Yow. The BBC reports today that women who get epidurals may have more difficulty breast-feeding than women who don't get pain relief during labor. University of Sydney researchers studied about 1,300 women who gave birth in 1997, 93 percent of whom breast-fed during the first week after childbirth. At 24 weeks, 53 percent of moms who'd had epidurals or local anesthetic were still breast-feeding, compared with three-quarters of moms who bypassed the shots. Researchers say "the fentanyl component of epidurals" -- fentanyl being an opioid analgesic frequently used as part of the pain-relief cocktail -- "may be associated with sleepy infants and difficulty establishing breastfeeding."
The study, which is the largest of its kind to date, doesn't suggest that women forgo pain relief during labor, only that women who do have epidurals get extra lactation training and support. And experts say the dopey baby hypothesis may not fully explain moms' breast-feeding problems. Pat O'Brien, a spokesperson for Britain's Royal College of Obstetricians and Gynecologists, told the Beeb, "There are other factors which may explain this link, including that if a woman chooses not to have an epidural, she may also be more motivated to persevere with breastfeeding. Also, a lot of those women who had epidurals also went on to have Caesarean sections which -- unless you have a lot of support -- make it difficult to breastfeed because it's harder for women to pick their babies up."
It seems likely that the medical and cultural debate over women's childbirth decisions will intensify. Sue Jordan, a senior lecturer in applied therapeutics at Swansea University, suggested that post-epidural breast-feeding difficulties are the result of an "adverse drug reaction." And even if medical professionals continue to agree that possible breast-feeding-related side effects shouldn't affect whether laboring moms choose epidurals, it's easy to see how the average mom-to-be might worry that having an epidural means she's not doing everything she can for her baby (especially since the breast-feeding debate is already clouded by public finger-pointing, maternal guilt and government scare tactics).
The fentanyl question certainly seems worth exploring further. I'm already wondering whether fentanyl findings apply to all opioids and what percentage of working mothers elect epidurals. But I'm a little leery of the outcome, lest the epidural discussion devolve into yet another game of blame the pregnant woman.