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

Public release date: 12-Jan-2011 [ | E-mail | Share ] Contact: Michael Torresmedia@camh.net416-595-6015Centre for Addiction and Mental Health

For immediate Release ? January 12, 2011 (Toronto) ? seven scientists at Canada’s Centre for Addiction and Mental Health (CAMH) have been awarded Young Investigator grant awards by the U.S.-based NARSAD: The Brain and Behavior Research Fund.

The CAMH awards will fund genetic, clinical and neuroimaging studies that will ultimately guide future treatments and personalized approaches for people with schizophrenia and depression.

The 124-member NARSAD Scientific Council, a volunteer group of pre-eminent mental health researchers, leads the rigorous and competitive process of identifying the most promising ideas for NARSAD grant awards each year. NARSAD aims to alleviate the suffering of mental illness by awarding grants that will lead to breakthroughs in scientific research. each award is worth up to $60,000 over two years.

“This body of research represents the cutting-edge of brain and behavior research,” said Benita Shobe, NARSAD president and CEO. “Young Investigators are selected for their innovation and potential to improve the lives of people living with mental illness through enhanced treatments and therapies and a better understanding of the causes of mental illness.”

“We are thrilled that our researchers have received these awards, which are known to be important in establishing the careers of young scientists,” says Dr. Bruce Pollock, Vice-President of Research at CAMH.

Awards were granted for the following CAMH projects:

Dr. Daniel Blumberger will look at specific brain function deficits and treatment resistance in older adults with depression. his study will explore whether these deficits, which occur with aging, predict their response to treatment. these findings will ultimately lead to more effective treatments.

Dr. George Foussias will be using functional magnetic resonance imaging to measure brain activity in people with schizophrenia while they do everyday tasks in a virtual reality environment. not only will this approach measure motivational deficits and affected brain regions more objectively than past methods, but the results are also expected to help guide the development of future treatments for these deficits in schizophrenia.

Dr. Zachary Kaminsky will conduct research on major depression in identical twins in a study involving epigenetics. this field of research examines how developmentally acquired or environmentally triggered changes to chemical attachments on DNA can alter the ability of genes to produce proteins. He will search for epigenetic markers in the blood, which will provide the basis for early diagnostic and therapeutic developments for depression.

Dr. Romina Mizrahi will use a brain imaging technique developed at CAMH to “see” brain inflammation levels in people with schizophrenia. this will be useful to test new treatment strategies and understand how inflammation relates to the severity of schizophrenia.

Dr. Tarek Rajji will study the effects of a brain stimulation technique to enhance brain plasticity, and consequently address attention and memory problems, in people with schizophrenia. Deficits with these complex thinking processes are common features of the illness, and improvements could enhance individuals’ ability to function in society as well as their overall quality of life.

Dr. Arun Tiwari’s research will examine the role that genes play on side effects that some people with schizophrenia experience after taking antipsychotic medicines. Understanding the genetic causes of the side effects that lead to obesity, diabetes, high blood pressure and other related symptoms will help predict who is at risk and which medications to take.

Dr. Aristotle Voineskos will conduct research on a brain stimulation treatment among people with schizophrenia to improve “working memory” deficits, which can lead to improvements in real-world function. in addition, he will examine whether specific genes predict someone’s response to this treatment, in an attempt to personalize treatments for each individual.

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Media contact: Michael Torres, CAMH Media Relations, 416-595-6015; or by email at

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The Centre for Addiction and Mental Health (CAMH) is Canada’s largest mental health and addiction teaching hospital, as well as one of the world’s leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. for more information, please visit camh.net.

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Posted on: Monday, 29 November 2010, 14:32 CST

People with multi-symptom asthma more often have night-time awakenings due to asthma-symptoms, a sign of severe asthma. Researchers writing in BioMed Central’s open access journal Respiratory Research have shown that asthma with multiple symptoms is more highly prevalent than previously suggested, comprising 20- 25% of all asthmatics.

Investigators from the University of Gothenburg have performed a large-scale epidemiological survey in West Sweden, comprising of a random sample of 30,000 individuals and a response rate of 62%. the authors have previously shown that the prevalence of asthma is high, at approximately 8.5%, but stable over the last two decades. In this study they found that the prevalence of severe asthma is as high as 2%. Lead researcher Jan Lötvall said, "Individuals reporting multiple asthma symptoms are likely to have a more severe form of asthma, which has been shown to increase the risk of asthma attacks, increases health care utilization and negatively influence quality of life".

The report further shows that the risk of having asthma with multiple symptoms is substantially increased in those reporting symptoms from the nose, including blocked nose and runny nose. Specifically, the investigators show that signs of chronic rhinosinusitis, which has been defined as having at least two symptoms of nasal blockage, runny nose, lack of smell and/or pain from sinuses over at least 12 weeks, further increase the risk of severe asthma. This is the first study based on an epidemiological cohort showing a close relationship between severe nasal symptoms and severe asthma.

According to Lötvall, "Our study strongly supports the concept that nasal disease and asthma often are closely related, and argues that doctors should consider whether asthma patients with symptoms from the nose have severe asthma, possibly requiring more intense intervention".

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GOTHENBURG, Sweden, Nov. 30 (UPI) — Swedish researchers suggest nasal problems lasting longer than 12 weeks increase the risk of severe asthma.

Investigators from the University of Gothenburg in Sweden also say symptoms of chronic rhinosinusitis — having at least two symptoms of nasal blockage such as runny nose, lack of smell and/or sinus pain lasting more than 12 weeks — further increases the risk of severe asthma.

“Our study strongly supports the concept that nasal disease and asthma often are closely related,” lead researcher Jan Lotvall says in a statement. “Doctors should consider whether asthma patients with symptoms from the nose have severe asthma, possibly requiring more intense intervention.”

The study, published in Respiratory Research, indicates asthma with multiple symptoms is more prevalent than previously thought — comprising 20 percent to 25 percent of all asthmatics.

While the prevalence of asthma remained stable over two decades — about 8.5 percent — the prevalence of severe asthma was 2 percent and higher than expected.

“Individuals reporting multiple asthma symptoms are likely to have a more severe form of asthma, which has been shown to increase the risk of asthma attacks, increases health care utilization and negatively influence quality of life,” Lotvall says.

The study was based on a survey of a random sample of 30,000 individuals, which has a response rate of 62 percent.