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Cruel and Misleading Advice on Epidurals

Don’t get an epidural because it will inhibit your ability to breastfeed.

Pregnant women, harangued by a recent government campaign on breastfeeding and subject to endless worrisome news stories about how their activity and choices will affect those of their babies, have something new to worry about: A recent Australian study claims to have found an unusual side of effect of having an epidural – more trouble breast feeding.

Or did it? Dig into the data and there is surprisingly little evidence to support the theory that epidurals actually cause difficulty breastfeeding.

The study, published in the International Breastfeeding Journal was conducted by surveying about 1200 women on whether they had an epidural or not, whether they breastfed in the first few days after birth, and whether they continued to breastfeed their babies for 24 weeks after birth.

The authors found that women who had an epidural were more likely to have problems breastfeeding in the first few days, and less likely to breastfeed their babies for the full 24 weeks. Therefore, those who had an epidural were less likely to breastfeed.

An important principle in making comparisons between two groups (in this case, those who had an epidural and those who didn’t) is that the two groups should be comparable. In other words, except for whether they chose to have an epidural or not, the two groups of women should statistically look pretty similar. This means they should have similar income, age, race, educational level, disposition toward breastfeeding, and similar birth experiences aside from the epidural.

But among the women in this study who had epidurals, 41 percent had cesarean sections (with anesthesia consisting of an epidural) and an additional 31 percent had births assisted with instruments. This compares with zero C-sections and two percent instrumental births among women who had no anesthesia. The two groups of women clearly had extremely different birth experiences.

This suggests that the women who didn’t breast feed may have been dissuaded from doing so due to complications from surgery or higher exhaustion or pain level postpartum. Epidurals may have had nothing to do with it. It is possible that c-sections lead to problems breastfeeding, rather than epidurals.

Only 28 percent of the women who had an epidural also had vaginal births without instruments. One might ask if those women also experienced more trouble breastfeeding than the women who didn’t have an epidural. And when these two groups were compared, the authors actually found that there was no statistically significant correlation between having an epidural and partially breastfeeding (compared to exclusively breastfeeding). In other words, among women who had vaginal births, women who had epidurals and those who didn’t were as likely to only partially breastfeed as they were to exclusively breastfeed.

However, there was a correlation between using an epidural and having trouble breast feeding, even among the women who had vaginal births. This suggests to the authors that there could be a pharmacological reason that some women have trouble establishing breastfeeding.

Even so, we should still be cautious in concluding that epidurals cause trouble. There are several obvious and rather subjective factors that also compromise any relationship between the epidural and breastfeeding. These variables might influence both breastfeeding and epidural use; without controlling for them, we should be very suspicious of any purported link. They include:

  • Attitude toward medical intervention. Women who are averse to using epidurals and prefer un-medicated births may also be averse to using formula instead of breast milk. This would easily explain why women who have epidurals are less likely to breastfeed.
  • Tolerance for pain or discomfort. Women with a higher tolerance for pain may both be less likely to request an epidural, and also more likely to breastfeed (which is known to be uncomfortable at the beginning for many women).
  • Exhaustion level from childbirth. Some women may get an epidural out of sheer exhaustion from labor. These same women may begin the process of caring for an infant more exhausted than women who had easier births, and find themselves less able to maintain or establish breastfeeding.

These factors may or may not play a role in why it is that some women have more success at breastfeeding than others. But without accounting for these rather obvious and potentially influential factors, it’s simply cruel to suggest that accepting pain relief by an epidural will cause breastfeeding problems.