Childbirth-easing drugs may affect breastfeeding

11:32 11 December 2006
NewScientist.com news service
Rachel Nowak

Drugs used to ease the pain of childbirth could interfere with breastfeeding, a new study suggests.

Siranda Torvaldsen of the University of Sydney, Australia, found that 416 women who received the opioid drug fentanyl by epidural injection during delivery were twice as likely to have stopped breastfeeding by the time their baby was six months old compared with 312 women who did not receive the drug.

Torvaldsen does not know whether this is because the drug has a direct effect on babies’ ability to suckle or that women who opt for (or need) epidural painkillers are also more likely to stop breastfeeding sooner.

A previous study found that the babies of women who have fentanyl tend to be drowsier at one-day-old, raising the possibility that the drug affects suckling at the critical time when breastfeeding gets established.

"Adverse reaction"

In Australia and the US only around 40% of babies are still receiving at least some breast milk at six months, although the World Health Organization recommends breast feeding exclusively until that age.

“Now we’re aware that painkillers may affect breastfeeding, we need to be sure that women who take them get adequate help,” says Torvaldsen.

Sue Jordan of Swansea University, UK, who is an expert on the effects of labour drugs and mental health, says the effect of opioids and epidurals on breastfeeding should be seen as an "adverse drug reaction".

In an article accompanying Torvaldsen’s study in International Breastfeeding Journal, Jordan calls for extra support for the most vulnerable women "to ensure that their infants are not disadvantaged by this hidden, but far-reaching, adverse drug reaction".

Journal reference: International Breastfeeding Journal (DOI: 10.1186/1746-4358-1-24)

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I am not anti-epidural. I'm becoming more anti-hospital, though I still maintain my belief that women need to be where and with whom they feel safe.

But I wonder how much publicity this little bit of information will receive.

People who are already opposed to the routine use of epidurals for all moms will think it's great.

Those who can't imagine why anyone would do anything other than opt for an epidural as soon as it can be given, will dismiss it as unsubstantiated.

The medical community probably won't even blink.

What does it take to cause change? What needs to happen, what needs to be discovered, for real changes to begin happening?

I want to see women seeking education about birth before they seek escape from it. If they ultimately decide that epidurals are definitely for them, at least it will be an educated choice and not a decision made in a vacuum - "I don't know what to expect and I don't wanna know."

I have heard of childbirth educators telling their classes, "Ninety-five percent of you will be getting epidurals anyway, so I won't go over relaxation techniques."

I have heard of nurses begging laboring moms to get pain relief. Even constantly asking the mom, "Do you want your epidural yet?" without knowing what her preferences are, or continually offering "something to take the edge off the pain" without using the word narcotic...these are all actions hostile to unmedicated birth, and apparently to the breastfeeding relationship, too.

So why doesn't this garner more of a reaction? Why don't mothers care more about it? If mothers cared, they would demand change, and the medical community would have to adapt, and men and sons and daughters would learn to act differently towards birth.

Virginia Woolf believed that if libraries were available to women in her time, that the world would split open. She too thought that knowledge would be enough.

I'm dismayed that women don't seek out their own education on certain things, especially childbirth.

It would be nice if every doctor made time to sit down with a pregnant woman and ask, "So what kind of birth do you want?" ...

It would be great if all doctors had a certain reverence for birth, understanding what is inappropriate to do or say when a woman is giving birth, reacting when needed, but showing restraint and respect when needed...

It would be nice if L&D nurses were trained so thoroughly that no laboring mom or doula would ever suspect that she knew more about birth than the nurse(s)...and if nurses all knew how important it is to support and nurture the connection between mom and baby...

It would be great if all childbirth educators were trained to help women find what kind of birth they want, how to increase their chances of having that experience, what to do if it doesn't happen, and how to recognize if something is going wrong, either during the birth or during the initial postpartum time...

But the reality is that none of these things are common or guaranteed.

So it's up to women, it's up to each woman to educate herself and learn to stand up for herself.

No more assuming that because someone went to nursing or medical school, they must therefore know what they're doing and would NEVER do anything destructive to the health and well-being of mom and baby. No more thinking that taking a single childbirth class covers all the bases and prepares you for anything, especially childbirth.

No more denying responsibility.

There is so much to learn. Do your research. Ask questions. Change care providers. Read everything you can.

It's all up to you.