What is an epidural or spinal anaesthetic and how do they work?
An epidural or spinal anaesthetic involves a small plastic catheter or needle that is placed into your black 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 or spinal is much less than what would be needed to control your pain with IV or injectable opioids.
Does the pain medication reach my baby?
Almost any medication given during labour and delivery has the potential to reach your baby, including local anaesthetics and opioid medications given by epidural or spinal. The epidural catheter or spinal is close to the nerves that sense pain, so medications given are used in very small doses compared to intravenous or intramuscular route. As a result, less medication will reach your baby.
How might an epidural or spinal affect breastfeeding?
If you receive an epidural or spinal, you will still be able to breastfeed. However, sometimes there are small differences in baby's behaviour and you may need additional help and support if you are having any problems. A few things to be aware of:
Research has shown 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.
You will 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 your baby to latch on and for the milk to flow well as the mother's milk supply increases over the next few days.
An epidural may affect the release of your own natural oxytocin, which triggers the let-down reflex and helps with bonding. This may have effects on early breastfeeding right after birth.
You may need help to position your baby for breastfeeding because you may be numb and have an IV and catheter into your bladder.
If you want or need to use an epidural for pain relief during labour, you shouldn’t decide against it because you have concerns about breastfeeding problems. Share any concerns you may have with your anaesthesia and obstetric care teams.
Learn as much as you can about breastfeeding and ask for help to get started.
© Australian Breastfeeding Association April 2022