During pregnancy, your main concerns are probably your growing baby and the impending birth. You wonder what your baby will look like, how painful birth will be, if it will be long and if you'll have an epidural. What many women don't realise when planning for their birth is that many common childbirth interventions can have an impact beyond labour. Interventions that seem benign — maybe even helpful — in the birthing room can have effects that lead to a more difficult start to breastfeeding.
Of course, it doesn't mean that it will be true for all women — it simply increases your chances of having problems. However it's better to be informed so you can prepare and plan for support, should you need extra help.
Here are 9 birth interventions that can impact on your breastfeeding experience:
Intervention #1: Induction Of Labour
Sometimes an in induction of labour with a pharmaceutical drug is medically necessary, which would make it the best option for parents-to-be. Either way, it's important to know that the risk of having a mildly premature baby increases with induction, and these babies tend to have more problems learning to latch and breastfeed effectively.
The most common means of induction is with synthetic oxytocin, which is called syntocinon (pitocin in the US). Synthetic oxytocin is administered via an intravenous drip, and is given in controlled doses to start or increase uterine contractions. The problem, however, is that syntocinon doesn't act the same way that oxytocin does in the body. The impacts can last well after the birth. Since oxytocin is one of the major hormones involved in lactation, breastfeeding can be at risk. So what can you do?
Use natural means of stimulating labour if you're past your due date, but most importantly, be patient. Don't consent to induction without clear medical evidence — actual proof that you or your baby are in danger of continuing the pregnancy. Just because you've reached your ‘due date', is not evidence that the baby must be born right away. Due dates are notoriously inaccurate, and 40 weeks of pregnancy is simply the mid-range of full term (which is 37-42 completed weeks of pregnancy).
Intervention #2: Assisted Birth
An assisted birth means giving birth with the assistance of a device, for example forceps or vacuum extractor (also known as ventouse).
When a baby is born with forceps, facial bruising and swelling is possible, as is facial nerve paralysis. These babies may be uncomfortable no matter how they are positioned at the breast. Jaw movement during feeding may be especially painful.
When a vacuum extractor or ventouse is used to assist delivery, bruising and swelling of the scalp can cause problems with the suck-swallow-breathe pattern necessary for feeding at the breast. How can you avoid this?
Choose to have an active birth. Use upright positions for labour and birth, especially when pushing and avoid giving birth on your back. Also, studies have repeatedly shown that doulas can help reduce the incidence of assisted births, as well as offering many other benefits (including for breastfeeding). Definitely consider hiring one.
Intervention #3: Continuous Fetal Monitoring
While no studies have directly linked routine continuous electronic fetal monitoring (EFM) with breastfeeding problems, continuous EFM does increase the risk of instrumental delivery and caesarean birth, both of which can directly impact breastfeeding.
Additionally, internal monitoring means an electrode will be placed in the baby's scalp, which is likely uncomfortable for baby (since there are muscles in the scalp and the electrode may cause bleeding or infection). This in turn may cause discomfort during feeding after the birth.
Women with internal monitors have also been found to have a higher risk of fever. Where possible, opt for intermittent monitoring with a fetoscope or handheld doppler device.
Intervention #4: IV Fluids
When a mother is overloaded with IV fluids as she labours, her whole body swells, including her breasts. These full, swollen breasts can make it very difficult for a baby to latch and remove milk effectively.
Techniques like a reclining position and reverse pressure softening can be effective at getting baby to breastfeed while the mother's fluid balance is restored over the days after birth. Another drawback — some babies are born with excess fluid, too. As they shed this fluid in the first day or so, it can look like excessive weight loss. Formula supplementation is much more likely for these babies. IV fluids typically coincide with pain medications and induction, so avoiding these may help you avoid fluid overload.
Intervention #5: Narcotic Pain Medications
When a mother has opiate-based medications for pain management in labour, some of the drug crosses the placenta and enters her baby's bloodstream. These babies tend to be especially sleepy after birth and may not give any hunger cues.
If the medications are given too close to birth, a newborn may not be able to clear the drugs from his system and may require special treatment, taking him away from his mother and her breasts. Try using natural pain relief options in labour and hiring a doula.
Intervention #6: Epidural
The research about epidurals and breastfeeding are mixed. However, having epidural anesthesia for pain management in labour may cause a ‘cascade of interventions.' A cascade of interventions means that just one intervention leads to needing many others, for example IV fluids, augmentation (speed up labour with synthetic oxytocin), continuous electronic monitoring, and more.
Instrumental delivery or caesarean birth is more likely with an epidural, due to the loss of feeling and mobility which continues during the pushing stage. If a mother develops a fever in labour (which may just be a side-effect of the medication), it can lead to testing for the baby after the birth — and separation from mum.
Anecdotally, lactation consultants notice that babies born to mothers who have had an epidural in labour cannot coordinate their suck-swallow-breathe behaviour necessary for feeding at the breast. This usually dissipates over the first day or so, but many opportunities for getting a solid start to breastfeeding are missed, and a new mother's confidence is usually fragile. Also, these babies have an increased risk of jaundice, which can lead to suggestions of formula supplementation.
Intervention #7: Caesarean Birth
Research shows that women who have a caesarean birth are less likely to breastfeed than women who have had a vaginal birth.
It could be the delay in being with baby, the pain of surgery, the groggy recovery period, and the difficulty moving around in the early days (leading to feeding less often). If you need to have a caesarean for medical reasons, try to have skin-to-skin time after the birth, and as much as you can in the following days.
Your partner can keep your baby with you in recovery (as long as you're both healthy), and your healthcare providers can help you get your baby to the breast. You'll likely need a lot of help the first days and weeks as you recover from surgery – generally there is a 6 week recovery period.
Find positions that are comfortable and that don't put pressure on your incision site — the football or clutch hold and lying down are both great for this. Reclining positioning is also helpful if it's hard for you to sit or get out of bed.
Intervention #8: Vigorous Suctioning After Birth
When a baby has oral suctioning done immediately after birth, especially if the intervention is done hastily or without thought as to how the baby is being handled, the risk of oral aversion increases. These babies tend to have problems latching — they don't want anything near their mouths.
One study found when a bulb syringe was used for suctioning, babies suffered scratches and broken capillaries on the back of their palates. Ask about your healthcare provider's policies, and ask that baby only be suctioned if medically necessary.
Intervention #9: Mother/Baby Separation
When a baby is placed skin to skin with his mother immediately after birth, and if mum has had a medication-free labour and birth, he will seek out the breast and nurse. Typically, this happens during the first hour after birth. This can be done after a caesarean birth, as well. Even in the days after birth, keeping mother and baby together gives them the chance to feed often, laying the foundation for a strong milk supply and a longer breastfeeding relationship. Ask your birthing centre about their policies for immediate skin to skin and rooming-in.
Overcoming Breastfeeding Challenges
Always remember that you have the power to avoid or overcome any breastfeeding problems related to birth interventions — even if you can't avoid the interventions themselves.
Start with prevention. The best way to do this is:
- Attend private (non hospital based) childbirth preparation classes to learn as much as you can about labour and childbirth.
- Find out if your birth place is “Baby Friendly” (learn more here).
- Consider hiring a doula to support you throughout the childbirth experience.
- Just as you might write a birth plan, have a breastfeeding plan in place with your desires for the early hours and days with your baby.
- Spend time skin to skin immediately after birth, at least until the first feeding.
- Keep your baby close to you, and feed often.
Most importantly — ask for help as soon as a problem rears it's head. If your baby isn't latching, or if breastfeeding hurts, find a lactation consultant or peer counselor to assist you. Try the Australian Breastfeeding Association here or La Leche League (US) here. To locate a board-certified lactation consultant (IBCLC), click here.
Gaskin, IM. (2003). Ina May’s Guide to Childbirth. New York: Bantam.
Genna, CW. (2012). Supporting Sucking Skills in Breastfeeding Infants. Sudbury, Massachusetts: Jones & Bartlett Publishers.
Goer, H. (1999). The Thinking Woman's Guide to a Better Birth. New York: Penguin Putnam.
Smith, L. J., & Kroeger, M. (2010). Impact of birthing practices on breastfeeding. Jones & Bartlett Publishers.
Walker, M. (2013). Breastfeeding management for the clinician. Jones & Bartlett Publishers.