Actually, research into the causative associations between drug use in labour and things such as alertness postnatally and breastfeeding is in its infancy, but results are already suggesting that drugs do have side– or after-effects; these are constantly discussed in the literature on anaesthesiology. Possible (or probable) side– or after-effects are widely accepted as including nausea and vomiting, feelings of confusion, lowering of the blood pressure, sedation, urinary retention, slower emptying of stomach contents and itching (pruritis)—and the pain relief is not always effective. Of course, in all cases, it’s not easy to establish what causes what.

        In a retrospective study conducted by Jordan, et al (Jordan, et al, 2009), which looked at 48,366 healthy women birthing singleton babies at term (i.e. women having healthy births), it was found that at 48 hours after the birth, rates of breast-feeding definitely seemed to be affected by epidurals, opioid analgesia (pethidine, diamorphine, etc) and ergomentrine (used in the third stage of labour). The researchers point out that ‘failure to breastfeed increases morbidity and mortality in both mothers and children in developed and developing countries’, so the impact of any possible effects of drugs used unnecessarily could be enormous. In this study, beyond sociological factors, which have long been known to affect breastfeeding rates, lower breast-feeding rates were associated with induction with pessaries (prostaglandins), epidurals and opioid analgesia, and ergometrine used for the   third stage of labour. (Oddly, they found that first-time mothers who’d had gas and air were more likely to breastfeed. Could this be because these mothers were determined to avoid drugs in labour as much as possible, so as to have as ‘natural’ a birth as possible, and to breastfeed successfully too? Any determination to avoid everything except gas and air could be a particularly British attitude, which is misguided, in my view, for other reasons, as I shall explain later. The view that it is considered ‘nothing’ is reflected in the off-hand statement made by many women postnatally: “Oh, I only had gas and air.”) Anyway, the study by Jordan, et al does provide some evidence that drug use in labour and birth has an impact on breastfeeding rates at 48 hours postpartum, which obviously will affect longer-term rates too, although it must be said that this evidence is not accepted by all anaesthetists as prospective randomised studies are seen as more reliable. After all, women usually request epidurals because of difficulties, so it is not necessarily epidurals per se which cause later problems. Cause-effect are difficult to establish.

        Other (prospective) studies reported fairly clear problems with narcotics used in labour  (Beilin, et al, 2005; Camann, et al, 2007; Torvaldsen, et al, 2006). In the study by Beilin, et al researchers concluded: “Among women who breast-fed previously, those who were randomly assigned to receive high-dose labor epidural fentanyl were more likely to have stopped breast-feeding 6 weeks postpartum than women who were randomly assigned to receive less fentanyl or no fentanyl. (Fentanyl was added to the drug bupivacain, in the epidural cocktail as bupivacain causes paralysis in the lower part of the body; adding fentanyl reduces this effect. Clearly, though, it’s a problem if too much is used.) The study by Torvaldsen, et al concluded: “Women in this cohort who had epidurals were less likely to fully breastfeed their infant in the few days after birth and more likely to stop breast-feeding in the first 24 weeks”… although the researchers felt they were unable to say whether there was a causal link between epidural anaesthesia and difficulties. This was despite the fact that “Intrapartum analgesia and type of birth were associated with partial breastfeeding and breastfeeding difficulties in the first postpartum week” and the fact that women who had epidurals were more likely to stop breastfeeding than women who used non-pharmacological methods of pain relief. Camann’s editorial (below) provides a good overview of this topic. See:

   Jordan S, Emery, S, Watkins A, Evans JD, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG: International Journal of Obstetrics & Gynaecology, 2009, online publication on 1 Sept

   Beilin Y, Bodian C, Weiser J, et al. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology, 2005, Dec;103(6):1211-7

   Camann W. Labor analgesia and breast feeding: avoid parenteral narcotics and provide lactation support. International Journal of Obstetric Anesthesia, 2007, Jul; 16(3):199-201

   Torvaldsen S, Roberts CL, Simpson JM, et al. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. International Breastfeeding Journal, 2006,Dec11;1:24