Guest Author - Nicki Heskin
Epidurals during labor can lead to increased challenges for breastfeeding. While epidurals are often thought of as a low-risk procedure, and as common as 90% or higher in some hospitals, both normal and unintended results of epidurals can make breastfeeding more challenging or more painful.
Epidurals Require Fluids
In any childbirth preparation class that covers epidurals, they'll explain that before an epidural can be given, the patient must first receive a bag of fluids via IV. Sounds harmless, but the reason for this is because epidurals lower blood pressure, and increasing fluids can combat that effect.
Anyone who has had an epidural may also remember the annoying, seemingly constant blood pressure cuff meant to monitor pressure levels, and fluids are given as needed to keep pressure constant. Over the course of a long epidural, this can add up to an extremely high level of fluids.
Some of this fluid will be removed from the body through everyday means of elimination like peeing and sweating. But much of it will take days to exit the body, and travels with gravity to bodily extremities such as hands, feet, and yes, the breasts. This phenomenon is known as 3rd spacing of fluids.
Breasts can become swollen with fluid making it difficult for the newborn to latch. There are strategies can help with this in many cases. However, those with flat nipples, inverted nipples or other structural issues that can be overcome with assistance may find establishing breastfeeding to be even more of a challenge.
Epidurals Lead to Other Birth Interventions
A study published in 1986 in the International Breastfeeding Journal (linked below) showed lower levels of breastfeeding success in the first week after birth and lower rates of women still breastfeeding at three months for women who had epidurals in labor. Anecdotally, many lactation professionals will tell you they can recognize an "epidural baby" almost immediately – sleepy, with reduced interest in nursing and disorganized sucking patterns (one of the first comments my LC made when I brought in my daughter was "you had an epidural in labor, right?").
Some of this is because, in some cases, epidurals can lead to other, more serious interventions such as c-sections, forceps deliveries and vacuum extractions. Less serious but also important effects might be longer pushing times, increased perineal tearing (due to decreased sensation and control in pushing) and general post-birth attention to the procedure when the mother's attention should be turning towards the baby and breastfeeding.
Epidurals can also interfere with the normal process of labor, speeding it up or slowing it down and causing stress on mother and baby. While my epidural labor with my first daughter was relatively uncomplicated, I have come to understand that our early breastfeeding troubles were likely exacerbated by that epidural (for details on this see my article "Epidurals and Breastfeeding – My Experience," linked below – coming soon).
Early breastfeeding difficulties and poor latch can certainly be overcome, but can lead to unnecessary pain and stress for a new mother. Having now done a natural labor as well, I'd argue the pain with my first epidural baby much was worse and over a longer time period than the pain of labor itself! A procedure meant to eliminate pain can, ironically, lead to more pain in childbirth recovery and breastfeeding than it avoids in labor.
So in short, yes, epidurals can and do affect breastfeeding. While this "revelation" may not significantly lower the epidural rate, it is a genuine risk of the epidural that needs to be more commonly discussed. I believe that women who are serious about breastfeeding or already may be facing challenges due to other issues should at least look with a more critical eye on the decision to prepare for natural or for medicated labor.
If you are interested in considering or want to learn more about natural or unmedicated childbirth, I strongly recommend labor preparation. We used the Bradley method for our second daughter, and its lessons about the physiological course of labor as well as methods for handling labor itself were absolutely invaluable. See the link below for information on finding a Bradley instructor in your area. I also found two books to be essential reads, and give them as gifts to anyone considering natural childbirth – The Birth Book and Ina May's Guide to Childbirth (see below for links). I actually think that The Birth Book is important for anyone, regardless of childbirth plans, and Ina May is especially great for natural birthers, water birthers or home birthers.
Disclaimer: All material on the BellaOnline.com Breastfeeding website is provided for educational purposes only and does not constitute medical advice. Although every effort is made to provide accurate and up-to-date information as of the date of publication, the author is neither a medical doctor, health practitioner, nor a Certified Lactation Consultant. If you are concerned about your health, or that of your child, consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation. Information obtained from the Internet can never take the place of a personal consultation with a licensed health care provider, and neither the author nor BellaOnline.com assume any legal responsibility to update the information contained on this site or for any inaccurate or incorrect information contained on this site, and do not accept any responsibility for any decisions you may make as a result of the information contained on this site or in any referenced or linked materials written by others.