9 Birth Interventions That Affect Breastfeeding

9 Birth Interventions That Affect Breastfeeding
Photo Credit: Tyler Olson / Shutterstock.com

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.

References:
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.

 
Last Updated: May 16, 2015

CONTRIBUTOR

BellyBelly.com.au


20 comments

  1. Wow… so as long as you don’t have a baby in a hospital then you are good… I had quite a few of these things happen and my son came out ready for the breast smacking his lips. I am happy I had an epidural and without an induction I don’t know if we would be here today. OORAH to modern medicine!!!!

  2. I have to disagree with this article! I was induced with my first, had an epidural and then forceps (assisted) delivery and my daughter fed within 10 minutes of birth and has not had any issue in breastfeeding in her 16 months of life so far!!

    1. The problems will not apply to everyone, just like research, it never applies to 100% of the population. However, this article was written by a highly experienced IBCLC (International Board Certified Lactation Consultant) who has lots of study, research and experience under her belt. This is what research tells us, and as a consultant, this is what she sees. References from several sources are also cited at the end of the article.

      The article was intended to prepare parents – no matter if they need to have interventions or not – for the possibility that there could be breastfeeding problems. It also suggests ways to overcome these hurdles if mothers trip on them, and how to get help.

  3. This article is a bit scary especially for new mums. It’s not as bad as sounds. I had a ceasarian with epidural and was able to breastfeed successfuly within an hour after delivery and breastfed exclussively for six months.

  4. What about majority of the women who just aren’t given the choice? I’ve recently been told during my first pregnancy I will be having a scheduled cesarean due to placenta previa. I want nothing more than to have a natural birth and to successfully breastfeed. I loose sleep thinking I’m failing my baby already. I would love to read an article on the successfull outcomes when medical intervention is the only choice.

    1. The article does address what you can do if you find yourself in the situation of needing intervention and breastfeeding has been affected. But at the end of the day, if anyone is having breastfeeding troubles, they should seek out an IBCLC as soon as possible. Alternately a breastfeeding help service or phone line like the Australian Breastfeeding Association or La Leche League (if in the US).

    2. Stephanie, I don’t know if you will find an article like that. But I will tell you my story. My first child I had an emergency C-section. My placenta began to tear away early during labor. My son’s heart rate got to 0. Because I was in the hospital, they were able to do an emergency C-section and my son is 7 years-old and perfectly fine. I nursed him within an hour of his birth. He never had a drop of formula. I have had 3 other C-sections since, all my babies nursed fine. As far as the C-section goes, my advice is ask lots of questions and tell the docs and nurses what you want to see happen. My last C-section they brought her right to me and put her on my chest, just like they would have in a vaginal birth. It was great. (And you know what she did? She kept bobbing, trying to get to my breasts to latch on!) Not much longer and we were back in our room and she was nursing.

      1. I rarely respond, but, this article irritated me a little. Please… be rest assured, that I have had 6 children (littlest one 9 months old) and have had to be induced every time, complete with epidural. My water broke with my last, but I still needed to be induced. I have a blood disease and because of blood thinners, my babies need to be scheduled for induction…So, I can wean off the blood thinners before birth to make sure I don’t bleed out, and I had all of my children vaginally. I can honestly say… I had every single scenario above and it didn’t prevent me from nursing. With my last, I was scared because she came 5 weeks early and was taken to the NICU immediately. She was fine and came home with me. Breast feeding was not easy at first, but we got the hang of it, and it all worked out. She went from 5 pounds at birth to 20 lbs at 9 months. So, don’t worry.

        I understand that there is a push towards the “natural” birth, but, I have to say from very traumatic experience…that sometimes medical intervention is necessary. Things can go wrong, it’s not to scare anyone but it happens and when it does you will be grateful for medical intervention. My 3 year old, was born with brain hemorrhages (which we didn’t know), it caused her to have seizures (which is what caused the Dr.’s to find the hemorrhages). She now has brain damage, and could not speak a word for the first 2 years of her life. Now, she rambles with basic words like 18 month old. Anyway, a few really minor things went haywire at birth, but, they were enough, that the Dr.’s attribute them to what caused the hemorrhages at birth. So, it definitely could have been worse, had I not been flexible. There is no perfect way to labor and birthing plans rarely go as planned, all you can do is relax and know you’re in good hands no matter how you deliver. I think you should be leary of anyone who tries to sell you a perfect labor or gives you assurances that that it will all go the way you plan it to. Please don’t ever consider yourself a failure because you choose an epidural, or your induced or need medical intervention. It will be ok, it was for me 6 times.

  5. I would love to know why circumcision is not mentioned here! Seeing as it can and has greatly hindered breastfeeding!

    1. Same here, since it is proven to reduce the chances of successful breastfeeding! 🙁 Many babies are too traumatized after the procedure to latch on and suckle properly.

  6. I had all but 2 of these things breastfeed my daughter for 14 months. My sister had a c/s and breastfed each of her c/s born children for a year. So yea instead of trying to scare women into what you think is the best course of delivery why not just give supportive breastfeeding tips like an IBCLC should do!

    1. Hey Jessica! An IBCLC (who also contributes to IBCLC journals) actually wrote this article. It contains factual information for people who want to make informed decisions. Sorry it didn’t appeal to you.

    1. Just one person not having any problems doesn’t mean no-one will experience them 🙂 This was written by a very experienced IBCLC (which requires loads of study and loads of experience hours) who picks up the pieces after interventions like this. It’s based on facts, not opinions, I promise 🙂

  7. Fetal monitoring? Really? Yes, fetal monitoring may increase C-sections or other interventions, you know what else it increases? LIVE BABIES. From a mother who nearly lost her first, but didn’t thanks to his heart rate being monitored (heart rate to 0, emergency C-section, turns out was the beginning of a placental abruption), fetal monitoring saves lives. I had absolutely no pregnancy complications, no warning signs. I had 4 C-sections. Every one of my kids was nursing within an hour. 2 of my kids never had a drop of formula in their lives. The other 2 nursed exclusively for many months and combo with formula for months after that (I was working and in grad school.) This is a very, very, very misleading article. I hear you about narcotics, even the epidural, even to some degree the C-section (although that was not my experience.) But tell a new expecting mom she might not be able to breast feed if she allows fetal monitoring? Good grief. How many babies did you just put in jeopardy?

    1. I accepted this article for publication from the writer not only because she has extensive training and experience, but we both well know what the research states about continuous fetal monitoring (not intermittent). To make it crystal clear, we are not saying intermittent monitoring — even for a homebirth, you need to check the baby with a doppler.

      From the Cochrane Database, which independently provides reviews of available studies:

      “Continuous cardiotocography during labour is associated with a reduction in neonatal seizures, but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography was associated with an increase in caesarean sections and instrumental vaginal births. The challenge is how best to convey these results to women to enable them to make an informed choice without compromising the normality of labour.”

      http://www.cochrane.org/CD006066/PREG_comparing-continuous-electronic-fetal-monitoring-in-labour-cardiotocography-ctg-with-intermittent-listening-intermittent-auscultation-ia

  8. I can understand the comments above from many mums, and their stories of breastfeeding success even though they had to have medical intervention, but I don’t think this has been written to scare women. I think its good to be informed so ‘if ‘ problems arise then women might be able to think it could be due to one of these factors rather than believing the old wives tales ‘your breasts are too small/ too big , your milk isn’t good enough, yourbaby just doesn’t like breastfeeding’ and many more. If a mum realises there may be another reason then she can work through it rather than doubting herself and feeling u necessarily guilty. All of the information above is factual and evidence based unlike a lot of the ‘information’ out there. I speak as a mum who had 2 emergency c sections, both at 36 weeks, and was induced with the second and also had a full uterine rupture. Baby was sent to special care and was there for a week. I also went to high dependency unit for 7 days as I had lots of problems after the rupture and went into organ failure. As you can imagine trying to breastfeed was hindered from the start and with my second I didn’t even get to see him for 24 hours and in the days after that it was a rare event as I was hooked up to all sorts drips and machines so I couldn’t leave my bed and he wasn’t allowed to leave special care. It was very difficult , as you can imagine, but I can say (after a very rocky start with both) I fully breastfed my first for 2 1/2 years , am still fully breastfeeding my second who is now 8 months and neither have had any formula(the second did have donor milk for several days along with my milk until I could increase my supply). I am also a breastfeeding supporter, so work with lots of mums , and know that the ‘possible problems’ listed in the article above ‘can’ have an impact on breastfeeding. That doesn’t mean that everyone who has any medical intervention is not going to successfully breastfeed……but it does mean that there ‘may’ be a higher chance of problems/difficulties and I feel that mums being aware of these is surely a good thing. Being prepared and feeling informed before you are in the middle of the situation gives mums a chance to think through their options and have the chance to discuss them with their midwife. I speak to so many mums that feel guilty about not breastfeeding or stopping earlier than planned or topping up with formula because they weren’t informed about their options and felt that their bodies had ‘failed’. Surely knowledge is power and gives the mum the ability to make an informed choice.

  9. Oh how I wish I’d been able to have skin to skin contact with my 4 babies. I didn’t have any medications, and with the first, I wanted to breast feed, but the Nurse I had was like “Hitler” I had to wash my hands before I touched my breast, and they had to be wiped down with alcohol, what kid would want to feed with that there…..? He refused to latch on. They kept U in hospital for a week after delivery then too. My second I didn’t have a Nasty Nurse, and my daughter did swell, for a while…no meds with her birth either, none with any of them. our second girl did well, but on the delivery table that ? Dr, gave me a shot, to dry up my milk…..never knew why that was done.with our 4th. second son. I don’t know what any of those things have to do with nursing, except I feel it depends on the child. Some will, some just won’t. I know mine were bottle fed in Nursery, and love the nipple!

  10. If you really want to breastfeed keep trying. See a lactation consultant – most hospitals have them and don’t listen to other people’s negative stories. Sometimes it is not possible to breastfeed sometimes it is. Everybody is different. Birth interventions are a fact of life of course we would avoid them if possible but sometimes you cannot. I am still breastfeeding my son at 18 months. He was born 9 weeks early via emergency caesarean as we had sudden onset of pre-eclampsia and HELLP syndrome. I did not get skin to skin as I was completely sedated and only touched his hand that night before he was sent to a larger hospital hundreds of kilometres away without me. I was in ICU and could not transfer immediately. I did not see or hold him for the first three days of his life. I pumped for eight weeks. When I finally got to my baby I did what an older midwife had advised and rubbed breastmilk onto my chest as I had fears he wouldn’t know me. I don’t know if this helped or not but now we are all good and I am wondering how on earth I am going to wean . So I think read up on the facts – do what works for you and look after yourself and your baby. Don’t be afraid to ask for more info/advice in hospital and if the staff are not helpful or not giving the info you need ask for their manager or for the consumer liaison officer.

  11. I had 7 out of 9 of these and I have had a a lot of complications with breastfeeding! I honestly think my birthing experience had something to do with the lack of success I have had.

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