When I was early into my lactation career, I worked in a local hospital in the postpartum unit. It was pretty busy there, we supported a lot of new families and helped them get off to the best start possible with their baby. After a while, I started to realize there seemed to be a real connection between how a baby was brought into the world and how breast/chest feeding was progressing. The more families I saw, the more it seemed that those struggling the most with breast/chest feeding were those who received epidural anesthesia during labor. This wasn’t always the case, but the link was there.
I became increasingly aware that epidural anesthesia not only affected the baby, but the circumstances surrounding a medicated birth may include increased fluid volume, increased duration of labor, or increased instrument delivery. All of these interventions have the potential to increase breastfeeding problems from the start.
As I progressed through my master’s program, I decided it would be worthwhile and educational to do my thesis on how epidurals impact breast/chest feeding, if at all. I was curious and wanted to learn more, and I thought maybe others would want to learn more as well. I was also a childbirth educator and spent a lot of time talking with families preparing for birth. Does epidural anesthesia really impact breastfeeding success? I wanted to know how to successfully breastfeed after epidural anesthesia. Maybe I could learn some valuable information that I could pass along.
What Is An Epidural?
If you aren’t sure what is involved with an epidural, here’s your basic definition. Epidural anesthesia is a regional anesthetic that blocks nerve impulses from lower spinal segments. Epidural anesthesia can be produced using a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are usually combined with opioids or narcotics such as fentanyl and sufentanil. Regional anesthetic is injected between the vertebrae in the spine using a catheter. The catheter is then secured to the back until after delivery. The type of medication used could depend on where you are giving birth or the provider administering the medication.
Why Get An Epidural
Why do some birthing parents choose to get an epidural? Several reasons, here are a few of the most common reasons to opt for epidural anesthesia for pain relief.
Rest
Epidural anesthesia can help the birthing parent rest. This can be especially helpful if labor is long, and the birthing parent just needs a break. An epidural should not be a replacement for birth support, however, so keep your support system close by.
Pain
Let’s face it, pain is subjective, and some people are better at handling pain than others. In my time working with new families, I have had some tell me they would opt for pain relief as a last resort. I have also had some tell me they want to know their options for pain relief as soon as contractions start. It’s important to know where you stand with pain, as this will make a difference in your decision. Some families report pain relief during labor led to a more enjoyable birth experience.
Feeling More Alert
When considering pain relief during labor, one of the nice things about an epidural is you can be awake and alert for the birth of the baby. Other pain-relieving medications can make you feel sleepy or groggy, but most birthing parents find that an epidural helps them feel attentive. This is important for decision-making, interacting, and being an active participant in your labor.
Side Effects
Most medications come with side effects, and an epidural is no different. Some feel that the benefits of an epidural outweigh the side effects, but it’s good to be informed.
Some common side effects are itching due to the medication, fever, decreased blood pressure, and breathing problems. These side effects can be managed with medication, IV fluids, and oxygen. The medication in the epidural does cross the placenta to the baby, which may lead to latch and suck problems after birth.
IV Fluids
It is common to receive more IV fluids when you have received an epidural. Increased fluids can lead to edema or swelling in the breast tissue. This can make it difficult for babies to latch effectively and comfortably. Some refer to this as engorgement. IV fluids are usually involved even if an epidural isn’t in the picture, but the fluids tend to be more in volume when an epidural is in place.
Operative Delivery
Epidural anesthesia has been linked to longer second-stage labor (the pushing phase) and increased operative delivery. Operative delivery is when the baby is born using forceps or vacuum. These devices can lead to birth trauma or birth injury, which may make it difficult for babies to breastfeed.
Additional Support
Researchers found that families who receive additional support during the early days of breastfeeding are much more successful. This is especially true when the birthing and breastfeeding parent experienced an epidural during labor.
Skin To Skin
Ask to have your baby placed skin-to-skin with you as soon as possible after delivery. This will help the baby to transition, regulate breathing and body temperature and initiate breastfeeding soon after birth. Skin to skin is kind of a cure-all, so make that the answer to everything in the newborn days. Baby’s fussy? Skin to skin. Not feeding well? Skin to skin. It fixes everything.
Lactation Help
Utilize the lactation consultants in the hospital as much as you can. Even if you feel like things are going well, make sure a lactation consultant observes a feeding. Ask a lot of questions. If you can’t see a lactation consultant or if the hospital doesn’t have one available, make sure you talk with your nurse about any breastfeeding questions you might have. Make an appointment with a lactation consultant in the first-week postpartum. This is one of the most important ways to ensure successful breastfeeding after epidural anesthesia.
Feed On Demand
Feed the baby as soon as they show signs, and make sure to wake the baby frequently for feeds as well. Frequent feedings will help you stay comfortable as milk is coming in, promotes a healthy milk supply, and helps the baby (and you) practice breastfeeding.
Be Educated
Being educated about medicated deliveries is probably the most important part of a medicated delivery. Make sure you are aware of side effects for you and for baby and what your options are. Ask your provider what other medications are available, or what comfort measures can be used. Consider hiring a doula to assist with your birth. Doula support can decrease the chances of medicated deliveries and cesarean deliveries. You will likely need additional breastfeeding support if you decide on an epidural.
The Bottom Line
Epidural anesthesia is a common form of pain relief. If you choose an epidural, that does not mean you cannot breastfeed, or that you will have horrible side effects. These are possibilities, and it is really important to be aware of everything that can happen. Learn all you can about epidurals before going into labor so you can make an informed decision.
