How Do Epidurals Affect Breastfeeding?

Ask a room of expectant parents if they intend to breastfeed and almost 100 percent of them will say yes. The American Academy of Pediatrics recommends breastfeeding for at least 12 months, and the World Health Organization encourages new parents to continue to breastfeed for two years. But only 49 percent of babies are breastfed at six months and only 27 percent are still breastfeeding at one year. (1)

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Why is the number of breastfeeding parents so low? How epidurals can affect breastfeeding Breastfeeding complications caused by epidurals are only temporary  The epidural procedure can affect the assessment of the baby’s weight and health Epidurals can lead to an instrumental birth which can later affect their latch There is debate if Pitocin paired with an epidural can also negatively affect breastfeeding Support can make all the difference Tips to help alleviate breastfeeding challenges caused by epidurals Join our Online Lactation Course! FAQs

Why is the number of breastfeeding parents so low?

One of the reasons for these poor numbers is that problems arise in the first few days after birth, when parent and baby are trying to establish a breastfeeding routine. Three days after giving birth, 92 percent of the new mothers said they were having problems breastfeeding (2), which can cause them to lose confidence in their ability to successfully breastfeed and to feel pressure to supplement with formula.

However, research has shown that there could be another reason why people at this stage are struggling with breastfeeding: there is a correlation between breastfeeding issues and epidurals.

How epidurals can affect breastfeeding

When someone receives epidural anesthesia, they also must get at least two bags of IV fluid to help keep their blood pressure from dropping (a side effect of the epidural). They continue to receive IV fluids throughout labor, and as a result, both parent and baby are full of excess fluid at birth. Within two days, the parent’s body re-absorbs the excess fluid, rendering their breasts more swollen, while their nipples become harder, flat, and more shallow, which can cause latching issues.

A typical scenario for new parents and babies is that the baby establishes a good latch on day one, but by day two, the nipple and breast have changed making latching difficult and frustrating for both parent and baby. 

Unfortunately, the parent is often blamed for having flat nipples and is given a breast shield (which is controversial among lactation consultants), or the baby is blamed for having a poor sucking reflex or being tongue-tied.

Watch the short video below for a better understanding of how epidurals affect breastfeeding.

Breastfeeding complications caused by epidurals are only temporary 

According to Dianne Cassidy, author and International Board-Certified Lactation Consultant, while this problem can be frustrating, it is only temporary. “If mothers realize the swelling and difficulty latching is just from the epidural, not forever…then they will have better breastfeeding.” 

Since more than 80 percent of pregnant people will choose an epidural, Cassidy stresses the importance of helping new parents get past these temporary difficulties and not give up on breastfeeding. It is extremely important that the new parent’s support team offers them encouragement and tries to build their confidence. If they are having breastfeeding problems due to latching and swollen breasts, encourage them to loosen up the breast by pumping, or hand express, to enjoy as much skin-to-skin contact as possible. It is also helpful to drink a lot of water to help flush out the edema.

The epidural procedure can affect the assessment of the baby’s weight and health

The effects of the excess fluid can also be seen in the baby. Within days of being born, babies tend to lose a percentage of their birth weight (10-15 percent), which can cause doctors to become concerned they are not getting enough milk when in reality, the infant is just peeing out the excess fluid. If the weight of the extra fluid is not accounted for, then the parent who was once committed to exclusively breastfeeding may feel pressured to supplement with formula. This added stress and anxiety can negatively affect milk supply.

As pediatrician Dr. Sonia Gidwani explains, “These parameters are set for people who are not ready to make clinical judgments on patients. Ten percent is a number given out to nurses or people at the hospital who are discharging these babies to identify if the baby needs to be seen immediately. The real way to assess a child is to monitor the baby’s urine output: Day one, one wet diaper, day two, two wet diapers, and day three, three wet diapers. This is an indication that there is enough fluid perfusing the kidneys. The baby should urinate at least once every eight hours. Parents can also look for pink crystals (uric acid crystals), which are signs the baby is getting dehydrated.”

Epidurals can lead to an instrumental birth which can later affect their latch

There are two more notable correlations between epidurals and breastfeeding to highlight. Epidural usage increases the chance of an instrumental birth with forceps or vacuum extraction, which can affect the baby’s jaw, thus affecting the latch. The baby exhibits a tight jaw and a poor suck pattern, more choppy than sucking. Babies born with forceps and vacuum assistance are also at higher risk for jaundice, which can render them tired and uninterested in feeding. Dianne Cassidy shared she has seen great success in remedying this issue with cranial-sacral therapy for the baby.

There is debate if Pitocin paired with an epidural can negatively affect breastfeeding

Some studies have suggested that an epidural paired with the use of pitocin, the synthetic form of oxytocin, may potentially have a negative effect on breastfeeding. One study suggested, “Women who delivered using EDA (epidural anesthesia) had a lower milk supply in the early postpartum period and lower breastfeeding rates at 4 months postpartum than women who delivered without using EDA.”(3)(4)  

In full transparency, there is no conclusive research. A systematic review showed “results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational.”(5)

Support can make all the difference! 

Having solid support can help you get past bumps in the breastfeeding road. Here are some suggestions to find support. 

Find a local breastfeeding support group.  La Leche League has local group as well as online support Consider working with an IBCLC, International Board Certified Lactation Consultant.  Talk to your partner ahead of time and tell them you need them to be confident in your ability to breastfeed your child.  Plan ahead of time and take a lactation preparation class. 

Learn more about how epidurals affect breastfeeding by listening to this episode of our podcast, Yoga | Birth | Babies where we discuss with Dianne Cassidy some of the challenges new parents may face within the first few days of breastfeeding. Listen here.

Tips to help alleviate breastfeeding challenges caused by epidurals

Given that 80 percent of pregnant folks will receive an epidural during labor, it is vital to support those facing breastfeeding challenges. Tips for getting past breastfeeding difficulties include:

If possible, give birth in a nursing-friendly hospital that encourages breastfeeding and does not push formula. Discuss ahead of time with your pediatrician the expectation of weight loss for the baby. Room-in with the baby. Find a breastfeeding support group like La Leche League or a local breastfeeding support organization. Seek out a lactation consultant. Become educated on newborn behavior and breastfeeding patterns. Adjust expectations of baby’s eating pattern. Babies do not eat a lot in the first week or two; they take in very small amounts during each feeding: a teaspoon in the first day or so, increasing to an ounce in the first week. Encourage skin-to-skin contact. Have tools available to help alleviate swelling and fluid from the epidural, such as a hospital-grade breast pump, or self express. Adjust expectations of ourselves as birthing people. Breastfeeding can be hard, but you can be successful!

Join our Online Lactation Course!

For a more in-depth understanding of breastfeeding, your baby’s nursing instincts, and how to ensure they are latching properly, join our Lactation Course for Pregnant People. 

In the course, we will also touch on nutrition, baby care, your baby’s weight gain, and troubleshooting common breastfeeding problems.

Join now by clicking the button below!

FAQs

How does an epidural affect the parent and baby?

The risks of an epidural to the baby are not great but can include some potential distress. This can happen when the parent’s blood pressure drops, leading to a slower heartbeat in the baby. This condition is treated by giving fluids to the birthing parent via IV and adjusting her position to enhance circulation. (6)

Will having an epidural affect the immediate bonding and breastfeeding experience with my baby?

An epidural will not affect your ability to bond with your baby. An epidural may affect the immediate postpartum experience in some cases, such as causing temporary numbness or reduced mobility for the parent. This can potentially impact the first breastfeeding session. However, with assistance from the medical team and proper positioning, most parents can successfully initiate breastfeeding soon after delivery. Skin-to-skin contact and prompt breastfeeding support can help ensure a positive bonding and breastfeeding experience. (7)

Are the medications used in an epidural safe for my baby if I plan to breastfeed?

The medications used in an epidural are considered safe for breastfeeding. Only small amounts of these medications pass into breast milk, and they are unlikely to affect the baby. (8) Research indicates that the benefits of breastfeeding far outweigh any minimal risk from epidural medications. It’s always best to discuss any concerns with your healthcare provider. 

Sources

https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf http://www.npr.org/sections/health-shots/2013/09/23/225349120/to-succeed-at-breast-feeding-most-new-moms-could-use-help http://www.medscape.com/viewarticle/449424 https://www.nature.com/articles/s41598-023-48584-6 https://journals.sagepub.com/doi/abs/10.1177/0890334415623779 https://kidshealth.org/en/parents/epidurals.html#:~:text=Some%20epidural%20medicine,improve%20her%20circulation. https://evidencebasedbirth.com/effect-of-epidurals-on-breastfeeding/#:~:text=It%E2%80%99s%20probable%20that,pacifiers%20if%20possible. https://www.parents.com/pregnancy/giving-birth/epidural/epidural-side-effects/#:~:text=While%20epidurals%20are%20relatively%20safe%2C%20they%20are%20not%20without%20risk.%20%22Any%20medication%20that%20you%20take%20to%20relieve%20pain%20will%20reach%20the%20baby%2C%22%20says%20Dr.%20Grant.%20%22However%2C%20with%20an%20epidural%2C%20the%20amount%20that%20enters%20your%20bloodstream%20is%20quite%20small%2C%20and%20with%20a%20spinal%2C%20it%27s%20even%20smaller.