Epidurals are a popular choice for pain relief during labour.
Around one-half of low-risk women giving birth to their first baby at private hospital have an epidural, and around one-third when giving birth at a public hospital.
Around one-third of low-risk women giving birth to subsequent babies at a private hospital have an epidural, and around one-tenth when giving birth at a public hospital.
One study found that among women who breastfed previously, those who were randomly assigned to receive a higher drug dose epidural were more likely to have ceased breastfeeding after 6 weeks compared to women who were randomly assigned to a lower drug dose epidural or no epidural.
It's unclear if epidurals directly affect breastfeeding.
However, it's possible that epidurals have several indirect effects on breastfeeding.
Here are 6 ways epidurals may affect breastfeeding and what you can do about it:
Note: BellyBelly is pro-informed decision making. It's most beneficial to be fully informed about the possible ways in which pain medication during labour may impact breastfeeding. This can help mothers to reduce the risk of any complications or issues, as well as prepare them and their babies for a healthy breastfeeding journey. BellyBelly understands that sometimes epidurals are needed. We support all mothers, no matter what birth choices they decide upon.
#1: Delaying Milk ‘Coming In’
A recent study showed a direct link between pain medications (including epidurals) used during labour and a delay in a mother’s milk ‘coming in’. In fact, it was found that women who had labour pain medications were 2-3 times more likely to notice a delay in their milk ‘coming in’ compared to women who did not use labour pain medications and delivered vaginally.
Spending as much time in skin-to-skin contact with your baby as possible, and watching out for and feeding your baby often (e.g. when he shows early feeding cues) can help your milk to ‘come in’.
#2: Dampening Of A Baby’s Feeding Behaviours
Breastfeeding is instinctive for babies. They display a series of typical feeding behaviours when placed on their mother’s chest that enable them to seek their mother’s breasts and begin feeding.
A baby is typically alert and eager for the first hour or two after birth. This is when nature intends for a baby to have his first breastfeed. When a baby’s feeding behaviours are functioning optimally, this helps a baby to be able to do find his mother’s breasts and in doing so get breastfeeding off to the best start possible.
A baby’s feeding behaviours may be dulled by pain medication exposure during labour.
Skin-to-skin contact between you and your baby can help your baby’s feeding behaviours to work well. So doing this as often as possible can help a great deal.
#3: Causing Breast Swelling
A common side effect of epidurals is causing blood pressure to drop. To try to counteract this side effect, intravenous fluids are given to the mother.
The use of IV fluids during labour may result in generalised swelling, including of the breast. Any swelling of the breast can make it harder for a baby to attach to the breast. If your baby is having trouble attaching, a lactation consultant or Australian Breastfeeding Association counsellor will be able to provide you with some helpful suggestions about what to do.
Also, IV fluids given to the mother in labour cross the placenta to the baby and this can artificially elevate a baby’s birth weight. This may make it appear as though the baby is losing ‘too much’ weight when the baby is really just shedding the excess fluid. In such a situation, a mother’s confidence in breastfeeding can be affected and it could lead to unnecessary supplementation.
#4: Disruption To A Mother’s Natural Oxytocin Release
An epidural inhibits the mother’s release of natural oxytocin.
Natural (not synthetic) oxytocin encourages bonding between a mother and her baby. This bonding can help with getting breastfeeding going well. Spending as much time as possible in skin-to-skin contact with your baby after the birth can help to overcome any disruption to the natural oxytocin release.
Also, epidurals increase the need for synthetic oxytocin. This may be to help counteract the slowing down of labour that is more likely with epidurals. It may also be epidurals interfering with a mother’s natural oxytocin release.
Synthetic oxytocin also interferes with a mother’s natural oxytocin release and its use means the need for IV fluids. These things may be why synthetic oxytocin use has been associated with an increased use of bottle-feeds and a shorter breastfeeding duration.
#5: Pain Due To Increased Instrumental Delivery
Epidurals increase the risk of instrumental delivery (e.g. forceps, vacuum). This can lead to pain and stitches for the mother, and pain, bruising and swelling for the baby. These things can make early positioning and attachment to the breast harder.
A midwife, lactation consultant or Australian Breastfeeding Association counsellor can help provide suggestions to help with the positioning and attachment of your baby at the breast.
#6: Mother and Baby Separation
Epidurals commonly cause a fever in women. There is a possibility the mother’s fever could be due to a uterine infection (even if the more likely cause is an epidural).
So, babies born to mothers with a fever are often assessed for infection (sepsis). This can involve the baby being taken to special care nursery until the test results are known. If a mother and her baby are separated after birth, this can make establishing breastfeeding more difficult.
If you and your baby are separated, you could remind the staff that breastfeeding is important to you. You could ask them if your baby could be brought to you for feeds. Or, you could ask if you could be taken to your baby. Or, if you don’t have a drip in place, you could just go to your baby by yourself. Being with your baby helps you both feel calmer, and helps with bonding and your milk supply.
Your Birth and Your Baby
When it comes to giving birth, it can help to be as informed as possible, so that if faced with any challenges, we can be more ready to tackle them.
If you decide to try alternative pain relief options for labour, take a look at BellyBelly's article about natural pain relief options.
Remember, no matter what events occur during the birth of your baby, they need not stop you from breastfeeding your baby successfully (whatever that may mean for you). At the first sign of troubles, seeking help quickly is key. A lactation consultant or a breastfeeding support organisation is a great place to start.