Monday, November 5, 2012

Birth Practices on Breastfeeding….Part 3

In the first two parts of this series I talked about the effects of drugs/epidurals and cesareans on breastfeeding. I haven’t really talked about *why* all this matters, though. Why do we care about the effect something has on the breastfeeding relationship? Well, the bottom line, is that breastfeeding is physiologically superior to artificial milk. Breast is not only “best”, it is NORMAL, and is *the* perfect food for your baby! In fact, not breastfeeding can actually be risky, and in fact, formula-fed babies are more likely to die. (1)

Ok, so what about these other interventions? Things like induction of labor, instrumentation (vacuum, forceps), suctioning and intubation, separation from mother for any reason, and maternal hydration?

Well, let me give you a quick rundown.

First of all, when labor is induced, it can trigger a cascade of interventions, including a high likelihood of an epidural, which of course leads to increased chances of having a surgical birth, and by reading the first two posts on this subject, you can see the well-studied and proven negative affect those can both have on breastfeeding.

And then there’s birth trauma. What is birth trauma? Well, it can materialize in several ways. The obvious is injury or damage to an infant’s body and the response a care provider has in treating the damage. Maybe not-so-obvious is the emotional and mental trauma that can affect both baby and mother by the use of instrumentation – there may be feelings of failure, violation if not handled properly by the provider, etc. Also, if a baby has been suctioned or intubated, it makes sense that they might be hesitant to open their mouths to breastfeed successfully.

The conclusion of one study on birth trauma states that the impact of birth trauma on mothers’ breast-feeding experiences can lead women down two strikingly different paths. One path can propel women into persevering in breast-feeding, whereas the other path can lead to distressing impediments that curtailed women’s breast-feeding attempts. (2)

I’ve talked about the separation of baby and mother a little bit in my other posts, but I want to emphasize here that when the baby is separated from his mother, he has a reaction of protest which includes frantic crying and initiates a cascade of stress reactions that eventually turns into despair, where the baby basically “gives up” and goes into an instinctive adaptation to avoid attracting attention. Despair causes harm to the baby’s development. If a baby is in despair, he won’t initiate breastfeeding while a baby who is comfortable and with mom constantly definitely will.

Lastly, I want to talk about IV Hydration in mothers. Keep in mind that with almost any intervention that can take place during labor, oral drinking and eating will be discontinued, and moms will be given IV fluids. This can cause excess fluid, causing edema, excess infant birth weight, and imbalance of fluids. It can also cause a delayed onset of lactogenesis (milk production), and cause excess newborn weight loss (3).

So, the bottom line is that to maximize your success with breastfeeding, be educated about the effects of birth practices, know your options in birth, and make sure to include breastfeeding outcomes when weighing your options as you make decisions throughout labor!


(1) “[USA] excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance” (Bartick & Reinhold, Pediatrics 2010)
(2) Beck, C. T., & Watson, S. (2008). Impact of birth trauma on breast-feeding: a tale of two pathways. Nurs Res, 57(4), 228-236.
(3) Chantry, C. J., Nommsen-Rivers, L. A., Peerson, J. M., Cohen, R. J., & Dewey, K. G. (2011). Excess Weight Loss in First-Born Breastfed Newborns Relates to Maternal Intrapartum Fluid Balance. Pediatrics, 127(1), e171-e179.

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