2.  P- The patient population/ problem is among babies born by vaginal birth, with gestational age of 36 to 42 weeks  I- The intervention of interest is epidural exposure  C- The comparison intervention is versus a natural child birth  O- Identify if it affects the ability of the baby to breastfeed.

3.  Among Babies born by vaginal birth, with gestational age of 36 to 42 weeks does an epidural exposure versus a natural child birth affect the ability of the baby to breast feed?

4.  Full term  No abnormalities  No other meds given during labor and/or delivery  Vaginal delivery with no complications

5.  The type of question is prognosis.  Based on the type of question (prognosis) the following databases and internet sites were searched: › CINAHL (EBSCOhost) › JSTOR › Science Direct

6.  Our group located 5 articles based on search terms and type of question. These include four observational cohort study, one study which encompassed retrospective, observational cohort and prospective cohort studies.

8.  Observational cohort study  Sample size 60 full term newborns  Population full term fetuses (37 to 40 wks) › Delivered vaginally in the vertex position

9.  Evaluate the effects of continuous lumbar epidural anesthesia on the newborn and the developing mother- infant relationship

10.  Although it is at times necessary and appropriate for some mothers to receive medication during childbirth, the implications of this study are that the elective use of medication should be minimized.  There is a large need to develop effective techniques of psychoprophylaxis for pain relief during childbirth

12.  This study included 1405 infants whose mothers requested epidural analgesia during labor.  Epidural analgesia and oxytocin augmentation obstructed breastfeeding success.

13.  The use of epidural agents resulted in a decrease in breastfeeding rates. (oxytocin/drowsiness)  Women without pain relief had the highest duration of breastfeeding compared to other women who had epidurals.

15.  Cohort Study  They sent out a question to 164 mothers breast- feeding problems with in the first 12 weeks of life.  99 mothers returned the completed questionnaires.  44% of the 99 mothers reported partial breast feeding or formula feeding the first 12 weeks

16.  Older age of mothers, use if epidural analgesia and the problem of “not having enough milk” were associated with the failure to breast feed fully  More studies are needed to establish weather there is a relationship between epidural analgesia and breast-feeding problems

18.  Objective: to compare the early breastfeeding behaviors of a full-term newborn during an uncomplicated labor with a mother who used EDA and one who did not

19.  Study consisted of 351 healthy women and babies per group  Significantly fewer babies whos mother had EDA during labor were breastfeeding within 4 hours of life, were more likely to receive artificial milk, and fewer were fully breastfeeding at discharge

20.  the study showed that epidural anesthesia is associated with impaired breast feeding including breast feeding at discharge from the hospital.  Further studies are needed on the effects of EDA on short- and long-term breast- feeding outcomes.

22.  Mount Sinai Hospital Department of Anesthesia and Pain, Obstetrics and Gynecology, and Pediatrics and Nursing.  Not a lot of well- established studies.  Too many confounding variables in studies that were well designed.

23.  Multiparous women, > 37 weeks gestation.  87 women, requested epidural analgesia, and previously breastfeed successfully.  Epidural data  Breastfeeding evaluated in three phases.  Degree of breastfeeding.

24.  No adverse neonatal outcomes  69% Lactation support.  First week follow-up 100% were successfully breastfeeding.  Six week follow-up, four women stopped breastfeeding.  > 150 units of cumulative fentanyl – 1 stopped.  < 150 units of cumulative fentanyl – 3 stopped.

25.  Breastfeeding cessation at 6 weeks post- partum is much lower than previously quoted in the literature  More studies need to be done using dosing information.  Too many variables to take into account.

26.  In conclusion, there is a lot of research which still needs to be done regarding the effects of epidurals on newborn babies’ ability to breastfeed which is determined by many other factors. Three of our five articles seemed to agree that women that were not given an epidural during labor and delivery seem to breastfeed longer than women who did choose to have an epidural. It also depends on what type of medication is administered through the epidural. Our group did not specify a specific drug, so the studies we found where on different medications given through an epidural each having a different outcome in the study.

27.  Ann D. Murray, R. M. (1981, March). Effects of Epidural Anesthesia of Newborns and Their Mothers. Child Development Vol. 52, pp. 71-82.  Ingela Wiklund, M. N.-M.-B.-A. (2009). Epidural analgesia: Breast- feeding success and related factors. Elsevier, Midwifery, pp. 25, e31-e38.  Lapland Central Hospital. (2004). Epidural Analgesia for Labor May be Linked to Breast-feeding Problems. Biotech Week, p. 282.  Tamagawa, K. &. (2010). Analyzing adverse effects of epidural anesthesia during labour. British Journal of Midwifery, pp. 704- 708.  Wieczoreck, P. G. (2010). Breastfeeding success rate after vaginal delivery can be high despite the use of epidural fentanyl: an observational cohort study. International Journal of Obstetric Anesthesia, 19, pp. 273-277. doi: 10.1016/j.ijoa.2010.02.001