Getting an epidural (with fentayl) may hinder breastfeeding (new study)

SmilingBluEyes · Feb 4, 2007

I think part of the problem is pressure moms and staff feel to get breastfeeding going and fast. Sometimes, we need to "let things happen" . Too often, we push the concept that successful breastfeeding MUST occur in the first hour of life. I have so many moms freak out when the first attempt is not perfect or successfully; they already begin to see themselves as failing or their milk is "no good" or the baby "does not like me". If I had a dime for every time I saw this, well you know.....

I have found that in naturally-delivered moms, often, the expectations are more realistic and they are more inclined to let nature take course. Truly today, versus yesteryear, there is so much pressure on patients and staff to get breastfeeding going ASAP for a couple reasons. One, the patient stay is so short. 24 hours (or even less) is not much time to help these folks gain the independence needed to take care of themselves and newborns well and ready to go home. Also, staffing just plain stinks often. Nurses are often spread thinly among numerous couplets and often, new moms do not get the much-needed help to get breastfeeding going to a good start. ONE problematic breastfeeding couplet can take HOURS of work for one nurse; multiply that by 2 or 3 and you have a problem. And nobody is cutting back on the charting and other things we must do away from their bedsides. One more reason is the unlimited visitation going on. I think visitors often get in the way of our being able to get breastfeeding going and successful. I have only so much time. If visitors are crowding the room and moms don't want to BF while they are present, I have to come back later. Later, I may have multiple things going on where my ability to help and time are limited. I often DO tell pts that breastfeeding and rest are more important than entertaining visitors, but so much of the time, this falls on dear ears. I can only do so much.....

Now, I am not saying there is no correlation between epidurals and difficulty breastfeeding, but I am saying we need to look at all the factors involved here. There is a lot more study needed to draw an absolute conclusion here, I am thinking.

Elvish, BSN, DNP, RN, NP · Feb 5, 2007

Very well said, SBE. People have very unrealistic expectations of how breastfeeding should go, I have found. If the kid doesn't feed like a champ from minute 1, they assume it's always going to be that way & get freaked out.

You also have a great point about staffing. If I only had 2 or 3 couplets I could probably spend more time helping c breastfeeding issues. Spread it out over 5 couplets, 3 of whom are primips, & you've got a recipe for no time to help anyone!

I would be interested to know if anyone else has noticed this also: Women who are from countries where BFing is more openly done and socially acceptably tend to have fewer breastfeeding issues. These moms can usually be patient until she & baby both can figure things out. I have found this to be true with or without epidural. We get these American women (nothing against American women, don't get me wrong....I am one!!) who believe they are incapable of breastfeeding until they've seen a lactation consultant and then must have her in there every time they breastfeed. Moms who assume that it's going to work find that it usually does.

(...giving myself an Off Topic for the last paragraph...)

strn96 · Feb 5, 2007

Very well said, SBE. People have very unrealistic expectations of how breastfeeding should go, I have found. If the kid doesn't feed like a champ from minute 1, they assume it's always going to be that way & get freaked out.

You said it! It seems a lot of my pts assume that since breastfeeding is natural that it will always be easy. When baby doesn't reach out, grab the breast and stick it in his mouth they get disenchanted with bf'ing. It's frustrating to spend hours coaching a primip (who states she really wants to bf), only to come back the next night and she's decided that bf'ing is too hard. I also think a big factor is that new moms frequently don't have the support system they used to. Family is too busy or lives too far away for Grandma and others to support mom like they used to. A lot of people like to come visit mom and new baby, but how many of them are able/willing to be much help?

Elvish, BSN, DNP, RN, NP · Feb 5, 2007

. Family is too busy or lives too far away for Grandma and others to support mom like they used to. A lot of people like to come visit mom and new baby, but how many of them are able/willing to be much help?

Yeah, and when they do help, they want to help with the baby. I told people coming to my house, no, I'm going to feed my baby. You go cook supper & do dishes.

mitchsmom · Feb 6, 2007

the unlimited visitation going on. I think visitors often get in the way of our being able to get breastfeeding going and successful. I have only so much time. If visitors are crowding the room and moms don't want to BF while they are present, I have to come back later. Later, I may have multiple things going on where my ability to help and time are limited.

*nodding* They don't even give us a chance to clean up the room before they have everyone and their neighbor come in!

That said, I have noticed that my babies tend to do MUCH better if they are introduced to the breast in the first hour. I try to introduce this idea to my moms ahead of time so they can have it in mind and I have definitely noticed a difference.

I also always tell them that it's no big deal if they don't latch on right away, we don't worry about it at all, etc. that it's good to get to know mommy, skin to skin, etc. (I always tell them that they maintain their temperatures better that way, etc.).

If I have the time and they seem open to it/able to understand it, I explain how it's also ideal for baby to go skin to skin with mom for its first contact with the outside world in order to colonize with moms normal bacteria/flora, since the baby will then get the antibodies for that same flora through moms breastmilk since those are the bacteria that mom has developed antibodies for (whether latching happens to occur at that time or not). That's a big jump on bugs!!!

(I think it's so amazing :)

I still haven't observed enough to really form an opinion on the fentanyl epidural - breastfeeding effect yet.

They have been running our new infusions with fentanyl at 14-18 cc/hr and I HAVE noticed that this has been way too dense for at least a couple of my pts. I had to really advocate for them and get it turned down/off and narrowly averted c/s both times. They both did perfectly fine when it wore off enough to push, of course.

I would be interested to know if anyone else has noticed this also: Women who are from countries where BFing is more openly done and socially acceptably tend to have fewer breastfeeding issues.

Moms who assume that it's going to work find that it usually does.

*nodding* That's one reason that it helps if new moms have been exposed to breastfeeding - family member, friends, something. One reason going to breastfeeding groups ahead of time can help also. I'm an IBCLC and big advocate, but I'm not even sure if I would have been as successful as I was with my first baby if it didn't just happen to be that ALL my circle of friends at the time were bf'ers. My husband just assumed that it was the normal thing also. Without those surroundings and the assumption that it would happen, I don't know if I would have ended up down the path I did (nursed all three of mine for at least a year and ended up being an IBCLC).

Yep, I went right off on a tangent too :) LOL