In Labor and Birth Care

According to a study soon to be published in Birth, epidural fentanyl and IV oxytocin have dose-dependent negative effects on instinctive newborn ability to suckle.

Investigators blinded to whether women had epidurals, IV oxytocin, or both evaluated videos of 63 newborns placed skin-to-skin on their mother’s chests for the 1st hour after vaginal birth. The fact that they merely observed instinctive behavior eliminated any confounding effects of conducting neurobehavioral testing or previous maternal experience with breastfeeding. Investigators compared results among women receiving neither drug, fentanyl alone as part of the epidural mixture, IV oxytocin alone, or both.

Data analysis revealed that epidural fentanyl, IV oxytocin, and Apgar score all independently affected whether the infant suckled. Furthermore, the more fentanyl or oxytocin the mother received, the less likely the baby was to achieve suckling during the 1st hour. (Note: Study authors cite research showing that fentanyl administered via epidural enters maternal circulation and crosses the placenta.)

Digital Journal, which reported on the study, provides a link to where a pre-pub copy of the study can be downloaded for free.

The Take-Away:

  • The dose-dependent relationship with fentanyl suggests that women desiring pain medication should go straight to epidural analgesia rather than trying systemic fentanyl first.
  • The dose dependent relationship with both drugs argues for delaying an epidural and for trying non-drug strategies to address slow progress before resorting to IV oxytocin.

Women who have fentanyl-epidurals, IV oxytocin, or both should be prepared to be extra patient and to seek advice and assistance early if they encounter difficulties with breastfeeding.

 

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