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Figuring How Medications during Labor Affect Breastfeeding

Sometimes the medications you have during labor affect your first nursing attempt. Some medications make the baby sleepy; some make you sleepy. Here are how some of the common medications given in labor can affect breastfeeding.

Inducing labor with Pitocin

Many women today are induced — given medications that jumpstart labor — either for their own convenience, the doctor's convenience, or because of a possible problem with mom or the baby. A drug called Pitocin is commonly used to induce labor. Pitocin induction has been associated with breastfeeding problems.

Pitocin has an anti-diuretic effect (it decreases your production of urine), which may cause you to retain fluid, creating severe engorgement or a delay in milk production. The drug can also contribute to newborn jaundice. If you're induced, you're also more likely to receive epidural anesthesia, and epidurals may also interfere with breastfeeding.

You probably don't want to be pregnant for one more minute than necessary. However, try to let the baby decide the timetable for delivery rather than the doctor's golf conference in Scotland or your nursery school carpool schedule. Every breastfeeding obstacle that you avoid may make the difference between success and failure.

Of course, many inductions are done for medical reasons; if your doctor feels you need to be induced, don't throw in the towel on breastfeeding. Most likely you and your baby will have no long-term negative effect from an induced labor. Remember, your doctor knows your case best!

Nursing after an epidural

No one ever said labor was painless. If anyone actually does say this to you, they're either suffering from memory loss or trying to ensure that you're not scared of labor.

If you deliver in the hospital, you have a 50 percent chance of receiving an epidural anesthesia. Epidurals are given through catheters placed in the epidural space near the spinal cord; the medication injected usually consists of a numbing anesthetic and a painkiller, such as fentanyl. An epidural gives very good pain relief from your abdomen down to your legs by numbing the nerves that reach those areas.

For years, childbirth educators and lactation consultants, including La Leche League instructors, have believed that the use of epidurals affects breastfeeding. Recent studies show that this may be true.

If you have an epidural, some of the medication enters your blood stream, where it passes across the placenta to the baby. Because the baby's immature liver can't break it down quickly, the effects of the medication — such as having difficulty coordinating sucking behaviors — may linger in the baby longer than they do in you. The effects generally wear off in 24 to 48 hours. Some studies also show that epidurals interfere with the release of oxytocin, the hormone responsible for your let-down (milk ejection) reflex.

Epidural anesthesia may lengthen labor and may increase the chance that you or your baby will run a fever after delivery. If either of you runs a fever, you're more likely to be separated from each other for longer times. (The baby may be sent to the neonatal intensive care for IV antibiotics if he runs a fever.) Several studies have also shown that epidurals as more likely to result in jaundiced babies.

Keep in mind that the side effects from epidurals are generally temporary, and epidurals provide helpful pain relief to many women. The bottom line: Talk with your doctor about possible risks and benefits of epidurals well before your due date!

Using narcotics during labor

Narcotics in labor are often given intravenously, which means their effects wear off within a few hours. But if you deliver your baby shortly after receiving an IV narcotic, the baby may be very sleepy. Every labor and delivery nurse has seen babies in this situation who are sleepy enough to require resuscitation.

Some studies have shown that Demerol is more likely to depress the baby than morphine. Both these drugs are given during labor and after delivery, especially if you've had a cesarean section. If your doctor is willing to give you a choice of medication during and after labor, morphine may be a better choice.

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