Epidural and breastfeeding: what are the effects?

For example, one study assessed breastfeeding behaviours using the Preterm Infant Breastfeeding Behavior Scale in 56 healthy newborns [3]. No difference was found between newborns whose mother had received an epidural and those whose mother had not, in terms of latch or neonatal suckling, either 1 hour or 24 hours after delivery. Levels of bupivacaine and fentanyl in umbilical cord blood were also measured, and no significant effect on breastfeeding variables was found. One possible reason for the absence of significant findings may be the very low dose of bupivacaine and fentanyl used in this sample.

A larger-scale study was carried out to compare the effect of the epidural dose. This study was conducted on 1,054 women, some of whom received high-dose epidural analgesia, others a combined spinal-epidural with a medium dose, or a low-dose infusion, or no epidural at all [4]. The authors found no difference between the groups in terms of breastfeeding initiation rates or duration.

A randomised double-blind study revealed a negative effect of the epidural fentanyl dose on neurological variables 24 hours after birth [5]. After 6 weeks, women who had received a high dose of fentanyl were more likely than those who had received a low dose to have stopped breastfeeding. These results may be explained by the fact that the high epidural dose affected the child's neurological score (NACS score), as babies who breastfeed easily have higher scores. Indeed, the depression of muscle tone in the newborn caused by epidural opioids impairs the newborn's ability to latch on. Such factors can prevent good breastfeeding behaviours in the first 24 hours of life, which may lead the mother to stop breastfeeding too early [6].

Similarly, in a study of 1,280 women, those who had received epidural analgesia showed an increased likelihood of breastfeeding difficulties and partial breastfeeding in the first week postpartum. They were also more likely to stop breastfeeding during the first 24 weeks compared with women who had not received epidural analgesia [7]. On average, another study observed a 1.4 times greater risk of stopping breastfeeding before 6 months in women who had an epidural [8].

For example, in several studies, women in the epidural groups also received other medications, including pethidine, which has been shown to have an adverse effect on breastfeeding [9].

Furthermore, the use of synthetic oxytocin during labour has been associated with a 3-fold increase in the risk of delayed breastfeeding initiation [10], and epidurals significantly increase the risk of receiving synthetic oxytocin to augment contractions and induce labour [11].

Furthermore, epidurals are associated with a fourfold increase in instrumental vaginal births [12]. The tissue damage caused by lacerations from instrumental delivery can take time to heal, which may delay immediate skin-to-skin contact between the newborn and the mother. During early postpartum skin-to-skin contact, the newborn initiates breastfeeding, inducing the release of maternal oxytocin necessary for milk production.

The epidural also prolongs the second stage of labour [13], which can greatly exhaust the mother and delay the initiation of breastfeeding.