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To the Editor: In her discussion of difficulties with breastfeeding, Dr Lawrence¹ mentions that epidural analgesia during labor may contribute to breastfeeding difficulty because of transplacental drug passage and its adverse effects on early suckling. Her references to support this allegation, however, all found extremely low neonatal blood levels of anesthetic drugs, normal Apgar scores, normal umbilical vessel acid-base status, and normal neonatal neurobehavioral scores. This is particularly important because several of these references used epidural anesthesia for cesarean delivery, which requires much greater doses of local anesthetic than labor analgesia. Nonetheless, none of these maternal or neonatal examinations showed evidence of infant depression.

Several authors have reported no adverse effects of intrapartum^2-3 or postcesarean⁴ epidural analgesia on early breastfeeding efforts. Maternal and neonatal blood concentrations of local anesthetics and opioids following intrapartum epidural analgesia are typically low and neonatal neurobehavioral scores are normal, even after prolonged infusions during labor.⁵ . . . [Full Text of this Article]

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