How Birthing Practices affect Breastfeeding (Part 2)

In part 1 of this article, I discussed how the large amounts of intravenous fluids mothers receive during labour and birth and the drugs used in the epidurals, in many cases result in:

 

  • overhydration of the baby,
  • unnecessary supplementation of the baby,
  • and the mother potentially getting fever.

 

Help with breastfeeding

 

All of which can negatively affect the initiation and continuation of breastfeeding.  I am not saying that interventions during labour and birth must never be done.  That is not true; sometimes interventions are necessary in order to prevent injury and even death of the mother or baby or both.

 

However, here are a few more, but not all, of the other birthing practices which may interfere with initiation and continuation of breastfeeding:

 

Oxytocin (Pitocin)

 

What about oxytocin which is given to mothers as a routine during labour and birth and afterwards, the infusion often continuing for hours after the baby is born? In hospital, almost all mothers receive oxytocin during labour and birth and after. Even babies born at home with midwives receive oxytocin, though the midwives usually give only one injection of oxytocin after the birth.

 

When giving birth in hospital, mothers will receive oxytocin by intravenous infusion to “help the contractions along and make the labour shorter”.  It is also continued after the birth to prevent postpartum hemorrhage.  Mothers labouring at home will not usually receive oxytocin during the labour but will receive a single injection of oxytocin after the birth, to prevent hemorrhage.

 

We know that having the baby skin to skin immediately after the birth and having the baby suckle at the breast at birth releases oxytocin naturally from the mother’s pituitary and decreases the risk of postpartum hemorrhage naturally.

 

Are there concerns about using oxytocin?

 

This study Jonas W, et al. Effects of Intrapartum Oxytocin Administration and Epidural Analgesia on the Concentration of Plasma Oxytocin and Prolactin, in Response to Suckling During the Second Day Postpartum Breastfeeding Medicine 2009;4:70-82  suggests that oxytocin infusion does indeed cause problems. The authors state: “Oxytocin infusion decreased endogenous oxytocin levels dose-dependently”, and “Epidural analgesia in combination with oxytocin infusion influenced endogenous oxytocin levels negatively”

 

This means that it is quite possible that the mother will have difficulty having milk ejection reflexes (letdown reflexes) in the early days after birth and this may result with the baby not getting enough milk, and given the usual hospital approach to breastfeeding, with formula supplementation that would not ordinarily have been necessary.

 

This study Gu V, Feeley N, Gold I, et al. Intrapartum Synthetic Oxytocin and Its Effects on Maternal Well-Being at 2 Months Postpartum. Birth 2016;43:28-35  concludes that “Women who were exclusively breastfeeding at 2 months postpartum had received significantly less synOT (synthetic oxytocin) compared with their nonexclusively breastfeeding counterparts. Higher synOT dose was associated with greater depressive, anxious, and somatization symptoms. SynOT dose was not associated with perinatal posttraumatic stress.”

 

This result provides evidence that the difficulties that might arise in the first days as suggested by Jonas and others can have longer term effects, into the second month after birth.

 

Induction of labour

 

In some hospitals, labour is induced in at least 1/3 of all mothers, often for questionable indications (labour has not started yet at 41 weeks gestation, for example, or “obstetrician is going on vacation”). What’s the problem with inducing labour?

 

Too often, this is the sequence of events: Induction is frequently followed by other interventions is then followed by failure to progress resulting often in cæsarean section.

 

See this study which suggests exactly that sequence of events:  Johnson DP, Davis NR, Brown AJ. Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix Am J Obstet Gynecol 2003;188:1565-72

 

“The induction of labor in nulliparous patients especially those with an unfavorable cervix…is associated with a significantly increased risk of caesarean delivery”. And, of course, the motto “once a caesarean, always a caesarean” still holds true in the minds of many, if not most, obstetricians.

 

Caesarean section

 

Too many mothers end up getting caesarean sections.  In some hospitals in North America particularly in the US, 50% of babies are born by caesarean section.  In some countries, Brazil, for example, more than 50% of babies are born by caesarean section.  This is medical technology gone insane.  And what is the problem with caesarean section?

 

First of all, caesarean section is not minor surgery.  And there are complications with any surgery, such as infection of the incision and the deeper tissues as well as opening up of the incision days after the surgery (dehiscence of the wound).  And pain. Pain not only in the days after birth, but often for weeks after the birth and even longer.  These complications are often treated with pain medications and antibiotics and mothers are then told that they cannot breastfeed, which is simply not true.

 

Cæsarean section often results in:

 

  • The mother having difficulties moving and finding a position in which to breastfeed the baby
  • Mothers who may then be less willing to breastfeed because of pain and discomfort
  • Increased likelihood of mother-baby separation. In some hospitals, babies born by caesarean section are still routinely being sent to the special care unit, even if the caesarean section was done as a “routine” and not for any true indication.  Even if the caesarean was done because of concern for the baby, if the baby is well at birth he should stay with the mother skin to skin.
  • Increased likelihood of the baby being bottle fed formula as a routine, due to separation.

 

As a result, the mother is more likely to get medication. For example, most mothers are not aware that they receive a shot of antibiotics during the surgery.

 

Pain for more than a few days?

 

This is what this study shows: Declercq E, Cunningham DK, Johnson C, Sakala C. Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey Birth 2008;35(1):16-24

 

Results: The most frequently cited postpartum difficulty was among mothers with a cesarean section, 79 percent of whom reported experiencing pain at the incision in the first 2 months after birth, with 33 percent describing it as a major problem and 18 percent reporting persistence of the pain into the sixth month postpartum. Mothers with planned cesareans without labor were as likely as those with cesareans with labor to report problems with postpartum pain. Almost half (48%) of mothers with vaginal births (68% among those with instrumental delivery, 63%with episiotomy, 43% spontaneous vaginal birth with no episiotomy) reported experiencing a painful perineum, with 2 percent reporting the pain persisting for at least 6 months.

 

It is obvious that even if the baby was born vaginally, persistent pain was still possible, but the more interventions occurred, the more likely that the mother would have persistent pain.

 

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Copyright: Jack Newman, MD, FRCPC, 2017

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