Epidurals and bfing

Found this on the BBC world service website this morning.


http://news.bbc.co.uk/2/hi/health/6161727.stm

(What really struck me was the comment that 93% of the women in the
study started out breastfeeding, and at 6 months over 50% were still
nursing! American women should do so well!)

Naomi


Having an epidural to relieve labour pains is associated with problems
breastfeeding, a study suggests.
Researchers said those who have the anaesthetic are more likely to have
problems in the first week after birth and to stop breastfeeding early.


University of Sydney researchers looked at 1,300 women who gave birth
in 1997.

A chemical in epidurals may affect babies or it may be that women who
do not have pain relief are more likely to persist with breastfeeding,
they said.

However, a UK expert said that while the International Breastfeeding
Journal study was interesting, women should not worry.

Around 20% of UK women have epidurals - inserted into a space near the
spinal cord - to ease the pain of labour.

Although the findings of this study are interesting and warrant
further investigation, it is so far a theoretical concern

Pat O'Brien
Royal College of Obstetricians and Gynaecologists

The researchers looked at the women's childbirth and breastfeeding
history.

Of the 416 who had an epidural, 172 also had a Caesarean section.

Although 93% of the women studied breastfed their baby in the first
week, those who were given an epidural were much more likely to have
problems.

They were also likely to completely stop breastfeeding before six
months compared with women who did not have any pain relief.

Three-quarters of those who had no analgesia were breastfeeding at 24
weeks, compared with 53% who received pethidine or epidurals.

Benefits

The researchers, led by Dr Siranda Torvaldsen, say: "There is a growing
body of evidence that the fentanyl component of epidurals may be
associated with sleepy infants and difficult establishing
breastfeeding."

They add: "Whatever the underlying mechanism, it is important that
women who are at higher risk of breastfeeding cessation are provided
with adequate breastfeeding assistance and support, both in the initial
postpartum period [just after birth] and the following few months."

Pat O'Brien, a spokesman for the Royal College of Obstetricians and
Gynaecologists, said it was possible that fentanyl had an effect on the
baby.

But he added: "There are other factors which may explain this link,
including that if a woman chooses not to have an epidural, she may also
be more motivated to persevere with breastfeeding.

"Also, a lot of those women who had epidurals also went on to have
Caesarean sections which - unless you have a lot of support - make it
difficult to breastfeed because it's harder for women to pick their
babies up."

He added: "For a woman who wants an epidural, there are a wide range of
obvious benefits, and although the findings of this study are
interesting and warrant further investigation, it is so far a
theoretical concern."

wrote:

Pat O'Brien, a spokesman for the Royal College of Obstetricians and
Gynaecologists, said it was possible that fentanyl had an effect on the
baby.

Based only on what's quoted here, it's not clear that fentanyl had any
effect on the baby, only that there may be an association. And as we
all know, association does not equal causation. They'd have to do some
actual physiologic studies on infants (presumably they'd start by using
non-human primates)

Even simple studies like quantifying those babies which have trouble
latching/sucking might be an indicator. They allude to this, but I
don't see the specifics of that aspect of the study.

But he added: "There are other factors which may explain this link,
including that if a woman chooses not to have an epidural, she may also
be more motivated to persevere with breastfeeding.

I think this is a HUGE confounder. Not discounting the study, perhaps,
but is substantial enough that it makes the results weaker.

Anyone know the rate of epidural in the US?

Interesting initial study, but from a scientist's perspective, it's
very weak. At least as presented here. Of course, as prelim work it may
lead to more indepth studies. And just so you know my bias, I didn't
have an epi (planned a homebirth) and generally don't like the idea of
them.

cjra wrote:
wrote:

But he added: "There are other factors which may explain this link,
including that if a woman chooses not to have an epidural, she may also
be more motivated to persevere with breastfeeding.

I think this is a HUGE confounder. Not discounting the study, perhaps,
but is substantial enough that it makes the results weaker.

Yeppers.

Anyone know the rate of epidural in the US?

In 97, I thought it was something like 66%. I've poked around this
morning, but can't find anything 'us-wide' since 97.

Caledonia

http://news.bbc.co.uk/2/hi/health/6161727.stm

(What really struck me was the comment that 93% of the women in the
study started out breastfeeding, and at 6 months over 50% were still
nursing! American women should do so well!)

I also saw this, it raised an eyebrow as the figures seemed "wrong", it
appears the actual study was in Austrailia, so off I went to find the
figures, for 2003 (the study appears to be based on mums who gave birth in
1997), initiation was 87% and at 4-5mths 48%, both several points lower than
in the study, so you have to wonder how representative the study is.

I think it is also meaningless to just do a group by group comparision, a
proportion of epidural use is related to the parents attitude to birth in
general and that attitude will probably also run to baby feeding, you'd have
to do some kind of pairing up of women based on attitudes to breastfeeding,
to get a meaningful result.

I know from my own friends, having an epidural and other birth interventions
is linked to breastfeeding sucess, but I don't think it's the effect of the
epidural, but the persons decisions about breastfeeding and birth, obviously
I've friends who have been sucessful with breastfeeding and had an epidural
(myself included), but when you find out more about the birth story, the
epidurals have often been several hours into a long labour, or a back labour
etc and it's been the persons prelabour comittment to breastfeeding that has
been the main factor.

Cheers

Anne

Based only on what's quoted here, it's not clear that fentanyl had any
effect on the baby, only that there may be an association. And as we
all know, association does not equal causation. They'd have to do some
actual physiologic studies on infants (presumably they'd start by using
non-human primates)

I've been trying to find out more about this, it seems accepted that
pethidine in certain time frames will have an effect on the baby's sucking,
I think the time window is when it's given about 1/2-3hrs before the birth,
but I'm not sure it can be the same with fentanyl as it's not going as
speedily into the blood stream, the amount that gets into the blood stream
from the epidural must be proportionally less and presumably takes more
time. I've had epidurals with both of mine, though both starting as planned
homebirths, first ended with induction and I got the epidural after uterine
hyperstimulation, that would not calm down, 2nd time was a posterior baby
and joint issues that arose in the few weeks prior to the birth, the time
window before the birth was 1.5hrs and 3.5hrs, with varying top ups in that
time, there was no breastfeeding issues at all in the first week and they
were both very alert after the birth, so I wonder if those times were just
too short for there to be an effect.

Cheers

Anne

Anne Rogers wrote:

http://news.bbc.co.uk/2/hi/health/6161727.stm

(What really struck me was the comment that 93% of the women in the
study started out breastfeeding, and at 6 months over 50% were still
nursing! American women should do so well!)

I also saw this, it raised an eyebrow as the figures seemed "wrong", it
appears the actual study was in Austrailia, so off I went to find the
figures, for 2003 (the study appears to be based on mums who gave birth in
1997), initiation was 87% and at 4-5mths 48%, both several points lower than
in the study, so you have to wonder how representative the study is.

I think you're right. As someone from Sydney who first gave birth two
years later I would have to say that the 93% figure is probably only
correct for those who had a 4-7 day hospital stay and were not from a
non-English speaking background. Most Australian hospitals do not
offer formula to babies and often they ask you to provide your own if
you are choosing to formula feed from birth. By 2003 it was becoming
more common for women to elect for early discharge and that has obvious
implications for establishing breastfeeding as you can see in the US.

Cheryl

Cheryl wrote:

I think you're right. As someone from Sydney who first gave birth two
years later I would have to say that the 93% figure is probably only
correct for those who had a 4-7 day hospital stay and were not from a
non-English speaking background. Most Australian hospitals do not
offer formula to babies and often they ask you to provide your own if
you are choosing to formula feed from birth.

Wow! Interesting concept. Far cry from most states (all but MA I think)
here who allow free samples of formula. I think in principle, that's a
great idea, but how do they deal with those low income folks? Here
that'd be people who rely on WIC for their formula. I know one should
argue BF is free, and therefore even more reason to BF if you're low
income, but there are other issues such as working at a low paid job
with no time for pumping breaks (some moms only take a few weeks
leave). And while I'm all about encouraging BF, that seems to *force*
BF to those who can't afford formula or simply don't plan ahead to
bring it with them. The BF advocate in me says one thing, but that
provide-for-all public health advocate knows the reality is very
different.

cjra wrote:
Cheryl wrote:

I think you're right. As someone from Sydney who first gave birth two
years later I would have to say that the 93% figure is probably only
correct for those who had a 4-7 day hospital stay and were not from a
non-English speaking background. Most Australian hospitals do not
offer formula to babies and often they ask you to provide your own if
you are choosing to formula feed from birth.

Wow! Interesting concept. Far cry from most states (all but MA I think)
here who allow free samples of formula. I think in principle, that's a
great idea, but how do they deal with those low income folks? Here
that'd be people who rely on WIC for their formula. I know one should
argue BF is free, and therefore even more reason to BF if you're low
income, but there are other issues such as working at a low paid job
with no time for pumping breaks (some moms only take a few weeks
leave). And while I'm all about encouraging BF, that seems to *force*
BF to those who can't afford formula or simply don't plan ahead to
bring it with them. The BF advocate in me says one thing, but that
provide-for-all public health advocate knows the reality is very
different.

I think it would work best if you're in a healthcare system where
you're expected to bring your own diapers, sanitary pads, and general
foodstuffs. If not, it seems somewhat off-kilter from the all-inclusive
(for 24-48 hours) Mom & Baby bill, if that makes sense.

Caledonia

I think you're right. As someone from Sydney who first gave birth two
years later I would have to say that the 93% figure is probably only
correct for those who had a 4-7 day hospital stay and were not from a
non-English speaking background. Most Australian hospitals do not
offer formula to babies and often they ask you to provide your own if
you are choosing to formula feed from birth. By 2003 it was becoming
more common for women to elect for early discharge and that has obvious
implications for establishing breastfeeding as you can see in the US.


longer hospital stays are not shown to improve breastfeeding, they may even
have the opposite effect, I'm not sure if there are any studies that show
that directly, but there are some that point to better establishment of
breastfeeding at home.

Cheers

Anne

I think it would work best if you're in a healthcare system where
you're expected to bring your own diapers, sanitary pads, and general
foodstuffs. If not, it seems somewhat off-kilter from the all-inclusive
(for 24-48 hours) Mom & Baby bill, if that makes sense.

in the UK, we were expected to bring everything, EXCEPT baby formula if you
were using it, I'm not sure whether what is available in the hospital was
given by companies, or was just what they bought in. I understand that some
hospitals have moved to having it in vending machines, I don't know at what
price. UNICEF baby friendly requires it not to be freely available, but a
locked cupboard suffices, not making people provide or purchase it, so if a
hospital is going for baby friendly status, they'd have to make some
changes. I'd think there may be issues about preparing of formula in
hospital, doesn't anyone know if when you have to provide it, they insist on
ready mix, or do you just prepare as usual.

Cheers

Anne