Guest Author - Nicki Heskin
While epidural anesthesia is often though of as a no-risk or low-risk procedure, there is generally little discussion of the affect of epidurals on breastfeeding (for a general discussion of these effects of epidurals, see my related article, Epidurals and Breastfeeding, linked at the end of this article). When I had my epidural for the birth of my first daughter, my biggest concern at the time was about possible post-partum headache. This seems to be the conventional concern of mothers getting the epidural, but in the throes of labor, many women are willing to take that chance.
But if I had known about the months of pain and stress I would have to endure in order to establish breastfeeding, the weeks of worry over my daughter's rapid weight loss and slow gain and the money I'd have to spend on breast pump rental and lactation consulting (still WAY less than even a few months of artificial milk), I'd have wished for the headache – not to mention gladly "suffered" the unmedicated contractions. I put "suffered" in quotes because having also now had an unmedicated labor with my second daughter, I actually found the pain, inconveniences and postpartum effects (not even counting the effect on breastfeeding) of the epidural to be much worse than labor itself. I write this because I only wish someone had told that to me beforehand.
In my case, I actually had a largely unmanaged labor, aside from the epidural itself. I never had pre-delivery pitocin or had my water broken. But because I had planned on the epidural, I did accept the hep lock in my arm, which caused constant pain. Now while this is not normal, when I complained, I was treated as annoying and told it was supposed to be mildly painful. When I said it wasn't mild, I was ignored. I mention this not only because it made labor more unpleasant, but also because I had a large bruise on my arm for days after the baby was delivered that actually made it difficult to hold and nurse my baby.
I waited to have my epidural until I had reached 5 ½ cm dilation. My goal was to go "as long as I could" so the epidural would be less likely to slow my labor. It worked. In fact, the relaxation the epidural created in my body seemed to speed up the second half of my labor, which had gone nowhere for a couple hours previous. This information was portrayed as proof of the value of an epidural by the nurses, and certainly seemed like a good thing at the time. (Incidentally, I have since learned that there is a natural "plateau" in labor where it is normal for dilation to pause. Presumably, the body is preparing for the baby's arrival in other ways during this time. Hospitals often do not recognize this phenomenon and treat this "failure to progress" as need for a myriad of possible interventions.)
However, as labor is still a bit of a mysterious process, interference can lead to unexpected results. In retrospect, it appears that the unnatural speeding of labor may have been responsible for stressing the baby into releasing meconium into the amniotic fluid. The meconium was light, but enough to alarm the pediatrician when my water broke naturally upon pushing. As a result, the baby was taken from me at birth and suctioned with a tube down her tiny nose and throat, just in case she had aspirated any of the meconium.
While they had the baby for the suctioning, they scrubbed, weighed and wrapped her. By the time they were done, I was halfway through my very cold, contraction-inducing post partum bag of pitocin. This is routine after labor in many U.S. hospitals to reduce the likelihood of hemorrhage post-delivery. While that also sounds like a good thing, such events are pretty rare, and the pitocin is actually artificially mimicking a process that is generated naturally in the body by nursing immediately after delivery. I was cold, miserable and shaking and in no state to try nursing, and didn't want to meet by baby that way. Ironically, the artificial treatment, pitocin, had precluded the natural one – nursing immediately after delivery.
So it was a while before I even attempted our first breastfeed, which seemed to go okay, as much as I knew. But then I had to have my epidural tube removed, stitches put in and any number of other requirements and monitoring by the nurses as a result of the anesthesia. During this time, the baby went into a deep sleep, which seemed convenient since so much needed to be done. It was only then that we were moved into the post partum wing to begin the process of recovery and establishing breastfeeding. I'll continue with that in my article "Epidurals and Breastfeeding – My Challenges" linked below.
Is it possible that all these labor issues would have occurred without the epidural? Sure. Can it be proven that the epidural caused my problems. Not with any certainty. But is it likely that the epidural caused or contributed to many of my challenges. Absolutely. Am I sorry that I ever had one? Yes, yes and yes again. Having also now had a natural, unmediated labor and an absolutely beautiful, uninterrupted initiation of breastfeeding, I feel like an absolute sucker for falling for the "I can't handle (or shouldn't *have* to handle) the pain" mantra of today's obstetrical world.
I would encourage any woman who plans to breastfeed, but especially those facing potential *known* breastfeeding challenges like flat or inverted nipples or implants to consider an unmedicated birth. Not all labor interventions can be avoided, and to be sure, some interventions save lives of mothers and babies, but a planned natural labor is the best chance for helping to ensure that the baby's natural instinct to nurse is uncompromised after labor.
Interested in more information on the issue of medical management of labor? Here's a great book and movie on this important topic.
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