P- The patient population/ problem is

among babies born by vaginal birth, with

gestational age of 36 to 42 weeks
I- The intervention of interest is epidural
exposure
C- The comparison intervention is versus
a natural child birth
O- Identify if it affects the ability of the
baby to breastfeed.

Among Babies born by vaginal birth, with
gestational age of 36 to 42 weeks does
an epidural exposure versus a natural
child birth affect the ability of the baby
to breast feed?
Full term
No abnormalities
No other meds given during labor and/or
delivery
Vaginal delivery with no complications
The type of question is prognosis.
Based on the type of question
(prognosis) the following databases and
internet sites were searched:
CINAHL (EBSCOhost)
JSTOR
Science Direct
Our group located 5 articles based on
search terms and type of question.
These include four observational cohort
study, one study which encompassed
retrospective, observational cohort and
prospective cohort studies.


Observational cohort
study
Sample size 60 full term
newborns
Population full term
fetuses (37 to 40 wks)
Delivered vaginally in
the vertex position


Evaluate the effects of continuous
lumbar epidural anesthesia on the
newborn and the developing mother-
infant relationship
Although it is at times necessary
and appropriate for some mothers
to receive medication during
childbirth, the implications of this
study are that the elective use of
medication should be minimized.
There is a large need to develop
effective techniques of
psychoprophylaxis for pain relief
during childbirth

This study included 1405 infants whose mothers
requested epidural analgesia during labor.

Epidural analgesia and oxytocin augmentation
obstructed breastfeeding success.

The use of epidural agents
resulted in a decrease in
breastfeeding rates.
(oxytocin/drowsiness)

Women without pain relief
had the highest duration of
breastfeeding compared
to other women who had
epidurals.


Cohort Study
They sent out a question to 164 mothers breast-
feeding problems with in the first 12 weeks of life.
99 mothers returned the completed questionnaires.
44% of the 99 mothers reported partial breast
feeding or formula feeding the first 12 weeks
Older age of mothers,
use if epidural analgesia
and the problem of not
having enough milk
were associated with
the failure to breast
feed fully
More studies are
needed to establish
weather there is a
relationship between
epidural analgesia and
breast-feeding
problems

Objective: to compare the early
breastfeeding behaviors of a full-term
newborn during an uncomplicated labor
with a mother who used EDA and one
who did not

Study consisted of 351 healthy women
and babies per group
Significantly fewer babies whos mother
had EDA during labor were
breastfeeding within 4 hours of life, were
more likely to receive artificial milk, and
fewer were fully breastfeeding at
discharge


the study showed that epidural
anesthesia is associated with impaired
breast feeding including breast feeding
at discharge from the hospital.
Further studies are needed on the effects
of EDA on short- and long-term breast-
feeding outcomes.

Mount Sinai Hospital
Department of
Anesthesia and Pain,
Obstetrics and
Gynecology, and
Pediatrics and Nursing.
Not a lot of well-
established studies.
Too many confounding
variables in studies that
were well designed.

Multiparous women,
> 37 weeks gestation.
87 women, requested
epidural analgesia,
and previously
breastfeed
successfully.
Epidural data
Breastfeeding
evaluated in three
phases.
Degree of
breastfeeding.

No adverse neonatal
outcomes
69% Lactation support.
First week follow-up 100%
were successfully
breastfeeding.
Six week follow-up, four
women stopped
breastfeeding.
> 150 units of cumulative
fentanyl 1 stopped.
< 150 units of cumulative
fentanyl 3 stopped.

Breastfeeding
cessation at 6
weeks post-
partum is
much lower
than
previously
quoted in the
literature
More studies
need to be
done using
dosing
information.
Too many
variables to
take into
account.


In conclusion, there is a lot of
research which still needs to be done
regarding the effects of epidurals on
newborn babies ability to breastfeed
which is determined by many other
factors. Three of our five articles
seemed to agree that women that
were not given an epidural during
labor and delivery seem to
breastfeed longer than women who
did choose to have an epidural. It
also depends on what type of
medication is administered through
the epidural. Our group did not
specify a specific drug, so the studies
we found where on different
medications given through an
epidural each having a different
outcome in the study.
Ann D. Murray, R. M. (1981, March). Effects of Epidural Anesthesia
of Newborns and Their Mothers. Child Development Vol. 52, pp.
71-82.
Ingela Wiklund, M. N.-M.-B.-A. (2009). Epidural analgesia: Breast-
feeding success and related factors. Elsevier, Midwifery, pp. 25,
e31-e38.
Lapland Central Hospital. (2004). Epidural Analgesia for Labor
May be Linked to Breast-feeding Problems. Biotech Week, p. 282.
Tamagawa, K. &. (2010). Analyzing adverse effects of epidural
anesthesia during labour. British Journal of Midwifery, pp. 704-
708.
Wieczoreck, P. G. (2010). Breastfeeding success rate after
vaginal delivery can be high despite the use of epidural
fentanyl: an observational cohort study. International Journal of
Obstetric Anesthesia, 19, pp. 273-277. doi:
10.1016/j.ijoa.2010.02.001