Epidural babies can't get grip on what's breast

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breast feedingWOMEN who give birth with the aid of pain-relieving epidurals find it harder to breastfeed than those who give birth naturally, an Australian study has found.

The research suggests some of the drugs used in epidurals make their way into babies' bloodstreams, subtly affecting their brains and development for weeks afterwards -- including making them less willing to breastfeed. The study by University of Sydney epidemiologist Siranda Torvaldsen adds to a growing body of knowledge that makes a link between the use of the pain-killing drug fentanyl in epidurals and problems with breastfeeding. During an epidural a catheter is inserted into the spine to allow the infusion of pain-killing drugs. These deaden the nerves that relay sensations of pain from the lower body.

In a commentary on the research, published today in International Breastfeeding Journal, British scientist Sue Jordan suggests the impact of epidurals on breastfeeding should be officially classed as an "adverse drug reaction". Dr Jordan, senior lecturer in applied therapeutics at Swansea University, said women given the infusions should be offered extra support to stop their infants being "disadvantaged by this hidden, but far-reaching, adverse drug reaction".

Dr Torvaldsen and her colleagues studied 1280 women who had given birth in the ACT, of whom 416 had an epidural. They found that 93 per cent of the women breastfed their baby in the first week, but those who had received epidurals generally had more difficulty in the days immediately after birth.

By the time six months had passed, the women who had been given epidurals were twice as likely to have stopped breast-feeding, even after allowing for factors such as maternal age and education. The authors suggest the most likely cause of the problem was fentanyl, an opioid widely used as one of the components of epidurals. Such drugs pass quickly into the bloodstream and easily cross the placenta to reach the unborn baby.

Dr Torvaldsen said she conducted the research after speaking to lactation consultants who had noticed that since the addition of fentanyl in epidurals they had seen more women having problems breastfeeding.

She said her research added to other studies in the area, particularly a Canadian study that examined fentanyl dosages and breastfeeding outcomes. The Canadian study of 177 mothers found they were less likely to be breastfeeding if they had been given an epidural with fentanyl. Joy Heads, a lactation consultant at Sydney's Royal Hospital for Women, said similar problems had been seen when the pain-killer pethidine had been given to mothers in late stages of labour.

She said 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.

source - Australian news