Booby Traps Series: “Epidurals don’t affect the baby,” and other myths about labor medications and breastfeeding

This is the 14th in a series of posts on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

When I had my second baby last year (a VBAC), my midwife put her directly on my chest.  And for a little more than an hour I waited to see if she’d self attach, or at least attempt to.  After it seemed clear that she wasn’t going to, I said off-handedly, “Well, I guess it was less likely because of the medication.”  Like 76% of mothers (2006), I had had an epidural.  My midwife responded by saying, “It shouldn’t matter because epidurals don’t cross the blood brain barrier.”  In other words, my baby shouldn’t have been affected by the medication.

I knew at the time that this was wrong, and when I got home I checked my bible on matters of birth and its relationship to breastfeeding.  Here is what the exhaustively referenced The Impact of Birthing Practices on Breastfeeding, by Linda Smith, has to say:

Injections into the epidural space are quickly detectable in cord blood [evidence of medications in the baby's circulatory system, which means they reach the brain]….Pain relief drugs cross the placenta and reach the fetus/infant very quickly, in a matter of seconds to a few minutes…The drugs tend to sequester in the infant brain tissue and affect central nervous system function.  The drugs are designed to numb sensory nerves in the mother; therefore, they also affect sensory and motor nerves in the infant that affect rooting, sucking, and breathing.

Linda Smith also cites a study which found 69.9% of mothers who had epidurals showed successful breastfeeding behaviors on day one, compared to 81% of mothers who had not.  And other studies have found diminished early suckling, early feeding behaviors, lower rates of breastfeeding in the first 2. 5 hours.  Linda described one study of infant feeding behaviors in a email to me:

The randomized, double -blind, controlled study of epidurals measured infant behavior in mothers who received high-dose fentanyl, low-dose fentanyl, or no fentanyl. Neither the person administering the drug, nor the mother, nor the person recording the baby’s behavior knew which dose she received. The more of the drug that the mother received, the more negative effect on the baby’s behavior.

Now, I know you’re thinking: “I had an epidural and breastfeeding went great, still going strong.”  Or maybe, “I didn’t have any drugs and my baby had trouble breastfeeding anyway.”  All of those experiences are possible outcomes of medication use/non-use.  But it’s in the research where we get the information we need to make recommendations, figure out policies, and prepare ourselves as mothers.  And it’s this information which we need to make sure mothers get – evidence-based information – otherwise, it’s just another Booby Trap.™

There are other myths about medication use.  One common one is that once medication has worn off in you it has also worn off in your baby.  Not so with a number of drugs, unfortunately.  The pediatric half-life (a measure of the duration of a medication in your system) of many labor medications is higher than the maternal half-life, which means that they may affect your baby’s ability to breastfeed after you no longer feel the effects.

Another myth is that there are forms of medication which don’t get to the baby.  When I posted this podcast interview with Linda, a mom from the UK wrote in to ask about “gas and air” (nitrous oxide), which is more commonly used where she lives.  Linda replied, “All drugs taken by the mother during labor, by any route, reach the baby/fetus in a matter of seconds to a few minutes.  Repeat: all drugs taken by the mother during labor reach the baby.”

Another myth is that there is a standard epidural which all anesthesiologists use.  I believed this until I heard mine talking about a certain “combination” which he personally preferred (a strange thing to hear as a needle is being inserted into your spine).  The truth is that epidurals can vary, both in terms of the medications used and the dosage.  And of course the dose you and your baby get depends on how long you have one.  Knowing this matters because the amount of medication does matter.  A 2005 study found a “dose response relationship between intrapartum neuraxial opiod analgesia and infant feeding.” (quoted in Smith).

There are other consequences of epidurals which can affect breastfeeding, most notably the “cascade of interventions” which can ultimately lead to cesarean birth.  Epidural use also raises the risk of maternal fever, infant fever, and consequent separation of mother and baby for evaluation and treatment.

Now, if you do use pain medications in labor, you can certainly go on to have a wonderful breastfeeding experience.  I’m an example of that, in fact!  But we believe that 1) you deserve to know what the evidence says about labor medications and breastfeeding, and 2) you deserve support should you experience breastfeeding difficulty, for this or any other reason.

I’m a great example of successful breastfeeding after labor medication use.  But my experience also matches up with the research.  After I had an epidural I had a fever, as did my daughter.  This resulted in extra evaluation of myself and my baby, my daughter’s treatment with antibiotics, and a prolonged hospital stay.  I’m a lactation consultant and can give myself all plenty of support, but obviously not everyone is so lucky.

Did your medication use (or non-use) affect your breastfeeding experience?



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17 Responses to Booby Traps Series: “Epidurals don’t affect the baby,” and other myths about labor medications and breastfeeding

  1. Larissa says:

    Next post? How infant circumcision negatively impacts breastfeeding and bonding. (This is well documented.) Please. Thank you.

    • Ashley says:

      I second the vote for circumcision as a “Booby Trap”. 75% of baby boys have breastfeeding difficulties following the surgery. That a big booby trap that could be easily avoiding if mother were properly informed.

      • Lauren says:

        I third! There’s a letter to LLL that has been sent asking them to do a better job of educating the public about the effects of circumcision on breastfeeding. Fortunately our daughters don’t have to worry about this, don’t our sons deserve the same?

  2. Don’t forget the effect of the IV fluids that are part of epidural anesthesia. It’s not just the drugs that are a challenge to early breastfeeding. The breasts being overly taught and distended with edema can make initial attempts at breastfeeding much more difficult and contribute to poor latch and feeding.

  3. Mria says:

    Getting an epidural did not affect my breastfeeding. I actually breast fed my first for almost three years and my second for a year and had to stop because I became pregnant with my third. Breast fed him for over a year too!

  4. Áine says:

    Thank you for highlighting this drawback to medicated births. I had no idea of any drawbacks when I gave birth. Luckily I succeeded in breastfeeding my son who is almost two and still going strong. I am certain that the birth was longer and much more complicated due to my having an epidural. I also identify with those breastfeeding obstacles in the early days and feel these were also due to the epidural.

  5. C says:

    Epidurals are probably the most common drug used, but in my case not only did I have an epidural in the hopes that it would even out my blood pressure, but when that didn’t work I ended up having magnesium sulfate. They *know* that affects babies – which is why an anesthesiologist needed to be on hand when my child was born. Worse yet, once you deliver, you still need to take the drug for 24 hours. I had lots of problems breastfeeding after delivery – mostly because both my child and I were sleepy from the drug, and I didn’t realize that we weren’t feeding often enough until she was terribly frustrated from hunger.

    • E says:

      If your blood pressure was high, that can be extremely dangerous for you- preeclampsia etc, so most likey they had to give you meds. There is no choice there. That can be a life & death issue.

  6. AnnS says:

    24 hours after birth of my 4.5 week preterm daughter, I was with a LC in the hospital whom I had never met. She observed my newborn nursing quite well for a new baby and said without hesitation “you did not have an epidural, did you?” and I said, ‘No” and she said “you did your baby a great favor by not doing so.” I also had an unmedicated birth with my son and he, too, nursed well, once we got past the initial postpartum period. I’m still convinced he was a bit ‘stuck’ and it affected his latch, though.

    • SarahJane86 says:

      I had an 8 week premature baby with an epidural. She came out SCREAMING, never needed any breathing support and she nuzzled with in the first 24 hours and started feeding at 35 weeks and by 35+6 was home where she belonged.

      She gained weight at an average rate of 250g per WEEK and once gained a whole pound. By 6 months she was average weight for her actual age and at 2.5 she is in the 88th percentile for height and the 65th for weight. We weaned at 15 months due to complications with my second pregnancy, but I had planned to tandem feed.

      That baby was born at term without an epidural, took a while to start screaming and was a sleepy, lazy feeder who often pasued breathing and once turned blue. He is now one and still breastfeeding, but still a lazy snack feeder who is only in the 45th percentile for weight for age despite being in the 75th for height.

      To say that that in NICU, where PSTD and guilt are frequently the order of the day was disgusting and irresponsible of that LC and I feel sick thinking that a mother whose baby was struggling to feed that had the type of terrifying emergency birth that often goes with prematurity might of heard that, especially as with prem babies epidurals have far, far less to do with feeding success than gestation, weight, reason for birth, use of bottles, dummies and NG tubes do. FTR, both my children used dummies from under 24 hours old, never had an ear infection and both are streaks ahead verbally for age.

      Good for you, but I hope you don’t share that story with too many other prem mothers.

      • E says:

        That sounds like you were the exception. You were extremely lucky that your preemie did so well. And it generally is better to have preemies without an epidural because the labor goes faster, and it’s best to get the preemie out quicker. I had a 25 weeker without an epidural, who also was born crying and breathing. Of course he was immediately intubated, because a baby that young will tire quickly. We were all lucky to have a vaginal birth at all. Many preemies are automatic c-sections. So really, epidural or not, we were all lucky.

  7. JoAnn Finger says:

    The epidural didn’t affect my daughter but Demeral affected my son big time. He slept for 2 days straight, refused to nurse and got dehydrated. He had to stay in the hospital an extra night because of excessive mucus in his lungs and dehydration. I finally asked for a bottle which the poor baby DOWNED and I was able to bring him home and nurse… But he was my first and going home from the hospital without him was very sad. Now he has asthma and sometimes, I wonder if it’s related… Would he have been able to clear the mucus on his own if he wasn’t so lethargic? Did the mucus affect his lungs? I don’t beat myself up, I just wonder… Never again with the Demeral.

  8. Joe Jackson says:

    Just wanted to add a quick comment. Anesthesiologists are your advocates during labor and delivery regardless of whether or not you want an epidural. PLEASE ask us questions if you have concerns. We want nothing more than for you to have a safe and pleasant experience. And if complications arise, we are here to help!

    • Leigh says:

      I am glad to hear you say that Joe, but unfortunately at my hospital that is not the case. The anesthesiologists and CRNAs roam the halls trying to sell their services (to patients, nurses, students…) They never mention the negative effects of epidurals on breastfeeding (and I don’t know if they are aware of the correlation). The only information they provide is epidurals and how “safe” they are. Yes, mothers rarely die from epidurals but they have many other side effects never mentioned. I don’t think mothers are truly able to have informed consent from someone “selling” an epidural. I don’t know who is truly an advocate for breastfeeding! I wish I could say nurses… but as a profession we have routine practices that negatively interferes with breastfeeding too!

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