Epidural Analgesia, Beta-Endorphin Concentrations in Colostrum, and Infant Neurobehavior as Breast-Feeding Predictors

Presently, the literature addressing the relationship between epidural analgesia and
likelihood of breast-feeding is inconclusive. Numerous studies have found that epidurals,
administered prior to vaginal delivery of a full-term, healthy neonate, significantly
decrease lactation success at follow-up times ranging from 24 hours to 6 months postpartum.
One proposed mechanism is that analgesics, by decreasing maternal pain during labor, decrease
maternal endorphin production and result in the transmission of lower endorphin levels to the
neonate during breast-feeding. Lower endorphin levels, in turn, may render the neonate less
likely to suckle optimally. Other studies have found that epidural analgesia does not
significantly decrease lactation success when used during the vaginal delivery of a
full-term, healthy neonate.

Although most studies to date have compared the breast-feeding success of epidural recipients
and non-recipients at various points postpartum, they do not specifically note whether
deficient feeding behaviors on the part of the infant contribute to failed breast-feeding.
The present study uses the LATCH assessment tool to score the infant's ability to latch onto
the breast and the presence of audible swallowing, as well as the mother's level of physical
comfort with breast feeding, whether she can successfully position the infant for feeding on
her own, and whether her nipples are inverted, everted, or flat. Thus, the LATCH assessment
enables the separation of multiple factors that may contribute to breast-feeding failure. A
multivariate regression analysis will determine how strongly the probability of
breast-feeding at hospital discharge correlates with epidural duration, LATCH scores, and
beta-endorphin concentrations in colostrum.