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Running head: EPIDURALS: THE EFFECTS EPIDURALS MAY HAVE ON BREASTFEEDING

Epidurals: The Effects Epidurals May Have on Breastfeeding


Angeline Johnson, Brooke Bond, Kaytlyn Stephens, Crystal Buck, Mariette Armitstead
NURS-2400-01B FA13

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Epidurals: The Effects Epidurals May Have on Breastfeeding
The purpose of this paper is to summarize an evidence-based practice research project
examining the use of epidurals during labor and delivery and whether or not the epidural affects
a neonates ability to breastfeed.
Practice Question
The current management of feeding of neonates after delivery is breastfeeding first, then
using formula, unless the mother requests formula be given in place of breast milk. This project
will investigate what effects, if any, an epidural during labor and delivery have on a full-term
neonates ability to breastfeed.
P- Patient Population or Problem
The patient population/problem is among babies born by vaginal birth, with gestational age of 36
to 42 weeks.
I- Intervention
The intervention of interest is epidural exposure.
C- Comparison
The comparison intervention is focused on natural child birth.
O- Outcomes
Identify if the use of an epidural affects the ability of babies to breastfeed.
The Following Question was developed:
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?
Evidence
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The type of question is prognosis. Based on the type of question, the following databases
and internet sites were searched: CINAHL (EBSCOhost), and JSTOR.
Search Items and Results of Search
Search terms developed from the PICO question included: full term, no abnormalities, no
other meds given during labor and/or delivery, and vaginal delivery with no complications. Our
group included the following types of studies in our search: cohort studies, descriptive studies,
and systematic reviews.
Our question was so specific that there was no need to change search terms or our
question based on our search results; however, we later realized that we did not specify what
type of epidural to include in our search, given that there are different kinds of medications in the
epidurals and can demonstrate a variety of effects. Our group located five articles based on
search terms and type of question. These include four observational cohort studies, and one study
which encompassed retrospective, observational cohort, and prospective cohort studies.
Study One
This study was an observational cohort study. The purpose of this study was to find the
effects of epidural anesthesia on women during their labor, and how this anesthesia affects the
newborn babies. The population was full-term fetuses (37 to 42 weeks gestation) that were
delivered vaginally in the vertex position to a neonate with no abnormalities. The subjects were
chosen by convenience and included sixty full-term babies. The result of this study was as
follows: babies that received oxytocin epidurals had greater depression of motor performance
and had a tendency to be tense and hypertonic. The results of this study were highly applicable to
the question we proposed and, through evidence, support our question. This study shows the
elective use of medication should be minimized and other psychoprophylaxis techniques for pain
EPIDURALS: THE EFFECTS EPIDURALS MAY HAVE ON BREASTFEEDING 4

relief should be used, thus reducing the depression of motor performance in neonates, namely a
poor suckling reflex.
Study Two
This research included retrospective, observational cohort, and prospective cohort studies
that analyzed the various adverse outcomes of labor and birth after the administration of epidural
analgesia. The population of this study included full-term infants whose mothers requested
epidural analgesia. They were chosen at random and included 1405 infants. This research
question was answered by the findings of increased negative effects of breastfeeding, including a
reduction in the rates of breastfeeding and the decreased likelihood that mothers would
breastfeed after 24 weeks. Among these groups, women without pain relief proved to have the
longest period of breastfeeding. Also, the researchers expressed the need for epidural analgesia
to be reconsidered as a common choice for pain relief during labor. This research contained
supporting evidence of the negative effects of epidural analgesia in relation to newborns and
breastfeeding; therefore, the results proved to be highly applicable to our research question.
Study Three
This study was a cohort study to see if an epidural during labor is linked to breastfeeding
problems within the first twelve weeks after being born. 164 new mothers who either had an
epidural for labor pains or gave birth naturally were selected randomly for this study. Out of
those 164 mothers, only 99 of them returned the finished questionnaire. These mothers reported
that they had trouble breastfeeding within the first twelve weeks of the babys life. Other factors
were also associated with breastfeeding problems, such as not producing enough milk and the
age of the mother. The results of this study suggested that more research about this topic is
needed before the hypothesis can be answered. I concluded that this article was relevant to our
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topic, even though the hypothesis wasnt answered; it helped us realize that there are many
factors to consider before reaching a conclusion.
Study Four
The purpose of this study was to compare the early breastfeeding success of full-term
newborns whose mothers received epidurals during an uncomplicated labor, with a group of
newborns whose mothers had not received epidurals. The study sample consisted of 351 women
chosen for convenience at the labor ward in Stockholm, Sweden. The study included only full-
term newborns whose mothers had received epidural analgesia during an uncomplicated labor.
For each epidural record, a control record was selected matching parity, age and gestational age
at birth, excluding all C-section, vacuum extraction/forceps, twin pregnancy, breech
presentation, or illness following birth.
The study found that significantly fewer babies of mothers that received an epidural
during labor suckled the breast within the first four hours of life. These babies were also more
often given artificial milk during their hospital stay and fewer were breastfeeding at discharge.
There were other factors that were positively associated with breastfeeding success such as
multiparity, birth weight between three and four kilograms, and oxytocin administration (which
was associated with an initial delay, but the baby was fully breastfeeding by discharge).
The study directly applied to our research question. Although this study did show a connection
between epidural use and a decrease in breastfeeding success, further studies are recommended.
Study Five
This observational cohort study evaluated if the use of an epidural agent in women who
had a vaginal birth had any impact on whether or not breastfeeding was successful. The size of
the study was 105 women and were chosen based on a stratified sample. This targeted population
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of the study was multiparous women who requested epidurals, who previously had breastfed
successfully, and who intended to breastfeed their newborn children. The research question was
answered based on the results of the study, which concluded that the success rate of
breastfeeding among women who received an epidural agent was significantly higher than was
previously reported in other research findings and literature. In conclusion, the level of evidence
and findings of the research suggest that further studies need to be done because of the many
variables that can affect breastfeeding success, such as post-natal support, time off of work, and
age of the mother. The results of the study were relevant and applicable to our research question.
Summary of Evidence and Practice Recommendation
Evidence in these studies suggests that there are many other variables which may lead to
the success or failure of breastfeeding. The scientific evidence confirms the negative effects of
epidurals, including depressed motor performance in neonates, difficulty of the mothers to
breastfeed, a reduction in breastfeeding rates, and a decreased suckling rate of the babies. The
practice recommendations are to minimize the use of elective pain control medications during
labor and delivery of full-term neonates.
Conclusion
In conclusion, there is more research that can be done regarding the effects of epidurals
on newborn babies abilities to breastfeed, given that there are numerous other factors to
consider. However, based on the research articles that we discovered, the articles support our
hypothesis that epidurals have negative effects on neonates abilities to breastfeed. Three of our
five articles seem to agree that women that were not given an epidural during labor and delivery
seemed to breastfeed longer than women who had elected to receive an epidural. Undoubtedly,
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there is a significant correlation with the use of epidural analgesia and breastfeeding. This
supports the idea of finding alternative controls for pain management during labor and delivery.











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References

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, pp. 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
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