What is an epidural and how does it work?
An epidural is small plastic catheter that is placed into your back to give pain medication for labour and for caesarean delivery. The medications used are usually a combination of local anaesthetic that helps to numb nerves and an opioid that provides additional pain control. The amount of opioid medication that is given through an epidural is much less than what would be needed to control your pain with IV or injectable opioids. Epidurals provide the most complete type of pain relief available for labour and delivery.
Do the pain medications reach my baby?
Almost any medication given during labour and delivery has the potential to reach the baby, including local anaesthetics and opioid medications given by epidural. Because the epidural catheter is close to the nerves that sense pain, medications given by epidural are used in very small doses compared to intravenous or intramuscular route and so far less medication will reach the baby.
How might an epidural affect breastfeeding?
Mothers who receive an epidural for labour pain should still be able to breastfeed, especially if you have experience breastfeeding a baby previously. However, small differences in infant behaviour are sometimes seen, and mothers should be given additional help and support for breastfeeding if you have any problems. Some studies have looked for links between epidural use and breastfeeding, and results are mixed. Studies may show that higher doses of the opioid medication fentanyl (most commonly used opioid in epidurals) may impact breastfeeding, but lower doses don’t seem to make breastfeeding more difficult.
In addition to the medications themselves, other aspects of epidural use for pain relief may impact breastfeeding success. You may receive fluids through your IV to help prevent problems with your blood pressure, and this may lead to swelling of breast tissue. Sometimes this makes it difficult for the baby to latch on and for the milk to “come in” over the next days. There may also be small changes in the levels of the hormone oxytocin and this may have effects on early breastfeeding right after birth.
According to the international Academy of Breastfeeding Medicine: “Like many other aspects of breastfeeding, neuraxial labor analgesia likely has minimal effects on women who strongly intend to breastfeed and have good support but may represent one more subtle challenge to women whose intention to breastfeed is more vulnerable.”. Mothers who wish to use an epidural for pain relief during labour should not forgo this type of pain control over concerns of breastfeeding problems. If you decide to have an epidural for pain relief and are interested in breastfeeding, please share any concerns you may have with your anesthesia and obstetric care teams.
For more information see:
ABA’s booklet Breastfeeding: caesarean births and epidurals
The Academy of Breastfeeding Medicine protocol Number 28: Peripartum Analgesia and Anesthesia for the Breastfeeding Mother.
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© Australian Breastfeeding Association July 2018
The information on this website does not replace advice from your health care providers.