| Purpose. The majority of infants currently born in the United States are exposed to maternal epidural analgesia during labor, in spite of controversial and inconclusive findings of epidural's effect on the newborn's neurobehavioral organization. The purpose of this study was to explore the relationships between maternal epidural analgesia, a measure of maternal/fetal stress responses at birth, and measures of neurobehavioral organization in full-term neonates at the initial feeding one-hour after birth.;Methods. This prospective, comparative study was conducted at a Midwest, inner-city, community hospital. Data were collected on 52 low-risk, mainly Black and Latino, mother-infant dyads that were exposed to either epidural analgesia or no labor pain medication. Variables of interest included ETA cortisol levels from maternal saliva and umbilical artery serum collected immediately after birth; frequency of infant alertness 5 minutes before, 1 minute during, and 4 minutes after the initial feeding; and infant nutritive sucking parameters collected one-hour after birth.;Results/implications. Maternal cortisol levels were significantly lower in the epidural group, a well-established finding in the literature. Additionally, Black women had significantly lower cortisol levels than Latina, which may suggest dysregulated HPA function. Umbilical artery results were not yet available. Frequency of alertness was not significantly related to epidural exposure or to nutritive sucking parameters. Latina infants were significantly more alert than Black infants, and a longer labor was significantly related to more alertness. Total number of sucks and sucking pressure were not significantly related to epidural exposure; although, an epidural drug dosage effect on total number of sucks was evident when gender was a factor. Unmedicated girls demonstrated significantly more sucks than girls in the high dosage epidural group (of either fentanyl or bupivicaine). Epidural drug dosage effects on neonatal neurobehavioral organization have been reported in the literature. Girls also demonstrated stronger sucking pressure than boys, unrelated to epidural group. Evidence in the literature supports earlier perinatal development of oral-motor skills and neonatal neurobehavioral organization in girls versus boys. Additionally, there were significant interactions between gender and race/ethnicity on sucking parameters. |
