Common medical procedure in childbirth hurts babies

And an attempted coverup is underway. First a press report below and then some comments

Women who give birth with the aid of pain-relieving epidurals find it harder to breast-feed than those who give birth naturally, a study has found. The research suggests that some of the drugs used in epidurals make their way into babies' bloodstreams, subtly affecting their brains and development for weeks afterwards - including making them less willing to breast-feed. If confirmed, such research could force a rethink over the use of the drugs.

Up to a third of British women giving birth are routinely given epidurals in which a catheter is inserted into the spine to allow the infusion of pain-killing drugs. These deaden the nerves that relay sensations of pain from the lower body and legs.

In a commentary on the research, published today, one expert suggests the impact of epidurals on breast-feeding should be officially classed as an "adverse drug reaction". Writing in International Breastfeeding Journal, Sue Jordan, senior lecturer in applied therapeutics at Swansea University, says women given the infusions should be offered extra support to stop their infants being "disadvantaged by this hidden, but far-reaching, adverse drug reaction".

Such a link could help explain why many British women fail to breast-feed, with 55% giving up within six weeks of birth. More than a third of women give up within a week, saying their babies simply refuse to breast-feed.

In the research, published in the same journal, Siranda Torvaldsen, from Sydney University, and colleagues from other institutions in Australia, studied 1,280 women who had given birth, of whom 416 had an epidural. The researchers found 93% of the women breast-fed their baby in the first week but those who received epidurals generally had more difficulty in the days immediately after birth.

By the time six months had passed, the women who had been given epidurals were twice as likely to have stopped breast-feeding, even after allowing for factors such as maternal age and education. The authors suggest the most likely cause of the problem was fentanyl, an opioid drug widely used as a component of epidurals. Such drugs pass quickly into the bloodstream and easily cross the placenta to reach the unborn baby.

Many women have a good experience with epidurals because the drugs allow them to relax. However, researchers have long known that there are also potential adverse side effects such as lowered blood pressure, a slowing of the birth process and a greater risk of having to pull the baby out with forceps. There has, however, been less research into the impact of such drugs on babies, although it is known that, because of their immature livers, the drugs can linger in the body.

Other researchers support Torvaldsen's findings. A study at Toronto University, Canada, of 177 women found they were less likely to be breast-feeding after six weeks if they had been given an epidural with fentanyl.

Source

This report seems to have caused some uproar. Even though it was cautiously worded, the editorial by Ms Jordan ("Infant feeding and analgesia in labour: the evidence is accumulating") in International Breastfeeding Journal 2006; 1: 25 has now been taken down. See the cached table of contents here. It must have hit pretty close to the mark to get censored. Truth is the most usual victim of censorship. The abstract of the Torvaldsen study ("Intrapartum epidural analgesia and breastfeeding: a prospective cohort study") is however still available here. I reproduce the abstract of the censored editorial below:

The interesting and important paper by Torvaldsen and colleagues provides further circumstantial evidence of a positive association between intrapartum analgesia and feeding infant formula. Not all research supports this association. Before failure to breastfeed can be adjudged an adverse effect of intrapartum analgesia, the research evidence needs to be considered in detail. Examination of the existing evidence against the Bradford-Hill criteria indicates that the evidence is not yet conclusive. However, the difficulties of obtaining funding and undertaking large trials to explore putative adverse drug reactions in pregnant women may mean that we shall never have conclusive evidence of harm. Therefore, reports of large cohort studies with regression models, as in the paper published today, assume a greater importance than in other areas of investigation. Meanwhile, women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour.

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