by Symptom Advice on October 23, 2011

Natural childbirth advocates are apparently desperate to demonstrate that “good mothers” don’t get epidurals for pain relief in labor. Unfortunately for them, the scientific literature, including the Torvaldsen study, fail to demonstrate that epidurals interfere with breastfeeding.

The Torvaldsen study looked at breastfeeding rates at 8, 16, and 24 weeks postpartum. At one week postpartum 93% of women were breastfeeding or partially breastfeeding. the investigators divided women into those who did any breastfeeding at all, regardless of how little, and those who had completely stopped breastfeeding. Strangely, the investigators never asked women about their breastfeeding plans. in other words, they ASSUMED (wrongly, no doubt) that all women planned to breastfeed for 6 months regardless of personal beliefs and regardless of employment status.

The data showed that the rate of breastfeeding dropped in each progressive week in ALL groups. At 24 weeks 52% of women who had received epidurals were still breastfeeding, compared to 72% who had received no pharmacological pain relief. but what percentage of women who stopped breastfeeding had never intended to continue until 24 weeks? we don’t know, because the authors never asked. They simply ASSUMED that anyone who stopped breastfeeding before 24 weeks did so involuntarily.

The investigators looked at many factors that were associated with duration of breastfeeding and of those, three had strong associations with duration of breast feeding. of those three, pain relief had the WEAKEST association with breastfeeding rates. A stronger association was found with maternal education level, and the strongest association was found with maternal age. Women over 30 reported a longer duration of breastfeeding and women with a university degree had the best rate of extended breastfeeding in the entire study.

It is interesting therefore, that lactivists claim that this study indicates that women risk harming the breastfeeding relationship by choosing an epidural. by their “reasoning,” lack of a university degree has an even higher risk of harming the breastfeeding relationship, yet, curiously, they do not recommend that women shouldn’t have children until they have a university degree.

It is obvious that young age does not “cause” a decrease in extended breastfeeding and failure to obtain a college degree does not “cause” a decrease in breastfeeding. They are maternal characteristics associated with a decrease in extended breastfeeding rates. in other words, rates of extended breastfeeding are dependent on personal characteristics of the mothers themselves. Older mothers and more educated mothers have a greater commitment to extended breastfeeding.

Similarly, epidural anesthesia does not “cause” a decreased in extended breastfeeding rates; the willingness to refuse epidural anesthesia is a maternal characteristic associated with extended breastfeeding, and only a minority of women (25%) refused some sort of pharmacologic pain relief.

This study does not show that epidurals interfere with breastfeeding. It shows that maternal personal characteristics determine extended breastfeeding rates. the women who were committed to unmedicated childbirth were also committed to extended breastfeeding, and as a variety of other studies have demonstrated, it is maternal commitment that is most closely associated with extended breastfeeding.

Sorry to disappoint those who insist they merit praise for refusing an epidural, but there is NO need to decline an epidural for fear that it will harm the breastfeeding relationship.

Amy Tuteur, MD commented on Feb 10 11 at 11:53 am

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