Monday, December 11, 2006

Epidural anaesthesia and breastfeeding

A study published in the International Journal of Breastfeeding has found a link between epidural anaesthesia and unsuccessful or hard-to-start breastfeeding.
This link is not new: a study in 1997 found much the same link.
This one blames the effects of fentanyl, the opoid often used in epidurals, on the baby.
To put it bluntly, the fentanyl dopes the baby up.
This is bad news as women have, in my experience, been consistently told by the medical profession that the epidural does NOT cross the placenta.

http://www.timesonline.co.uk/article/0,,2-2497626,00.html
Meanwhile in a sidebar to this report, Dr Thomas Stuttaford makes some comments which badly need scientific back up, though he does not provide such. According to him, the epidural is marvellous because it "increases bonding" between mother and baby!!!
I wonder what evidence he has for this? In my experience a mum who has had a theatre forceps delivery or emergency c-section because of the difficulties caused by her epidural finds bonding a bit more difficult than an empowered, oxytocin-sodden mum who has felt in touch with her body throughout her labour.
I've checked on PubMed and I cannot find any study which backs him up, except those which show that C-section mums find it easier to bf and bond after a local epidural anaesthetic as opposed to a general anaesthetic. Well, Duh!
I find Dr Stuttaford's lack of concern for the possibility of a baby being UNABLE TO LATCH ON PROPERLY after birth seriously worrying!!!!
In the past I have also seen him brush aside the danger of an instrumental delivery, increased by having an epidural, as an unimportant concern. (70% of primips who have an epidural end up with an instrumental delivery)
Since there is now concern for the short term effects of forceps and ventouse on a baby's comfort, I am puzzled by his very cavalier attitude to epidurals and instrumental delivery.
I seriously wonder if Dr Stuttaford has ever seen a natural birth where a woman was in a quiet, safe environment, allowed to labour in positions of her own choice, with caring, unobtrusive support?

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