A Woman Experiencing Difficulty With Breastfeeding—Reply

In Reply: In response to Dr Camann, it has been observed that breastfeeding infants sometimes have difficulty in latching on to the breast and this difficulty has been associated with epidural anesthesia.¹ In a previous study,² we noted that for the average epidural anesthesia used in the support of labor, there was no effect on breastfeeding. When, however, the epidural anesthesia lasted more than 4 hours, there was a potential association. When a mother receives epidural anesthesia for cesarean delivery, the infant is delivered and the cord cut in a very short period so that there is no opportunity for the drug to reach the infant despite the larger dose of anesthetic. The observations in the obstetrical literature regarding epidural anesthesia in labor are different from those for cesarean delivery.^3- 4 I did not mean to imply that there is absolute proof of the association in the case described in the article. The differences are subtle, and if the ability to latch onto the breast and the strength and duration of the suck are not measured specifically, then the impact on breastfeeding cannot be truly determined.