

The researchers followed 1,280 women, of whom 416 had an epidural. The researchers found that 93% of the full group breast-fed their babies in the first week, but those who had epidurals had more difficulty breast-feeding in the first few days after giving birth. After six months, the women who had epidurals were twice as likely to have given up breast-feeding.

I have done comprehensive research of my own, and can say without a doubt that my two babies who were born at home with no pain relief were both wonderful latchers, ate heartily and – despite the minor complication of my hugely swollen breasts – had no trouble with breast-feeding at all.

However, my first baby did not have it that easy. To start with, she was a back labour, which meant that although she was lying head down, she was facing the wrong way and had to turn around completely before she could come down the birth canal. That process of her turning around was so agonising that I started baying loudly for pain relief. The first shot of epidural had the desired effect of relaxing me – they dimmed the lights, I had a superficial nap, Thomas went home for a shower – but the top-up two hours later meant that my blood pressure suddenly dipped dangerously, labour speeded up, and since I could feel nothing (and so couldn’t push), the doctor had to go in and fetch Lily with a tool that looked like something you’d unblock your loo with. Thomas got to hold our little baby, while the doctor took a needle and thread and repaired the damage she’d done to me. I remember asking her how many stitches there were and her saying, “You don’t need to know.” Actually, I did – I felt like a warhorse who’d survived a bloody battle and I needed to know the extent of my wounds.

After two nights in our busy London hospital – where the full extent of my breast-feeding education was being told “you’re not doing it right” – we were sent home. Things went rapidly downhill. The first night at home I spent alternatively trying and failing to feed my baby, and staring down her throat as she screamed. I think if a nice hospital nurse had come by and muttered comfortingly, “Let me give her a bottle, dearie, and you get some sleep”, I would have willingly surrendered my breast-feeding principles on the spot. We persevered, but it remained difficult for quite a while. At the time, I thought this was because:

  1. She was very tiny, with a minute little mouth
  2. She had a bad headache from being suctioned out of me
  3. We had got ourselves into some bad latching habits (“not doing it right”)

But I now know there is also every chance that she had some fentanyl in her bloodstream, which made her coordination bad, especially in the jaw area. I didn’t stop breast-feeding, and I wasn’t tempted to do so. I was determined, quite hardcore really, that this was the way I was going to feed my baby, and with the help of a committed midwive who staved off mastitis at the eleventh hour, the Le Leche League’s mind-altering advice to lie down and get some sleep while feeding my baby and a small library of baby books, we got through it. But it would be good, as the researchers point out in their report, if women who had epidurals during birth received the education and the support they needed to cope with any problems before leaving hospital. Or, at the very least, the telephone number of their nearest La Leche League support group.

Advertisements

Author: charlotteotter

Novelist, feminist, crime writer

23 thoughts on “How Epidurals Affect Breast-Feeding

  1. I will definitely have to do a blog post on breast-feeding one of these days, or more specifically: “How I Failed At Breast Feeding And Went Through Months Of Angst And Guilt About It”. It seems that as the months pass I’m given more insights into why I “failed” (as the medical professionals termed it). At the time I got more contempt than reassurance.

    I had three epidurals (for the one labour). The first two didn’t work. Kiko was a vacuum extraction too. He was in an incubator for two days after the birth and I couldn’t get near him. He was also being pumped full of all sorts of other drugs, and I was in a massive amount of shock (him too probably!) I suppose these were all factors in my “failure” although when I did try to breast-feed him, he was able to latch on and was sucking strongly. But I was producing no milk and he quickly caught on that the bottles they had given him in intensive care produced milk and I wasn’t… so why was he bothering with me?!

    In the second two trimesters of pregnancy, I noticed no changes in my breasts and I didn’t produce a drop of milk until a week after Kiko was born (and then only two drops). So I was also wondering if it was a hormone thing, although I’m very interested in the epidural research. I wish more research would be done into breast-feeding difficulties. It would be much more helpful than medical staff branding women as “failures”.

    Thank you for this post, it made me feel better.

  2. Oh how interesting. That makes a lot of sense.

    There is so much pressur on women to give birth naturally and to breastfeed. What we forget is that both of those things are only best if they are possible and safe. We forget that women used to die in labour and that the neo-natal mortality rate was dreadful too. So what is now a “difficult birth” leaving the mother feeling ineffectual, battered and guilty is actually a triumph for all concerned, for her and for her support team. However-many years ago, things could have been so different.

    It makes huge sense that an epidural would affect a baby’s ability to suck. I do hope though that militant midwives don’t use it as yet another stick to make women who do need interventions feel like failures.

    Thanks for posting Charlotte.

    Aphra

  3. Charlotte, This is entirely anecdotal, but of my two non-epidural twins, one hated nursing and the other loved it. The one who had a hard time yelled and bonked his head against my breasts and yelled some more and then wailed and wailed every time he tried to nurse. This went on for what seemed like forever. The other guy waited his turn and had a very nice time of things. Who knows, maybe some babies get it and some have more work to do. Maybe it’s the drugs they get, maybe not.

    Bottom line is that anything that can be done to make labor work, including pain relief during difficult labors, and breastfeeding go well should be done — but it’s not always going to go well and the worst thing is when you feel like it’s your fault! It would be interesting for someone to post about the myth of perfect childbirth and perfect parenting — who’s behind that anyway?

    As for the epidural research, I think it’s good to know these things ahead of time and wish there was more of a willingness among doctors to tel you the pros and cons of your decisions in a neutral, helpful way.

  4. I saw that study too and my own experience confirms it. Baby #1 — epidural, bad latch, horrible time breastfeeding, I have the scars to prove it! Baby #2 — completely med-free, great latch, no breastfeeding troubles.

    I’m sure there are other factors but at least this study would suggest that perhaps medical staff could be a bit more attentive to the breastfeeding issues when the mom has an epidural.

  5. OK, let’s look at what exactly this article says:

    “WOMEN who give birth with the aid of pain-relieving epidurals find it harder to breast-feed than those who give birth naturally, a study has found.

    The research suggests that some of the drugs used in epidurals make their way into babies’ bloodstreams, subtly affecting their brains and development for weeks afterwards — including making them less willing to breast-feed.”

    Notice two things. One: it’s one study. Two: use of the words “the research suggests”.

    There are certainly other possibilities, such as that women who for whatever reason need an epidural are experiencing more difficult labors, which could be in part due to the temperment or even physical structure of the baby, the physical structure of the mother, the overall cycle of pregnancy, etc. Remember, labor is one stage of an ongoing cycle that includes pre-conception, conception, gestation, birth, growth, nurture, environment, etc. It may be that we have to look at breastfeeding as part of a larger process, not as an independent activity.

    Great that they continue to research into the methodologies we use for birthing and other medical procedures, but heaven help us if anyone thinks there’s a certainty here.

    Also, this is just anecdotal from our tiny sample of postings, but I noticed that some of you said that Baby #1 seemed to be the one with the harder time latching. That could just be a matter of birth order. I mean, isn’t it typically believed that mothers have a harder time with the first baby, having never done this before. Part of that could be that first babies just have a harder time of it too.

  6. And of course your first baby is the one where you’re more likely to need an epidural: because first Labours are longer and can be more difficult.

    As a junior Dr in Obs and Gyne I seem to spend a lot of time persuading women out of having C Sections because they’re scared of the pain of Labour.

    Most of my patients are young, scared, and fairly ill informed to be honest, very few breastfed and no one seems bothered about natural childbirth. Many of my patients smoke because they think that smaller babies will be easier to give birth to!

    For many women the promise of an epidural is the only thing keeping them away from a section. A C Section is really best avoided because it can cause all sorts of complications esp with the next pregnancy.

  7. Contentious issue here! I was interested to read it, as I too had an epidural with my first and nothing with the next two. it was more difficult to get going wiht feeding my first baby, but I put it cown to inexperience. Eventually one or other of the health visitors helped me get the position right and it got easier. It would be great if there was better support in the hospitals and the lying down to feed is a breakthrough.

    The interesting thing to me was that the epidural left me on a high. Everything tasted wonderful and looked brighter for a few days, I was quite sad when it wore off..but when I filled in the hospital questionnaire before leaving, I just ticked that everything was wonderful, invluding the food!

  8. I am with Z: what if it was not chemical but cultural? I am sure you can find that women asking for pain relief right away tend to ask for a bottle when things get complicated in terms of breastfeeding. And the first-baby effect is sure important.
    Our experience with baby #1: epidural in such a dose that my wife could not feel ANYthing at all; no breastfeeding difficulties whatsoever (at least in the early days).

    Things are changing, even out here in France, and now more and more midwives tell mothers about the Leche League and that we often need help and advice for breastfeeding: it is sometimes less natural than we wish it was.

  9. Helen, I’m sorry that you were made to feel a “failure” – that ties in with what Aphra says about women being made to feel guilty for difficult births, which are in fact triumphs since they rise to healthy babies.

    BlogLily, thanks for your anecdotal evidence of twins behaving differently. Back in the mists of time, I did post about how the myth of being a perfect mother has replaced the myth of being the perfect wife, but perhaps it’s time to revisit that with birthing, babies and feeding in mind.

    YogaMum, I quite agree, both with you, Kareng7 and Z, that other factors come into why breast-feeding can be difficult to establish, especially inexperience of the first-time mother. As a first-time mother, I would have been grateful for some gentle breastfeeding tips for me and my tiny, hungry baby, and all I got was scolding. So hospitals, if they aren’t already, need to improve this side of their service.

    Kit, glad to hear your epidural had a pleasant side-effect! Did you crash when you got home?

    Mandarine, it was mind-blowing for me to discover precisely that, that breast-feeding, which you expect to be as easy as flicking the “on” switch, turns out to be sweaty and difficult. More help and more advice would be good.

  10. Delurking to say — that could be my story. First baby with back labour, agony, eventual epidural, eventual ventouse, huge problems breastfeeding including hours of being up holding him while he howled for food, centimetres from the breast that he would not or could not latch onto. We managed eventually, and I would not give formula even when the baby nurse at my GP told me (wrongly) that I was starving my four week old.

    Second baby, unmedicated birth, no problems at all.

    This is all worth knowing and worth passing on. It’s all hard enough. Thanks.

  11. This may well be true – it’s certainly biologically plauseable. I haven’t read the orginal research, but it should certainly make sure it excludes the confounding factor of a first labour being harder and also more likely to need problems with breastfeeding. Also there is the confounding factor that women who choose not to have an epidural may be the ones who persevere with breastfeeding more.

    I’ll ask the midwives at work if this is something they notice.

    As for more encouragement with breastfeeding. I know we have a ‘breastfeeding support group’ that meets up every morning for the previous days mothers. I don’t know what goes on in there and how supportive they actually are.

  12. I’m glad to hear English hospitals have moved on in the last seven years! There were certainly no support groups in the Middlesex in 2000, or if they were, I wasn’t told. Thanks for persevering, Z, and I would be interested to hear if the midwives have noticed any patterns.

  13. Never got to give birth, so I have no anecdotal evidence from personal experience. I do appreciate the information, though, since I deal with pregnant ladies on a regular basis.

  14. Of course, now I’m wondering if it’s a coincidence that this child has immaturity of the mouth muscles, and lisps and spills her food! I forsee law suits!

  15. How very interesting! My son was back to back with me, too, and I had an epidural, and it’s true he was a windy, colicky, breast-fed baby. I was also a hopeless first time mother, and it’s hard to distinguish everything that went wrong, but I wish I’d known about this at the time. Incidentally, he is also (at age 12) not the clearest pronouncer of words. I do think there’s something in it.

  16. I’ve just asked 5 experienced midwives on Labour ward, they were all together in the office – and the verdict:

    ‘That’s rubbish! we haven’t noticed that at all, if anything the lack of pain sometimes means the Mums can think about breastfeeding rather than pain’!

  17. I had the epidural after thirty hours of labour and it was a very traumatic delivery. After the birth I had constant flashbacks to the horror of it all and couldn’t sleep for ten days. I am sure that this, combined with (lack of?) hormones, was the reason I didn’t produce any milk. I have often asked myself, if I’d had the epidural earlier or had a caesarean or if the birth hadn’t been as traumatic, would I have been able to breast-feed? Those are unanswerable questions, but I have to say, the epidural was the best thing about the birth and it is the one thing I don’t regret.

  18. I was never aware of this before, and might never have been had you not posted on the subject. My birth was traumatic too–for both Mom and me–and the doctors ended up using forceps to drag me out; from what I know, Mom didn’t breast feed past one month. It makes my blood boil every time I read of the complete disregard new mothers are treated with and I’m terribly sorry you had to go through such an ordeal. I’m so grateful that you share these stories here though, because it gives those who’ve been through something similar comfort in knowing they’re not alone, and those of us who’ve yet to confront the situation a far better base on which to stand for the future.

  19. I am in my fifth week of trying to get my fifth baby to latch, and have been through such hell. I can’t help but blame myself when it doesn’t work, I’ve fed her mostly formula with the small amount of expressed breast milk I can produce, also through a bottle, and have read everything printed on why I should persevere with the breast. I always assumed breastfeeding would come easily to me, had no idea people had problems (apart from sore nipples) or that babies couldn’t get the hang of it.

    I had an epidural with my c-section, and the anaesthetist had a lot of trouble getting it in – it took over an hour, while my feet twitched and shot with pain, but the rest of me carried on feeling. Eventually everything went well, but my baby has never managed to latch, not for a second, not for a drop of breast milk. I spent the first three weeks crying solidly about this, now I only cry once or twice a day. My best friend said: ‘Try to remember why you had her’, and I know this is good advice, but it’s hard because there’s so much literature promoting breastfeeding’s benefits, and it certainly does its job in terms of scare stories for those who can’t breastfeed.

    Anyway, I think it is very possible the epidural had an effect, she was a very very sleepy baby and had no idea how to suck for days. But perhaps it’s that c-section babies are more likely to involve epidurals, more likely to be born early (because they schedule planned sections 2 weeks early, they did with mine), so the baby is smaller.

  20. Doh! First baby, not fifth baby.

  21. Victoria, I am so sorry to hear what a tough time you are having. Firstly, don’t beat yourself up if the breast-feeding doesn’t work. In a year’s time you’ll be remembering smiles and first meals and toddly steps and this will be a distant memory. Secondly, have you had any assistance from a breastfeeding expert, either a midwife (someone you really like and trust – don’t tolerate the company of anyone who is toxic to you) or a lactation consultant (do they exist in the UK) or La Leche League.

    The one thing that helped my non-latching firstborn was to lie down to feed. It was against my principles, but it worked – she found breast access easier, I was less sweaty and anxious and we both slept, which was lovely. The experts all say you’ll create a habit around feeding, but you know, she’s six now and she doesn’t need to lie down with me to go to sleep AND we have a beautiful, close relationship. Try it. It may help. Feel free to e-mail me if you want to talk it over further. This is a subject close to my heart.

  22. Has anyone actually read the research? It’s pretty poorly undertaken. The theory that fentanyl is the cause of poor breastfeeding is just that – a theory! By far the most likely cause is that people who are less likely to request an epidural are more likely to persevere with breastfeeding. (See post no.6 from ‘Z’. Anyone who works on a delivery suite will agree with her)

    Many women who do not have an epidural have opioids via another route – often intramuscular pethidine or diamorphine which will also cross the placenta. Quite how epidural opioids are more likely to affect feeding than intramuscular, I have no idea and the researchers didn’t even consider it.

    I am all for more support for breastfeeding mothers and more research into drugs used in pregnancy and childbirth but this research really tells us nothing and has been very sloppily reported by the media.

    Please don’t let this rubbish affect your choices when it comes to pain relief during labour!

  23. i’m confused. you initially say you gave birth twice with no pain relief, but with your first you had an epidural? huh???

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s