Last update July 11, 2022

Regional Anesthesia


Safe substance and/or breastfeeding is the best option.

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)

  • There are studies that show that with epidural anesthesia there is a greater risk of delaying the lactogenesis II period (stimulation of milk production) beyond 3 days (Herrera 2015, Lind 2014), lower self-efficacy (Nilsson 2020) and lower frequency and duration of breastfeeding (Oommen 2021, Agea 2020, Torvaldsen 2006), although they do not affect the initial weight loss of the newborn. In some studies, the newborn appears to be at greater risk of delaying the first breastfeeding, due to having a higher body temperature and presenting irritability or drowsiness (Ransjö 2001). Epidural anesthesia can reduce prolactin levels (Uvnäs 2020). This being the case, more support will be needed for breastfeeding mothers who have received analgesia ante- and intra-partum. (Zuppa 2014)
  • But other studies do not find significant problems in the initiation and maintenance of breastfeeding due to epidural anesthesia in childbirth or caesarean section. (Fan 2020, Mahomed 2019, Xu 2019, Grant 2019, Lee 2017, Mauri 2015, Shrestha 2014, Zuppa 2014, Wilson 2010, Wieczorek 2010, Goma 2008, Chen 2008, Wang 2005, Chang 2005, Radzyminski 2003)
  • Some authors found a shorter duration of the first breastfeeding but no delay in the onset of breastfeeding or other problems related to breastfeeding (Gizzo 2012). The onset of breastfeeding was earlier and with more frequent feeds in vaginal delivery than after caesarean section and with epidural anesthesia than with general anesthesia. (Kutlucan 2014, Sener 2003)

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.

See below the information of these related products:

  • (General Anesthesia) (Safe substance and/or breastfeeding is the best option.)
  • Bupivacaine (Safe substance and/or breastfeeding is the best option.)
  • Fentanyl (Safe substance and/or breastfeeding is the best option.)
  • Lidocaine (Safe substance and/or breastfeeding is the best option.)
  • Mepivacaine Hydrochloride (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Ropivacaine Hydrochloride (Safe substance and/or breastfeeding is the best option.)

See below the information of this related group:

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.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Regional Anesthesia is also known as Local and Epidural Anesthesia / Neuraxial analgesia. Here it is a list of alternative known names::

Regional Anesthesia in other languages or writings:


Regional Anesthesia belongs to this group or family:


  1. Takahashi Y, Uvnäs-Moberg K, Nissen E, Lidfors L, Ransjö-Arvidson AB, Jonas W. Epidural Analgesia With or Without Oxytocin, but Not Oxytocin Alone, Administered During Birth Disturbs Infant Pre-feeding and Sucking Behaviors and Maternal Oxytocin Levels in Connection With a Breastfeed Two Days Later. Front Neurosci. 2021 Jun 29;15:673184. Consulted on June 29, 2021 Abstract
  2. Oommen H, Oddbjørn Tveit T, Eskedal LT, Myr R, Swanson DM, Vistad I. The association between intrapartum opioid fentanyl and early breastfeeding: A prospective observational study. Acta Obstet Gynecol Scand. 2021 Dec;100(12):2294-2302. Consulted on April 22, 2021 Abstract
  3. Heesen P, Halpern SH, Beilin Y, Mauri PA, Eidelman LA, Heesen M, Orbach-Zinger S. Labor neuraxial analgesia and breastfeeding: An updated systematic review. J Clin Anesth. 2021 Feb;68:110105. Consulted on Feb. 22, 2021 Abstract
  4. Nilsson IMS, Kronborg H, Rahbek K, Strandberg-Larsen K. The significance of early breastfeeding experiences on breastfeeding self-efficacy one week postpartum. Matern Child Nutr. 2020 Jul;16(3):e12986. Consulted on July 22, 2020 Abstract
  5. Agea-Cano I, Linares-Abad M, Ceballos-Fuentes AG, Calero-García MJ. Breastfeeding at 1, 3 and 6 Months after Birth According to the Mode of Birth: A Correlation Study. Int J Environ Res Public Health. 2020 Sep 18;17(18). pii: E6828. Consulted on April 22, 2020 Abstract
  6. Roshan Fernando, Pervez Sultan, Sioned Phillips. Quick Hits in Obstetric Anesthesia. Springer. 2022 Full text (link to original source)
  7. Fan HSL, Wong JYH, Fong DYT, Lok KYW, Tarrant M. Association Between Intrapartum Factors and the Time to Breastfeeding Initiation. Breastfeed Med. 2020 Jun;15(6):394-400. Abstract
  8. Uvnäs Moberg K, Ekström-Bergström A, Buckley S, Massarotti C, Pajalic Z, Luegmair K, Kotlowska A, Lengler L, Olza I, Grylka-Baeschlin S, Leahy-Warren P, Hadjigeorgiu E, Villarmea S, Dencker A. Maternal plasma levels of oxytocin during breastfeeding-A systematic review. PLoS One. 2020 Aug 5;15(8):e0235806. Abstract
  9. Xu Q, Wu ZF, Yang NN, Shi M, Zhu ZQ. Impact of epidural analgesia during labor on breastfeeding initiation and continuation: a retrospective study. J Matern Fetal Neonatal Med. 2020 Nov;33(22):3816-3819. Abstract
  10. Mahomed K, Wild K, Brown C, Green A. Does fentanyl epidural analgesia affect breastfeeding: A prospective cohort study. Aust N Z J Obstet Gynaecol. 2019 Apr 8. Abstract
  11. Grant GJ, Agoliati AP, Echevarria GC, Lax J. Epidural Analgesia to Facilitate Breastfeeding in a Grand Multipara. J Hum Lact. 2019 Feb;35(1):165-167. Abstract
  12. Karasu D, Yilmaz C, Ozgunay SE, Cansabuncu S, Korfali G. A comparison of the effects of general anaesthesia and spinal anaesthesia on breastfeeding. C R Acad Bulg Sci . 2018;71:993-1000. Abstract Full text (in our servers)
  13. Orbach-Zinger S, Landau R, Davis A, Oved O, Caspi L, Fireman S, Fein S, Ioscovich A, Bracco D, Hoshen M, Eidelman LA. The Effect of Labor Epidural Analgesia on Breastfeeding Outcomes: A Prospective Observational Cohort Study in a Mixed-Parity Cohort. Anesth Analg. 2018 May 25. Abstract
  14. Lee AI, McCarthy RJ, Toledo P, Jones MJ, White N, Wong CA. Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial. Anesthesiology. 2017 Oct;127(4):614-624. Abstract
  15. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  16. French CA, Cong X, Chung KS. Labor Epidural Analgesia and Breastfeeding: A Systematic Review. J Hum Lact. 2016 Aug;32(3):507-20. Abstract
  17. Herrera-Gómez A, García-Martínez O, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C, Ocaña-Peinado FM. Retrospective study of the association between epidural analgesia during labour and complications for the newborn. Midwifery. 2015 Jun;31(6):613-6. Abstract
  18. Mauri PA, Contini NN, Giliberti S, Barretta F, Consonni D, Negri M, Di Benedetto I. Intrapartum epidural analgesia and onset of lactation: a prospective study in an Italian birth centre. Matern Child Health J. 2015 Mar;19(3):511-8. Abstract
  19. Cobb B, Liu R, Valentine E, Onuoha O. Breastfeeding after Anesthesia: A Review for Anesthesia Providers Regarding the Transfer of Medications into Breast Milk. Transl Perioper Pain Med. 2015;1(2):1-7. Abstract Full text (link to original source) Full text (in our servers)
  20. Lind JN, Perrine CG, Li R. Relationship between Use of Labor Pain Medications and Delayed Onset of Lactation. J Hum Lact. 2014 Abstract Full text (link to original source)
  21. Bolat E, Bestas A, Bayar MK, Ozcan S, Erhan OL, Ustundag B. Evaluation of levobupivacaine passage to breast milk following epidural anesthesia for cesarean delivery. Int J Obstet Anesth. 2014 Abstract
  22. Dalal PG, Bosak J, Berlin C. Safety of the breast-feeding infant after maternal anesthesia. Paediatr Anaesth. 2014 Abstract
  23. Zuppa A, Alighieri G, Riccardi R, Cavani M, Iafisco A, Cota F, Romagnoli C. Epidural analgesia, neonatal care and breastfeeding. Ital J Pediatr. 2014 Abstract Full text (link to original source) Full text (in our servers)
  24. Alus Tokat M, Serçekuş P, Yenal K, Okumuş H. Early Postpartum Breast-Feeding Outcomes and Breast-Feeding Self-Efficacy in Turkish Mothers Undergoing Vaginal Birth or Cesarean Birth With Different Types of Anesthesia. Int J Nurs Knowl. 2014 Abstract
  25. Kutlucan L, Seker İS, Demiraran Y, Ersoy Ö, Karagöz İ, Sezen G, Köse SA. Effects of different anesthesia protocols on lactation in the postpartum period. J Turk Ger Gynecol Assoc. 2014 Dec 1;15(4):233-8. Abstract
  26. Shrestha B, Devgan A, Sharma M. Effects of maternal epidural analgesia on the neonate - a prospective cohort study. Ital J Pediatr. 2014 Abstract Full text (link to original source) Full text (in our servers)
  27. Szabo AL. Review article: Intrapartum neuraxial analgesia and breastfeeding outcomes: limitations of current knowledge. Anesth Analg. 2013 Abstract
  28. Gizzo S, Di Gangi S, Saccardi C, Patrelli TS, Paccagnella G, Sansone L, Barbara F, D'Antona D, Nardelli GB. Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding. Breastfeed Med. 2012 Aug;7:262-8. Abstract
  29. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012 Abstract
  30. Reynolds F. Labour analgesia and the baby: good news is no news. Int J Obstet Anesth. 2011 Abstract
  31. Chantry CJ, Nommsen-Rivers LA, Peerson JM, Cohen RJ, Dewey KG. Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance. Pediatrics. 2011 Abstract
  32. Wieczorek PM, Guest S, Balki M, Shah V, Carvalho JC. Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study. Int J Obstet Anesth. 2010 Jul;19(3):273-7. Abstract
  33. Wilson MJ, MacArthur C, Cooper GM, Bick D, Moore PA, Shennan A; COMET Study Group UK. Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia. 2010 Abstract Full text (link to original source) Full text (in our servers)
  34. Matsota PK, Markantonis SL, Fousteri MZ, Pandazi AK, Manikis DE, Christodoulopoulou TC, Loizou MM, Kostopanagiotou GG. Excretion of ropivacaine in breast milk during patient-controlled epidural analgesia after cesarean delivery. Reg Anesth Pain Med. 2009 Abstract
  35. Goma HM, Said RN, El-Ela AM. Study of the newborn feeding behaviors and fentanyl concentration in colostrum after an analgesic dose of epidural and intravenous fentanyl in cesarean section. Saudi Med J. 2008 May;29(5):678-82. Abstract
  36. Chen YM, Li Z, Wang AJ, Wang JM. [Effect of labor analgesia with ropivacaine on the lactation of paturients]. Zhonghua Fu Chan Ke Za Zhi. 2008 Jul;43(7):502-5. Chinese. Abstract
  37. Camann W. Labor analgesia and breast feeding: avoid parenteral narcotics and provide lactation support. Int J Obstet Anesth. 2007 Abstract
  38. Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006 Abstract Full text (link to original source) Full text (in our servers)
  39. Howie WO, McMullen PC. Breastfeeding problems following anesthetic administration. J Perinat Educ. 2006 Abstract Full text (link to original source) Full text (in our servers)
  40. Wang BP, Li QL, Hu YF. [Impact of epidural anesthesia during delivery on breast feeding]. Di Yi Jun Yi Da Xue Xue Bao. 2005 Abstract Full text (link to original source) Full text (in our servers)
  41. Halpern SH, Ioscovich A. Epidural analgesia and breast-feeding. Anesthesiology. 2005 Abstract
  42. Beilin Y, Bodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, Martin G, Holzman I. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology. 2005 Abstract
  43. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005 Abstract
  44. Jordan S, Emery S, Bradshaw C, Watkins A, Friswell W. The impact of intrapartum analgesia on infant feeding. BJOG. 2005 Abstract Full text (link to original source) Full text (in our servers)
  45. Sener EB, Guldogus F, Karakaya D, Baris S, Kocamanoglu S, Tur A. Comparison of neonatal effects of epidural and general anesthesia for cesarean section. Gynecol Obstet Invest. 2003 Abstract
  46. Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs. 2003 Abstract
  47. Lang C, Geldner G, Wulf H. [Anesthesia in the breast feeding period. Excretion of anesthetic agents and adjuvants into breast milk and potential pharmacological side-effects on the suckling infant]. Anaesthesist. 2003 Abstract
  48. Ransjö-Arvidson AB, Matthiesen AS, Lilja G, Nissen E, Widström AM, Uvnäs-Moberg K. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth. 2001 Abstract
  49. Ortega D, Viviand X, Lorec AM, Gamerre M, Martin C, Bruguerolle B. Excretion of lidocaine and bupivacaine in breast milk following epidural anesthesia for cesarean delivery. Acta Anaesthesiol Scand. 1999 Abstract
  50. Hirose M, Hosokawa T, Tanaka Y. Extradural buprenorphine suppresses breast feeding after caesarean section. Br J Anaesth. 1997 Abstract Full text (link to original source) Full text (in our servers)
  51. Hirose M, Hara Y, Hosokawa T, Tanaka Y. The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain. Anesth Analg. 1996 Abstract
  52. Cuypers L, Wielalck A, Vertommen JD, Van Aken H. Epidural sulfentanil for postcaesarean pain: breast milk levels and effects on the baby. Acta Anaesthesiol Belgica 1995;46:104-5.
  53. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993 Jul;48(7):616-25. Review. Abstract Full text (link to original source) Full text (in our servers)
  54. van Oss GE, Vree TB, Baars AM, Termond EF, Booij LH. Pharmacokinetics, metabolism, and renal excretion of articaine and its metabolite articainic acid in patients after epidural administration. Eur J Anaesthesiol. 1989 Abstract
  55. Baker PA, Schroeder D. Interpleural bupivacaine for postoperative pain during lactation. Anesth Analg. 1989 Sep;69(3):400-2. No abstract available. Abstract
  56. Lie B, Juul J. Effect of epidural vs. general anesthesia on breastfeeding. Acta Obstet Gynecol Scand. 1988 Abstract
  57. Madej TH, Strunin L. Comparison of epidural fentanyl with sufentanil. Analgesia and side effects after a single bolus dose during elective caesarean section. Anaesthesia. 1987 Abstract
  58. Jouppila R, Jouppila P, Moilanen K, Pakarinen A. The effect of segmental epidural analgesia on maternal prolactin during labour. Br J Obstet Gynaecol. 1980 Abstract

Total visits


Help us improve this entry

How to cite this entry

Do you need more information or did not found what you were looking for?

   Write us at

e-lactancia is a resource recommended by El Parto Es Nuestro of Spain

Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM