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| LETTER TO THE EDITOR |
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| Year : 2012 | Volume
: 2
| Issue : 1 | Page : 57-59 |
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Impact of epidural analgesia on breast feeding: A possible relation and the existing controversies
Sukhminder Jit Singh Bajwa1, Sukhwinder Kaur Bajwa2
1 Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
2 Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| Date of Web Publication | 4-Aug-2012 |
Correspondence Address:
Sukhminder Jit Singh Bajwa
Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, Pin-147001
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2249-4472.99339
How to cite this article:
Bajwa SJ, Bajwa SK. Impact of epidural analgesia on breast feeding: A possible relation and the existing controversies. J Obstet Anaesth Crit Care 2012;2:57-9 |
How to cite this URL:
Bajwa SJ, Bajwa SK. Impact of epidural analgesia on breast feeding: A possible relation and the existing controversies. J Obstet Anaesth Crit Care [serial online] 2012 [cited 2022 May 24];2:57-9. Available from: https://www.joacc.com/text.asp?2012/2/1/57/99339 |
Sir,
The article "Breastfeeding in the perioperative period" by Kundra and Kundra, published in the Jan-June issue of Journal of Obstetric Anaesthesia and Critical Care was beautifully and concisely presented. [1] However, we like to highlight certain facts related to epidural analgesia which can possibly have an impact on initiation of breast feeding during immediate delivery period. Labour analgesia has advanced tremendously over the last two decades. Somehow, this progress has been interrupted occasionally by one concern or the other. One of the most understudied aspects is the impact of regional anaesthesia on initiation of breast feeding. The universal guidelines mandate initiation of breast feeding during the first hour post-partum. [2] Numerous reviews and research studies have highlighted the impact of epidural anaesthesia on mother and the neonate but there are hardly conclusive statistics regarding the disruption of breast feeding. The available literature is at variance and as such the observations are not conclusive enough. These differences are mainly attributable to demographic variation, the amount and type of drug used, study design, and methodology as well as the minimal studies regarding the impact of regional anaesthesia as compared to general anaesthesia. Few studies have observed a significant negative impact of epidural anaesthesia and timely initiation of exclusive breast feeding. [3],[4] One of the main possible mechanisms could be the lower neuro-behavioral scores observed in neonates and various neuraxial anaesthetics such as mepivacaine, bupivacaine, pethidine, fentanyl, etc. have been implicated in failure of spontaneous breast feeding. [5] Additionally, few studies have observed a definite relationship between epidural analgesia and increased need for oxytocin administration. [6],[7] Another significant observation included a high incidence of breast feeding failure in primipara as compared to multipara. [8]
The positive side to the relationship between EDA and breast feeding is the short-term impact which allows early resumption of normal breast feeding practices with little support. The most likely mechanism involving EDA and difficulty in initiation of BF is the decreased release of endogenous oxytocin and thereby resulting in reduced plasma levels of oxytocin and stimulation of BF. [9],[10 ] Normally, the amounts of maternal oxytocin levels are increased during the initial 2-3 h after delivery. In one large Swedish study involving 585 women, it was observed that EDA is associated with impaired BF after delivery as well as during the discharge from the hospital. [11]
In spite of the available literary evidence from various studies, there still exists a huge gap in our understanding about the possible impact of epidural analgesia and BF. A study using infant breast feeding assessment tool (IBFAT) to assess the co-relation between BF and EDA failed to find a significant impact of the latter on BF. [12] However, the conclusions from a large meta-analytical study clearly established a definite relationship between anaesthesia for lower segment caesarean section (LSCS) and lactation failure which was highly observed in emergency situations as compared to elective procedures. [13]
In one of the study, it was also observed that early skin to skin contact, rooming-in, maternal smoking, child pacifiers, and literacy level of mothers hardly had any effect on BF. [14] Another common observation during one of the study included relation of EDA and problems of "not having enough milk" and partial breast feeding. [4] The study also concluded that levels of local anaesthetic bupivacaine in neonates can possibly be the causative factor in stimulating less production of milk. [4] These findings were further corroborated by another study in which the motor and orientation performance among neonates were studied with Brazelton neonatal behavioral assessment scale (NBAS) and established a dose response relation between epidural analgesia failures of early BF. [15] However, many studies are at variance with respect to use of epidural analgesia and initiation of early BF. [3],[15] Further a definite relationship exists between EDA for labor and LSCS and initiation of BF. The evidence indicates that the amount of drug circulating in the blood during a large period of labour analgesia is much higher as compared to anesthesia for LSCS. [16],[17] As a result, the researchers have focused on use of low concentration of drugs for LSCS as it is considered to exert minimal side effects on the neonate and BF. At present, many studies are going on throughout the globe based on various regimens of labor analgesia and an attempt should be made in such studies to include initiation of breast feeding as one of the important parameter during observation. To establish a definite relationship between EDA and BF, a large study sample is essential to rule out any existing controversies and to improve our knowledge in this regards.
| References | |  |
| 1. | Kundra S, Kundra S. Breastfeeding in the perioperative period. J Obstet Anaesth Crit Care 2011;1:46-7. 
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| 2. | De Chateau P, Wiberg B. Long-term effect on mother-infant behavior of extra contact during the first hours postpartum. II. A follow-up at three months. Acta Paediatr Scand 1977;66:145-51.
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| 3. | Baumgarder D, Muehl P, Fischer M. Effect of labour epidural anaesthesia on breast-feeding of healthy full-term newborns delivered vaginally. J Am Board Fam Pract 2003;16:7-13.
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| 4. | Volmanen P, Valanne J, Alahuhta S. Breast-feeding problems after epidural analgesia for labour: A retrospective cohort study of pain, obstetrical procedures and breast-feeding practices. Int J Obstet Anesth 2004;13:25-9.
[PUBMED] |
| 5. | Ransjo-Arvidson A, Matthiesen AS, Lilja G. Maternal analgesia during labour disturbs newborn behaviour: Effects on breast feeding, temperature and crying. Birth 2001;28:5-12.
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| 6. | Halpern S, Levine T, Wilson D. Effect of labour on breast feeding success. Birth 1999;26,83-8.
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| 7. | Leighton BL, Halpern S. Epidural analgesia: Effects on labour progress and maternal and neonatal outcome. Semin Perinatol 2002;26:122-35.
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| 8. | Tu MT, Lupien SJ, Walker CD. Multiparity reveals the blunting effect of breast feeding on physiological reactivity to psychological stress. J Neuroendocrinol 2006;18:494-503.
[PUBMED] |
| 9. | Rahm VA, Hallgren A, Hogberg H. Plasma oxytocin levels in women during labour with or without epidural analgesia: A prospective study. Acta Obstet Gynecol Scand 2002;81:1033-9.
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| 10. | Goodfellow CF, Hull MGR, Swaab DF. Oxytocin deficiency at delivery with epidural analgesia. Br Obstet Gynaecol 1983;90:214-9.
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| 11. | Wiklund I, Norman M, Uvnäs-Moberg K, Ransjö-Arvidson AB, Andolf E. Epidural analgesia: Breast-feeding success and related factors. Midwifery 2009; 25:31-8.
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| 12. | Reid SJ, Ly D. Does ultra-low dose labor epidural analgesia influence early breast-feeding? Anesthesiology 2001;94:A21.
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| 13. | DiMatteo RM, Morton SC, Lepper HS, Damush TM, Carney MF, Pearson M, et al. Cesarean childbirth and psychosocial outcomes:A meta-analysis. Health Psychol 1996;15:303-14.
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| 14. | Scott JA, Binns CW. Factors associated with the initiation and duration of breast-feeding: A review of the literature. Breastfeed Rev 1999;7:5-16.
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| 15. | Sepkoski CM, Lester BM, Ostheimer GW, Brazelton TB. The effect of maternal epidural anesthesia on neonatal behavior during the first month. Dev Med Child Neurol 1992;34:1072-80.
[PUBMED] |
| 16. | Scanlon JW, Brown WU, Weiss JB, Alper MH. Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology 1978;40:121-8.
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| 17. | Halpern SH, Leighton BL, Ohlsson A, Barrett JF, Rice A. Effects of epidural vs parenteral opioid analgesia on the progress of labor. JAMA 1998;280:2105-10.
[PUBMED] |
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