Some of the drugs used in epidurals can make their way into babies’ bloodstreams, subtly affecting their brains and making them sleepy and less willing to breast-feed, a study published today in the International Breastfeeding Journal suggests. It is the largest study of its kind.

Siranda Torvaldsen and colleagues at Sydney University studied 1,280 women who had given birth, of whom 416 had had an epidural. The researchers found that 93 per cent of the women breast-fed their baby in the first week but that those who had epidurals experienced more difficulty in the few days immediately after birth. After six months, 72 per cent of women who had not received painkillers were breast-feeding, compared with 53 per cent of those who had been given epidurals.

The most likely cause of the problem was fentanyl, an opioid drug used widely as a component of epidurals, the authors suggest. Such drugs pass quickly into the bloodstream and cross easily into the placenta to reach the unborn baby.

If confirmed, such research could force a rethink over the use of such drugs, which appear to impair infants’ development and co-ordination in the crucial days after birth.

In response to the research, one expert suggests the impact of epidurals on breast-feeding should be officially classed as an “adverse drug reaction”. Sue Jordan, senior lecturer in applied therapeutics at Swansea University, said that women given epidurals should be offered support to stop their infants being “disadvantaged by this hidden, but far-reaching, adverse drug reaction”.

The research could help to explain why many British women fail to breast-feed, with 55 per cent giving up within six weeks of birth, especially young mothers or those discouraged from breast-feeding for social or cultural reasons. More than a third of women give up within a week, saying that their babies simply refuse to breast-feed.

Dr Jordan said that the lack of research into how epidural drugs affected newborn babies was “terrible”.

“A lot more work needs to be done, but we think that drugs can pass into the baby and make it less coordinated, in the jaw and other areas,” she said. “This means that it cannot latch on to the mother properly as she tries to initiate breast-feeding. Many mothers get frustrated and simply give up because they think bottle-feeding is easier.”

Many women favour epidurals because the drugs allow them to relax. However, researchers have known for some time that there are potential adverse side-effects, such as lowered blood pressure, a slowing of the birth process and a greater risk of a forceps delivery.

Smaller previous studies have supported the latest findings. A study at Toronto University of 177 women, found that they were less likely to be breast-feeding after six weeks if they had been given an epidural with fentanyl.

Rosie Dodds, policy researcher at the National Childbirth Trust, said: “Mothers should receive detailed information while pregnant about the potential side-effects of different types of epidural and local anaesthetic, and should receive extra support when starting to breast-feed if they have received opioid pain relief during labour.”

First feed

Sources: National Childbirth Trust, NHS Information Centre

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