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

  1. Getting an epidural may hinder breastfeeding
    Moms who opt for popular narcotic during labor have more trouble nursing

    Do your anesthesiologists use fentanyl in your epidurals? We've just started using a Naropin and fentanyl infusion exclusively. We haven't been using it long enough for me to notice any breastfeeding effects. I have probably only done three or four so far with the new mix, and I don't think they were breastfeeders. The only thing that it seems like I have noticed is more intense itching. Our head anesthesiologist said that the mix should be an improvement over the Naropin-only epidurals but I'm not sure I've noticed any appreciable difference.

    What do you all use?
    Have you found this study to be true in your experience or seen anything of note?

    Often the bf stuff is hard for us to tell, because we have the moms for such a short period of time. The study mentions less bf'ing in the first week after birth and at 6 months - and we aren't around for that part.
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    About mitchsmom

    Joined: Oct '03; Posts: 1,951; Likes: 97
    Lactation consultant, L&D RN, some postpartum
    Specialty: OB, lactation


  3. by   skipaway
    Sorry, but some man had to have done that study. Fentanyl has been in use for decades...I know my sister's, cousin's, friends kids did just fine.
  4. by   mitchsmom
    Quote from skipaway
    Sorry, but some man had to have done that study.
    LOL ... I looked up the actual study out of curiosity... it was 4 women and one man. I didn't take it like they were trying to dog on epidurals, but more study the fentanyl component.

    Just because fentanyl has been used for decades doesn't mean it couldn't have side effects - and apparently other studies have shown the same effect(see towards the bottom of the discussion section in the study: International Breastfeeding Journal | Full text | Intrapartum epidural analgesia and breastfeeding: a prospective cohort study )
    "There is a growing body of evidence that the fentanyl component of epidurals may be associated with sleepy infants and difficulty establishing breastfeeding. Lower neurologic and adaptive capacity scores have been reported among infants whose mothers had a bupivacaine and fentanyl epidural compared with mothers who had bupivacaine with sufentanil or bupivacaine alone [14]. Another study found that mothers who had had intrapartum fentanyl were less likely to be breastfeeding at discharge from hospital and that there was a dose-response relationship between fentanyl and bottle feeding, independent of other factors [3]. However the strongest evidence to date comes from a recent randomised controlled trial in which 177 women who had previously breastfed were randomised to receive an epidural containing either no fentanyl, intermediate dose fentanyl (up to 150 μg fentanyl) or high dose fentanyl (>150 μg fentanyl) [15]. Women randomised to the high dose fentanyl group were more likely to have stopped breastfeeding at six weeks postpartum than women who were randomised to the other two groups [15]."
  5. by   HappyNurse2005
    We have fentanyl/bupivicaine, sufenta/bupivicaine, and just bupivicaine epidurals. its per physician preference.
    i've not seen any breastfeeding problems yet after epidural...
  6. by   ElvishDNP
    I haven't seen anything so far either. But it's true that we are with our patients for such a short period of time it's hard to know what happens once they are at home.
  7. by   BabyRN2Be
    While I have seen some problems with infants whose moms had an epidural for a long period of time (18 hours), I don't know what was in the epidural mix although I believe it could be fentanyl. These infants seemed to have problems sucking compared to other infants who were exposed to the epidural meds for a shorter period of time.

    Keep in mind that this is anecdotal information and I'd love to see a long term study done on this (6 months after delivery).
  8. by   SmilingBluEyes
    I have read this before. I have to say, anecdotally, I do find more mothers who have natural labor experiences far more ready to nurse (as well as their babies) in that first hour after birth, than those having regional anesthesia (not just fentanyl epidurals, but duramorph spinals, too). I dont' think it is a coincidence, but again, just my simple observations of nearly 10 years in OB.
  9. by   SheriLynnRN
    I did not have an epidural during labor, I received Nubain and Phenergan ivp. I believe that my son was sleepier than he would have been otherwise, and consequently had decreased interest in breastfeeding for the first 2-3 days. Of course this is purely anecdotal, but I am inclined to beleive that epidural narcotics could play a role. BTW, he is nearly six months old and still breastfeeding.
  10. by   NeuroICURN
    Can't quote on the study...didn't take the time to read it, but....

    Yes, that's probably one of the most common drugs in our epidurals (which I mostly see in trauma pt's with rib fx). The most commonly used mix for us is fentanyl and bupivicaine.
  11. by   babycatcher2B
    I went to a Hale conference last year and he mentioned the new evidence they were finding on fentayl and bf'ing. He advised avoiding using it until more conclusive evidence was reached.
  12. by   strn96
    All of our epidurals are fentanyl/bupivicaine. Haven't really noticed a difference with breastfeeding. Not saying there's no effects-I don't know. The babies (and moms) that I seem to have the most trouble with getting started with bf'ing are the ones who have residual IV narcs, Phenergan or Mag. I agree that more study is needed. I also think that when parents-to-be are given information about pain control, they should be warned about the potential SE of IV narcs. It frustrates me to get a baby who's depressed at delivery b/c a mom's had 2mg of Stadol hourly and IV Phenergan 25mg q3 (not for N/V, but to potentiate Stadol) for hours on end because she didn't want an epidural. Talk about trouble BFing, try getting this couplet to BF! Not that I'm saying a little Stadol is a bad thing. I just think sometimes it's overdone.
  13. by   Mooncricket55
    This is my observation and PERSONAL OPINION from 28 years as an OB nurse: epidurals with Fentanyl do cause problems with breastfeeding. Back in ancient times (late 70's,80's, early 90's), the institution that I worked at didn't use epidural anesthesia, or rarely used epidurals. Most babies went to the breast with minimal assistance from staff, very rarely did a mom need to use a breast pump. From mid-late 90's to the present most facilities that I have worked at use epidurals for most laboring women (at teaching hospitals the residents really push the epidural even if the mom wasn't planning one). Since this increase in epidurals so many babies seem to have problems with nursing. Now the moms need so much intervention from staff, so many pump and then bottle feed the breast milk. I did notice that when I worked in Hawaii for a few monthes in 2003 that very few women in the two hospitals that I worked at had epidurals and the breastfeeding came naturally and went well. Just wishing we could get back to a simpler time in childbirth !!
  14. by   SmilingBluEyes
    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.