Friday, October 12, 2012

Birth Practices on Breastfeeding...Part 1

For the rest of this month I’m going to be talking about some issues surrounding birth. Since I’m freshly back from the SD Regional Breastfeeding Summit, I really want to give you some highlights of one of LindaSmith’s presentations on how birth affects breastfeeding.

I wrote briefly about this awhile back where I posted an excerpt from the Womanly Art of Breastfeeding. I had long suspected this was the case, and in recent months have found and received information and research verifying that yes, birth in fact *does* have an impact on the breastfeeding relationship. It actually can have a very big impact. So, I was very excited when I learned that this was going to be one of Linda’s topics. (insert happy dance for doula, blogger, and studying childbirth educator-to-be)

Ok, so what about today’s birth practices can have such a big impact and why?

Well, it’s going to be difficult to put all the information Linda gave us on this topic in one little blog post, so I’m actually going to do a mini-series on it, but let me give you the bottom line: ANY intervention can have an effect on breastfeeding and the breastfeeding relationship/ability of your baby.

Linda gave us the following practices that compromise infant status and/or feeding ability:
  •          ALL labor drugs - *including* epidurals
  •          Cesarean surgery
  •          Induction of labor
  •          Instruments (vacuums, forceps)
  •          Suctioning, intubation
  •          Separation from mother for ANY reason
  •          Maternal IV hydration

Today I’m going to talk about labor drugs that are commonly used.

I don’t know how many times I’ve heard - from all sorts of different people…from other women to  medical providers to random strangers on the Internet that epidurals are safe – that they don’t reach the baby anyway, so really all that’s happening is mom is more comfortable as she labors (well, sometimes she is – that’s the goal anyway).

I’m going to repeat Linda here: All drugs reach the baby within seconds. Period.

First of all, several types of analgesia given to the mother during labor may interfere with the newborn’s spontaneous breast-seeking and breastfeeding behaviors and increase the newborn’s temperature and crying (1) and disturbs newborn behavior in general. There can be *measurable* effects for at least 30 days after birth! (Sepkoski) Can you believe that? No wonder some babies sleep so much!

Epidurals are actually a combination of narcotic (i.e. fentanyl or morphine) and anesthesia (i.e. bupivacaine or lidocaine) that is administered via a small catheter into a woman’s epidural space in her spine. Each hospital and anesthesiologist will differ on the dosages and combinations of medication, so you may want to talk with your provider about theirs. One reason to ask about dosages, is that there are significant negative effects from high dosages of fentanyl. In fact, in the study that Linda cited, the conclusion was that among women who breast-fed previously, those who were randomly assigned to receive high-dose labor epidural fentanyl were more likely to have stopped breast-feeding 6 weeks postpartum than women who were randomly assigned to receive less fentanyl or no fentanyl. (2) And as we know, not breastfeeding is a risk to baby's health!

There are other reasons that epidurals and drugs in labor affect breastfeeding…since all of these drugs go directly into baby’s blood, baby is actually altered and can have a more difficult time feeding, latching on, etc. Drugs can undermine a mother’s confidence, block or reduce endorphins that are released in labor (endorphins are natural pain relievers), and can also suppress onset of lactation because the baby isn’t feeding effectively enough.(3)

So, if you don’t get anything else from today’s post, please just be really educated about risks vs benefits of things like epidurals and other drugs that are often given in labor and delivery. Drugs can have a significant effect on not only your birth, but your breastfeeding relationship with your baby and success, so please weigh your options carefully before proceeding.

In the next post, I’m going to go through even more birth practices that Linda talked about that have shown to have an effect on breastfeeding.


  1. Ransjo-Arvidson, A., Matthiesen, A., Lilja, G., Nissen, E., Widstrom, A., & Uvnas-Moberg, K. (2001). Maternal analgesia during labor disturbs newborn behavior. Birth, 28, 5-12.
  2. BeilinY et al. Effect of labor epidural analgesia with and without fentanyl on infant breastfeeding: A prospective, randomized, double-blind study. Anesthesiology 2005, 103(6), 1211-1217
  3. Smith, L., Impact of Birthing Practices on Breastfeeding 2012, Drugs for Pain Management Clinical Implications, 12.


Daniel and Rachel said...

I don't know a lot about the scientific side of this, but just wanted to share my real-life experience...I had a 100% natural birth with my first, and had an epidural with my second. I didn't notice any difference in their nursing behavior (both of them wanted to nurse right after birth, then fell asleep and didn't want to eat much that first night...then the next day they started nursing like crazy!). I nursed both of them until almost a year (when they lost interest) and never noticed any differences in my second (with whom I had an epidural). I'm sure this isn't always the case, but in my situation it didn't affect my ability or her interest to breastfeed. :)

Evie said...

Thanks for sharing Rachel! I have a very similar personal experience with my two children. 1st was a very medicalized intervention-heavy birth and my 2nd was a drug free at-home birth. I noticed the most difference in the first few days of their lives. My 1st was extremely sleepy and didn't want to wake up very often to nurse. She did well, but just was overly sleepy. My 2nd slept a long time after his first nursing after birth, then got on a regular schedule very quickly after that. I nursed them 13 & 15 months, respectively. You and I are perfect examples of who would have been in the minority groups of the studies I reference here :)