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To the Editor: In her discussion of difficulties with breastfeeding, Dr Lawrence1 mentions that epidural analgesia during labor may contribute to breastfeeding difficulty because of transplacental drug passage and its adverse effects on early suckling. Her references to support this allegation, however, all found extremely low neonatal blood levels of anesthetic drugs, normal Apgar scores, normal umbilical vessel acid-base status, and normal neonatal neurobehavioral scores. This is particularly important because several of these references used epidural anesthesia for cesarean delivery, which requires much greater doses of local anesthetic than labor analgesia. Nonetheless, none of these maternal or neonatal examinations showed evidence of infant depression.
Several authors have reported no adverse effects of intrapartum2 - 3 or postcesarean4 epidural analgesia on early breastfeeding efforts. Maternal and neonatal blood concentrations of local anesthetics and opioids following intrapartum epidural analgesia are typically low and neonatal neurobehavioral scores are normal, even after prolonged infusions during labor.5 There is now overwhelming evidence that modern regional analgesia for labor or cesarean delivery does not result in significant drug accumulation or adverse neonatal neurobehavioral effects.
Epidural analgesia is not risk free. Nonetheless, obstetric anesthesiologists have made considerable strides to ensure that one of the most painful events in a woman's life—childbirth—can, if the woman desires, be experienced without pain, and more importantly, with great safety for both mother and infant. In the absence of other confounding factors, transplacental drug passage of labor epidural medications should not be implicated in postpartum breastfeeding difficulties.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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