Lamaze: No evidence that epidural affects breastfeeding, but we can still pretend

Yesterday’s post on the inaptly named Lamaze blog Science and Sensibility acknowledged that, contrary to the fervent wishes of natural childbirth advocates, there is NO EVIDENCE that epidurals interfere with breastfeeding.

But why let a little thing like evidence stop you? The Lamaze blogger helpfully offers a series of ridiculous reasons why NCB advocates can continue to pretend otherwise.

The blogger, Sylvie Donner, starts with a review of the literature. She notes that the studies that purported to find a link between epidural and breastfeeding were small, retrospective and of low quality. The rest of the literature finds no link between epidural and breastfeeding, or draws no conclusion after noting the fact that confounding variables make it impossible to determine whether there is a relationship.

None of this is the least bit surprising to obstetricians and anesthesiologists. When narcotics are injected along with local anesthetics into epidural catheters, only a tiny amount reaches the maternal bloodstream and an even tinier amount crosses the placenta. Epidural narcotics do not sedate mothers; therefore, it makes no sense that they would sedate the babies who receive a far lower concentration.

So there is no evidence that epidurals impact breastfeeding and no physiologic explanation for why they would affect breastfeeding, but the folks at Lamaze really, really, really want to believe that epidurals are BAD. Donna tries to help them out:

Common sense might lead us to view even these studies which find no link between epidurals and breastfeeding with some caution.

Of course, I’ve just explained that common sense would support the fact that there is no link between epidurals and breastfeeding because there is no evidence that babies would be sedated by tiny fractions of the same medications that do not sedate their mothers. But “common sense” among homebirth advocates apparently isn’t that common and doesn’t make much sense.

After all, the following need to be taken into account as well:

Epidurals are associated with a general medicalization of birth (since they usually and/or frequently involve IV lines and urinary catheters, as well as electronic fetal monitoring and ongoing monitoring of blood pressure) and this may contribute to greater maternal discomfort postnatally, meaning that breastfeeding could be affected.

Ahh, yes, the dreaded “medicalization.” It may make women uncomfortable in labor and breastfeeding could be affected! Really? How? No explanation is given.

Epidurals are known to be associated with a higher rate of instrumental delivery and caesarean.  Postpartum perineal discomfort, or pain as a result of abdominal surgery, will also inevitably make breastfeeding less comfortable, and therefore less likely to occur.

Of course there is no evidence that perineal or abdominal discomfort “inevitably makes breastfeeding less comfortable” but why not pretend? How about the fact that breastfeeding itself is often uncomfortable? That, apparently, is completely irrelevant. Any caring mother would ignore cracked and bleeding nipples, but perineal pain? OMG, who could be expected to endure that?

Epidurals can influence the fluctuation of hormone levels that play an important role in breastfeeding.

Look ma, no evidence! Oh, wait, there was a study that showed that epidurals might possibly affect the interaction between the adrenals and the pituitary. And the pituitary produces other hormones … and prolactin is one of those hormones … so if the epidural could affect one hormone, it could affect them all!!!

Furthermore, most studies conducted so far are unlikely to have compared physiological, unmedicated active labor with epidural labors. Comparing breastfeeding success after epidural birth to opiate-medicated birth (or birth with other forms of analgesia, such as Entonox) is not the same as comparing physiological birth to epidural birth.

 How do we know they are different? Duh! Because Lamaze says so. And how do we know those “differences” have any impact on breastfeeding? Duh! Because Lamaze says so.

The conclusion is inevitable. Just because there is no evidence to show that epidurals have no impact on breastfeeding, we can still pretend that they do.

After all, any other conclusion is completely unacceptable. Epidurals are bad, bad, bad, so they must interfere with breastfeeding or else the folks at Lamaze will be sad, sad, sad.