Correlation or causation?

Correlation or causation?Do epidurals 'lead to breast-feeding troubles'?

Women who have painrelieving epidurals during childbirth have more difficulty breast-feeding and are twice as likely to give up within six months than those who give birth naturally, researchers say. Up to 40 per cent of British women are routinely given epidurals during childbirth, involving a catheter being inserted into the spine to allow the infusion of pain-killing drugs. These deaden the nerves that relay sensation from the lower body and legs.

Some of the drugs used in epidurals can make their way into babies'Â’ bloodstreams, subtly affecting their brains and making them sleepy and less willing to breast-feed, a study published today in the International Breastfeeding Journal suggests. It is the largest study of its kind.The most likely cause of the problem was fentanyl, an opioid drug used widely as a component of epidurals, the authors suggest. Such drugs pass quickly into the bloodstream and cross easily into the placenta to reach the unborn baby.

This sounds possible, but it seems unlikely to last more than a day unless there is some huge imprinting effect on a baby's desire to breastfeed or a big rush to substitute a bottle in the first day.An alternative explanation is that women who opt for epidurals are more likely to give up on breast feeding because of the birth experience, their personality, lifestyle or surgical recovery:

Pat O'Brien, a spokesman for the Royal College of Obstetricians and Gynaecologists, said it was possible that fentanyl had an effect on the baby.But he added: "There are other factors which may explain this link, including that if a woman chooses not to have an epidural, she may also be more motivated to persevere with breastfeeding."Also, a lot of those women who had epidurals also went on to have Caesarean sections which - unless you have a lot of support - make it difficult to breastfeed because it's harder for women to pick their babies up."

Thanks to Mickey.