Objective: To determine the effect of caesarean section on breast milk transfer (BMT) to the normal term infant over the first week of life. Method: A sample of 88 healthy nursing mothers who had a normal vaginal delivery, and 97 mothers who had a caesarean section were recruited from a teaching hospital. Mothers and midwives were instructed to weigh the infants before and after each feed throughout the study period using calibrated portable electronic scales. Results: The volume of milk transferred to infants born by caesarean section was significantly less than that transferred to infants born by normal vaginal delivery on days 2 to 5 (p < 0.05), but by day 6 there was no difference between the two groups (p = 0.08). The difference could not be explained by any of the maternal and infant variables measured. Birth weight was regained by day 6 in 40% of infants born vaginally compared with 20% in those born by caesarean section. Conclusion: There is a lag in the profile of the daily volume of breast milk transferred to infants delivered by caesarean section compared with those born by normal vaginal delivery. This study also challenges the widely followed schedules of milk volumes considered to be suitable for the term infant, which appear to be excessive, at least for the first four to five days post partum.T he effect of obstetric procedures on the transfer of breast milk from nursing mothers to their infants is not known. Anecdotal evidence suggests that variability in breast milk transfer (BMT) is dependent on the mode of delivery of the infant. BMT is a function of a finely tuned feedback mechanism, which is potentially susceptible to pharmacological, physical, and psychological manipulations of the mother and/or her infant.The effect of maternal opioids on newborn motor and respiratory behaviour is well documented. Nissen et al 1 have shown a delay in rooting and suckling behaviour in infants whose mothers received one modest dose of intramuscular pethidine in labour. These initial infant reflexes are considered pivotal in promoting BMT.The importance of maternal regional anaesthesia on the newborn's neurobehaviour is difficult to assess. There is no uniform neurobehavioural assessment tool, and changing anaesthetic protocols make it difficult to compare one study with another and relate them to continually evolving contemporary practice. Nevertheless, newborn effects have been reported. Scanlon et al, 2 using a combination of neurological tests, found that infants whose mothers received a continuous epidural block using lignocaine had lower motor scores, including rooting behaviour, than infants where a block was not used. This effect persisted for at least eight hours. However, the use of epidural bupivacaine did not appear to have the same effect in a later study by the same author. Study infants were similar to the non-medicated control group. Yet, using the neonatal behavioural assessment scale, Sepkoski et al 4 found that epidural bupivacaine did affect infant orientation and motor scores, even after...

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