Kevara Wilson and Dr. Debra Hobbins-Garbett, Nursing
Every mother wants to give the best to her baby, and many mothers feel breastfeeding is doing just that—giving the best. For these mothers, the effect of epidural anesthesia on those first breastfeeding encounters is an important one. Unfortunately, few researched-based answers about these effects exist.
The question is the following: Are neurobehavioral deficiencies (manifested by impaired latching at the breast and swallowing) seen in some newborns a result of the epidural anesthesia administered to the mother, or due to normal variation among newborns?
In my research, I looked at the results of the latch and audible swallow portions of the LATCH tool (used to measure latch, audible swallow, type of nipple, comfort level of the mother in breastfeeding, hold, and help needed) of newborns whose mothers received epidural anesthesia. The sample of newborns was taken from those newborns born at Utah Valley Regional Medical Center in Provo, Utah during the month of March, 2000. The infants needed to 1) have been born vaginally to a mother who received epidural anesthesia and no narcotic anesthesia, 2) be appropriate size for gestational age, 3) be full-term at 38-42 weeks gestational age, 4) have Apgar scores equal to or greater than 8 (indicating no complicating illness) at one and five minutes. The data were collected by chart review in conjunction with Medical Records.
The LATCH tool is based on assessment of the facets of breastfeeding listed above, being rated 0-1-2, with a 2 being the highest possible score and a zero being the lowest. This research was intended as a pilot study, or trial, in order to discover low scores or any difference in the L and A portions of the score, which would be an indication for further research in the area.
Such differences were found in the research done at Utah Valley Regional Medical Center. The mean score for latch among this subset of newborns was 1.719 and the mean for audible swallow was 1.5. From this finding we might draw the conclusion babies who were born to a mother who received an epidural have more difficulty swallowing than they do latching on to the mother’s breast. However, could the difference between the two means be a normal pattern of development among all newborns? And, are the means at a level which is normal for nonmedicated births as well?
The results I encountered were not definitive for a variety of reasons. The LATCH tool uses numbers for its scoring, however, the assessment of a score is subjective. Although training was provided, the LATCH tool was still relatively new for the nurses. The disqualifier for half of all those patients disqualified from the study was the absence of a complete LATCH score. These facts cast some doubt on the accuracy of those scores that were recorded. In addition, some scores were recorded in such a manner as to indicate the time at which they were done, while others were not. Because of this, there was no way to differentiate between a newborn whose breastfeeding ability was measured an hour after birth and a newborn who was measured 20 hours after birth. The effect of the anesthesia would decrease the further the newborn was from the time of birth. Finally, without a control group to compare LATCH scores with nonmedicated births, or a standard of the “average” baby’s scores, the results have less meaning.
As mentioned, further study in the effect of epidural anesthesia on breastfeeding is warranted. Results of this research have raised more questions which only more in-depth research can answer. Follow-up research would want to have the following characteristics: 1) recorded time of assessment and a method to account for the time from birth and/or anesthesia administration to assessment and scoring, 2) nurses who were familiar with the LATCH charting system and scoring requirements, 3) a control group (nonmedicated labor and birth) and an experimental group (labor and birth with epidural anesthesia), and, if possible, 4) establish some consistency in assessment of the scores (by providing standardized training, disqualifying floating nurses, etc.).