Last update July 11, 2022
Very Low Risk
Topical anesthetics, for local, dental, root or epidural use, have no clinically significant systemic absorption. (Reece 2017).
NEURAXIAL ANALGESIA (EPIDURAL, SPINAL): Used to reduce pain in areas below the waist, such as during childbirth. The injected local anesthetic has no effect on breastfeeding or the infant. It usually associates with an opioid derivative, usually fentanyl.
Unlike general anesthesia, epidural anesthesia allows skin-to-skin bonding of the mother with the baby immediately after delivery and breastfeeding (Roshan 2022, p111). Regarding the epidural, general anesthesia was associated less frequently with breastfeeding and exclusive breastfeeding at 6 weeks (Orbach 2018) and at 6 months (Karasu 2018). The use of local anesthetics and regional anesthesia (spinal, epidural or peripheral block) decreases the need for opioids and other analgesics which can interfere with breastfeeding (Reece 2017)
The use of epidural anesthesia has seen increased instrumented delivery and cesarean sections related to fetal distress, misleading overweight of the child at birth (via fluids administered to the mother) and breast engorgement.
There is controversy (Szabo 2013, Reynolds 2011, Camann 2007, Halpern 2005) over whether drug analgesia during childbirth (epidural with local anesthetics with the addition or not of fentanyl) can or can't affect the onset and duration of breastfeeding, whether due to delayed lactogenesis II, or due to impairment of the infant's own competencies. (Roshan 2022 p419, Oommen 2021, Takahashi 2021, Heesen 2021, French 2016, Herrera 2015, Howie 2006)
It appears to be of more paramount importance the women's support for the establishment and continuation of breastfeeding, than the negative effect that would be exerted by administration of analgesia or anesthesia during labor. (Zuppa 2014, Torvaldsen 2006)
Postoperative pain control with continous epidural bupivacaine continues for 3 days after caesarean section improved breastmilk production and infant weight gain (Hirose 1996), but the opposite occurred when buprenorphine was associated (Hirose 1997). There is consensus that there is greater milk production and greater neonate weight gain if pain is adequately controlled pharmacologically after delivery or cesarean section.
Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.
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e-lactancia is a resource recommended by Asociación Pro Lactancia Materna (APROLAM) of Mexico
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