Mothers –to- be who may be considering having epidurals in order to relieve labor pains may decide to rethink their choices after reading the report published in the International Breastfeeding Journal.
It details the findings of a recent study by researchers in Sydney. They studied 1280 women who had children between March and October in 1997. Of these women 416 had epidurals and 172 of those having the pain-killing medication also had Caesarean sections.
The team found that mothers who decide to have an epidural in order to relieve labor pains have a greater chance of problems in the first week after birth and may be more likely to stop breastfeeding earlier than usual.
They are also now of the opinion that the chemicals, bupivacaine and fentanyl, which is an opioid, present in epidurals may have an adverse affect on the unborn babies. They suggest that some of the drugs used enter the bloodstream and cross into the placenta to reach the fetus. They can affect the unborn infants' brains and make them over sleepy and less disposed towards breast-feeding.
Dr Siranda Torvaldsen, leader of the research team, remarked that there was a growing body of evidence to show that “the fentanyl component of epidurals may be associated with sleepy infants and difficulty in establishing breastfeeding.”
Dr Torvaldsen stated that some newborn babies had lost their "sucking co-ordination" if the mother had an intra-muscular injection of the pethidine in the last half hour of a normal delivery.
Ninety three per cent of the women who were studied breastfed their babies in the first week. But 75% of those who had no analgesia was still breast-feeding at six months whereas only 53% of those who had received epidurals or pethidine were.
Having an epidural involves the insertion of a catheter into the spine to permit the blending and infusion of pain-killers that numb the nerves of the lower body and legs.
A similar study of women at Toronto University, Canada, found that 177 were less likely to breast-feed were they to be given an an epidural with fentanyl.
If these findings are confirmed they may compel physicians and patients to reconsider using them.
Pat O'Brien, a spokesman for the Royal College of Obstetricians and Gynaecologists, agreed that there was a possibility of fentanyl affecting an infant, but he continued that other factors too may explain this link. He felt it could just be that if a woman decided not to have an epidural she may also decide to continue with breast-feeding.
The fact was that many of the women who had epidurals also had C sections which often makes it difficult for a patient to lift a weight such as the baby. This could be a reason for some women preferring to bottle-feed rather than breast-feed.
He reiterated that there are obvious benefits to having an epidural and said that the findings merited further investigation, labeling it as " yet a theoretical concern."
Senior lecturer in applied therapeutics, Swansea University, Dr. Sue Jordan, regards the effect of opioids and epidurals on breast-feeding as “an adverse drug reaction”.
Jordan also bemoaned the lack of research into how epidural drugs affect newborns.
Some of the known adverse side effects of epidurals on the mother are lower blood pressure, a slower than normal birth process and greater chances of perforce having a forceps delivery.
An expert from the UK however cautioned against unnecessary worry with regard to this. Around 20% to 40% of UK women have epidurals inserted at the time of labor.
It was suggested however, that women should be made aware of this effect when considering their options for labor and those who fall into this category should be given enough assistance and support in the initial postpartum and in the following few months.
