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Dr. CamannEpidural Anesthesia and Breastfeeding
by William Reid Camann, MD

Q. Will epidural anesthesia hinder my newborn from nursing? I have heard that epidurals can interfere with "latching." Is this true? Does the epidural affect how "aware" the baby is born?

A. Many studies have been done to examine the neurobehavioral state of newborns after different anesthetics during labor. In general, the consensus is that newborns born after modern-day epidural analgesia during labor have intact reflexes and breastfeed normally. A concern has been raised because many observational studies have shown an association between difficult breasfeeding and anesthetic use during labor. The problem is that many of these studies do not account for the fact that many of the patients had very long and difficult labors, a factor in itself which can cause difficulty with early breastfeeding. There are now a number of good studies that clearly show no difference in percentage of women successfully breastfeeding at one week, four weeks, and six weeks after delivery, regardless of whether epidural analgesia or not was used during labor.

Q. If I receive anesthesia, will the anesthesia drugs be present in my breast milk? Is this dangerous?

A. Modern day epidural anesthesia for labor and delivery uses extremely low doses of medications. Sensitive assays can detect the presence of these medications in the baby, although the absolute levels are extremely low, even after prolonged epidural infusion during labor or cesarean delivery. Regional (spinal or epidural) anesthesia is often used for cesarean delivery, and although sometimes a cesarean baby may have difficulty breastfeeding due to the reasons why the cesarean was necessary, the effects of the anesthetics are minimal. However, if the mother has received general anessthesia, this may cause some degree of drowsiness in the baby, also related to the fact that general anesthesia is most often used when the cesarean is an emergency. Thus the issue is confounded by several different factors. Some women may experience difficulty with breastfeeding for a wide variety of reasons, regardless of the methods of anesthesia used during labor or delivery, or whether the delivery was vaginal or cesarean.

A lactation consultant may be available at your hospital, who could help you achieve successful breastfeeding. Breastfeeding offers optimum nutrition to your child in the absence of medical contraindications.

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