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?