NURSING Messages: Re: Epidurals and other factors related to Breastfeeding (LONG)

Re: Epidurals and other factors related to Breastfeeding (LONG)
From: Teri Walsh, RNC (ktwalsh@lvcm.com)
Sat, 23 Nov 2002 05:24:06 -0600 (CST)

Messages sorted by: [ date ][ thread ][ subject ][ author ]
Next message: jared_brown@und.nodak.edu: "Re: info on C-section attendance"
Previous message: Teri Walsh, RNC: "info on C-section attendance"
In reply to: jared_brown@und.nodak.edu: "Epidurals and other factors related to Breastfeeding (LONG)"

At Mon, 16 Sep 2002, jared_brown@und.nodak.edu wrote: >
>> Jared, I read you reaserch with interest. I am an OB nurse and have been since 1978. Until 1991, I worked with mothers who did not have access to epidural anethesia. The only analgesia was IM Or IV Meds. Our C-setions recieved either spinals or generals. In 1991, I move to a large metropolitan city and was exposed to epidurals and many other intervensions. I can tell you that from personal experience that from 1978-1991, I observed fewer problems with mothers breastfeeding especially at the beginning than I have in the years since. The big difference being epidurals. There are articles out there in midwifery that talk about the effects of epidurals on breastfeeding and I mean nurse midwives. I guess that I tend to believe that epiduals do cause problems at the beginning and that requires alot of teaching and work with the mothers to keep them interested and not discouraged. It is sad though for those mothers who become discouraged and quit. I realize that your research shows that this is a small number but as the benifits of breastfeeding are becoming more and more apparent that small number becomes important! Hi. My name is Jared Brown and I am nursing
>> student at the University of North Dakota. For my childbearing class
>> we are assigned to register to an OB website that offers
>> discussion. We are to look at the topics that have been discussed
>> and contribute our own knowledge to the topic using researched
>> references.
>> I see that people are asking about if epidurals
>> contribute to a difficulty in breastfeeding. This topic seemed
>> interesting to me because from what I know, both are highly
>> encouraged to pregnant women. However, if one contributes an
>> adverse reaction to the other, then why are both encouraged. So I
>> did a little research to find out some facts.
>> Halpern, et al., (1999)
>> asked the question: Does intrapartum analgesia influence
>> breastfeeding success at 6 weeks postpartum in a setting that
>> strongly supports breastfeeding?÷. The study consisted of 171
>> healthy females that completed the study. Demographic data, labor
>> induction status, delivery mode, and analgesic medications were
>> recorded. At 6 weeks postpartum patients were asked to describe
>> breastfeeding use, problems encountered, solutions derived,
>> sources of support and information, and satisfaction. The results
>> of this study showed that 59% received epidural analgesia, 72%
>> breastfed fully, and 20% breastfed partially (>50% of infant
>> nutrition) at 6 weeks postpartum. A correlation between
>> breastfeeding success at 6 to 8 weeks and labor analgesic was
>> not demonstrated. This study concluded that in a hospital that
>> strongly promotes breastfeeding, epidural labor analgesia with
>> local anesthetics and opioids did not impede breastfeeding success.
>> Chapman and Perez-Escamilla (1999) focused on (Identification of
>> risk factors for delayed onset of lactation÷. They focused on
>> infant feeding, socioeconomic demographic, and delivery related
>> factors that affect women s self-reported timing of the onset of
>> lactation. They did phone call surveys starting on day 1
>> postpartum until self-reported onset of lactation occurred. Daily
>> phone calls were made regarding infant feeding methods, breast
>> symptoms, and perception of onset of lactation. One hundred
>> ninety-two women with healthy term infants completed the study.
>> ("Because of the limited information collected on anesthesia and
>> the confounding of use of spinal anesthesia with scheduled
>> cesarean deliveries, it was not possible to draw conclusions
>> regarding the effect of anesthesia type on the timing of onset of
>> lactation÷" (Chapman & Perez-Escamilla, p. 453)
>> However, the study did conclude risk
>> factors related to the delayed onset of lactation to be
>> white/Hispanic ethnicity, heavy/obese body build, delivery by
>> unscheduled cesarean delivery, vaginal delivery with prolonged
>> stage 2 labor, infant birth weight less than 8 lb., and exclusive
>> formula-feeding before the onset of lactation. Additional breast-
>> feeding support and teaching is suggested for women with these
>> type of risk factors for delayed onset of lactation.
>> Riordan, Gross, Angeron, Krumwiede, and Melin (2000) performed a
>> study focusing on the effect of labor pain relief medication on
>> neonatal suckling and breastfeeding duration÷. This study
>> consisted of 129 mother-infant dyads that had term vaginal births
>> with baby weight 3477 +/- 479 g, and the mothers' age ranging
>> from 24-32 years of age. Lactation consultants used the Infant
>> Breastfeeding Assessment Tool IBFAT which consisted of infants
>> readiness to feed, rooting, fixing, and suckling during a quiet
>> time in each mother's hospital room. A higher IBFAT score
>> represented more vigorous, effective suckling. Comparisons were
>> made between IBFAT and type of labor medication received 1. no
>> labor medication 2. only epidural analgesia 3. only intravenous
>> analgesia 4. both epidural and intravenous analgesia. Study
>> results indicated mothers receiving no labor medication resulted
>> in infants scoring high on IBFAT, mothers receiving only epidural
>> or intravenous labor medication resulted in infants scoring medium
>> on IBFAT, and mothers receiving both epidural and intravenous
>> labor medications resulted in infants scoring low on IBFAT. A
>> direct correlation between the use of any epidural analgesia and
>> the duration of breastfeeding at 6 weeks was not shown. The study
>> concluded that labor pain medications have a negative affect on
>> early suckling and more teaching and support is needed for those
>> women using labor analgesia.
>> In my research on this topic of epidurals related to
>> breastfeeding I have found (no definitive research results
>> correlating epidural analgesia with) a decrease or difficulty in
>> breastfeeding. The Halpern, et al. (1999) and Riordan, et al.
>> (2000) research studies did not find a relationship between
>> epidural labor analgesia and duration of breastfeeding at six
>> weeks. However, through my reading of the cited articles I learned
>> that women at risk for either early suckling difficulties or
>> delayed onset of lactation need additional breastfeeding support
>> and education. If you ask me, all pregnant women, with or without
>> risk factors, should be getting the appropriate support and
>> teaching needed for breastfeeding.
>> Please feel free to respond to my comments or if you have
>> additional information please share it with us. I hope this helps
>> with your question on epidurals and breastfeeding and I hope to
>> hear your comments.
>>
>> Thank you, Jared Brown, College of Nursing, University of North
>> Dakota.
>>
>> Reference:
>> Riordan, Gross, Angeron, Krumwiede, & Melin (2000). The Effect of
>> Labor Pain Relief Medication on Neonatal Suckling and
>> Breastfeeding Duration. International Lactation Consultant
>> Association, (1)16, p. 7-12.
>>
>> Chapman & Perez-Escamilla (1999). Identification of risk factors
>> for delayed onset of lactation. Journal of the American Dietetic
>> Association, (99)4, p. 450-454.
>>
>> Halpern, Levine, Wilson, MacDonell, Katsiris, & Leighton (1999).
>> Effect of Labor Analgesia on Breastfeeding Success. Birth, (26)2,
>> p. 83-88.
>>

-- Thank you! Teri Walsh, RNC

Next message: jared_brown@und.nodak.edu: "Re: info on C-section attendance"
Previous message: Teri Walsh, RNC: "info on C-section attendance"
In reply to: jared_brown@und.nodak.edu: "Epidurals and other factors related to Breastfeeding (LONG)"

recommended search...

OBGYN.net forums endometriosis zone Web

use when must restrict search to only the nursing forum...

Enter search keywords:
Returns per screen: Require all keywords:

Return to Technical Problems: webmaster@obgyn.net
Last Updated: Mon May 19 17:09:14 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.

Women's Insurance Checklist from Auto Insurance Quote

Enter search keywords:
	Returns per screen: Require all keywords: