Contrary to popular opinion, an epidural is anything but risk-free. Just like any intervention, there are side effects. A study finds that babies lost more weight after an epidural, probably because of the fluids required (see IV fluids below). Babies lost an average of 226 g after an epidural and without one the loss was only 142 g! I've never heard of this side effect being explained by the anesthesiologist before the epidural was given. This could be the reason a study found a relationship between epidural use and less mothers breastfeeding at 1 month. Perhaps when milk production is reduced at the beginning, the frustration of breastfeeding doesn't seem as worth it. This is especially important to consider if your baby is even slightly preterm, you've had milk production problems before, or you have any complicating factors such as previous breast surgery.
Starting labor artificially should only be done when there is a clear medical reason. It can make breastfeeding more difficult for a variety of reasons. Both mother and baby don't have the benefit of the normal hormones of labor, leaving them more tired and feeling worse than they otherwise would. It also means the baby may be premature and not have a completely mature nervous system, enough body fat, or be strong enough to nurse efficiently. If there is a health reason to induce early, be proactive in meeting with a lactation consultant. You may need to pump and/or supplement your baby for at least a little while.
I have other posts on induction here and here.
Often women are given antibiotics in labor if they are positive for the GBS bacteria or if their water has broken. Although GBS infection is relatively rare, the use of antibiotics should be weighed against your other risk factors because the consequences could be deadly for your newborn if he develops the infection. Most babies who are treated in labor would not have developed the infection anyway.
Currently, there is no evidence that there is benefit to giving antibiotics vs. treating a non-GBS infection that develops later. The way this can affect breastfeeding is that when the balance of bacteria are disturbed by the antibiotics yeast can take over and thrush can develop on mother's nipples and baby's mouth. This is an infection that is common these days and difficult to get rid of unless both mother and baby are treated at the same time. Keep in mind these treatments are not without their own side effects, like sores in baby's mouth. It should be clear by now how one intervention in the natural process-even if warranted-leads to other problems down the road.
Studies clearly show that IV fluids will cause the baby to weigh more at birth, and then that leads to it looking like they're losing more weight than they really are. That extra weight is just water from the IV.
This drop in weight could lead to advice to supplement with formula, which can be a hard thing to recover from.
Another reason that IV fluids could hurt breastfeeding is that it causes swelling in mom's breasts. This makes it difficult for baby to latch onto, sort of like trying to bite a beach ball. There are some other less common problems, like cause low sodium in the baby.
It is standard practice in most hospitals to swaddle babies tightly. We know it's important to keep babies warm, so it seems like a good idea. Evidence is plentiful now, however, that babies actually do much better in several ways when they are skin-to-skin. Not only does mom's chest keep the baby warm, but mom produces milk better with the skin contact. In studies swaddled babies were the coldest and drank the least amount of milk!
Mothers who have a Cesarean delivery (and about a third do) have many challenges after the birth. It is surprising to many when their milk is delayed in "coming in". After a vaginal delivery a mother can expect her milk to start being produced in greater volume around day 3, but after a Cesarean it's often more like day 5. This can be frustrating and could lead to supplementation if the baby loses too much weight. Often, babies born by Cesarean are not able (because of medical problems or because of hospital procedure) to nurse during the first hour after birth, which is known to be important for preventing breastfeeding problems. There are also problems created by IV fluids, antibiotics, and presence of the wound site which makes it difficult in the first days and weeks especially.
The good news is that there are solutions to problems a new mom may be experiencing. A doula or lactation consultant will have ideas to make the process easier. With a lot of determination many women have pushed through a difficult labor to establish a long-term nursing relationship. These are just some things to consider when thinking about your birth plan and breastfeeding goals.