A Swiss research project is currently looking at how inducing labour before c-section might help mothers to initiate breastfeeding.
Studies show mothers who give birth via elective c-section are more likely to experience breastfeeding initiation difficulties compared with women who birth spontaneously.
Inducing Labour Before C-Section To Help Breastfeeding
Only a very small percentage of women have elective c-sections, compared with the increasing rate of surgery that takes place after labour has already begun (known as emergency c-section).
In most cases, an elective c-section occurs at the mother’s request, because the baby is at risk and needs to be born ahead of time, or because there is a risk to the health of the mother.
Elective c-section is not without risk and should certainly be considered carefully. Inducing labour beforehand can be of some benefit, but does it really promote breastfeeding initiation?
What Promotes Breast Milk Production?
In the simplest terms, it doesn’t matter whether a baby is born vaginally or via surgery – a mother’s body will produce breastmilk when the placenta is no longer present.
Typically, in the last months of pregnancy, a woman’s breasts make colostrum, the ‘first milk’. One of the placenta’s main roles is to produce high levels of progesterone, which in turn puts milk secretion and volume ‘on hold’.
When the placenta is expelled, progesterone levels drop dramatically and prolactin levels stay high; this causes milk production to begin.
Milk production occurs in the first days after birth, before a woman’s milk ‘comes in’. The process is driven by hormones, regardless of whether breastfeeding occurs or not.
After this stage, when milk is removed from the breast, what is known as the supply-demand process of breastfeeding continues.
After birth, however, breastfeeding has to be initiated. A newborn baby will survive on colostrum until his mother’s milk comes in but a mother must want to breastfeed if that is to happen.
What Initiates The Drive To Breastfeed In A Mother?
Oxytocin, the ‘love hormone’, is responsible for the mother-baby bonding process.
This hormone is the reason women want to care for their newborns. It’s this drive to nurture and nourish their babies that helps women to initiate breastfeeding.
Breastfeeding stimulates the release of oxytocin, which in turn stimulates the milk let down reflex. As your baby continues to nurse, more oxytocin is released, breast milk flows from your breast to your baby, and the cycle continues.
How Does Birth Method Affect Breastfeeding Initiation?
When labour begins, a series of complex hormonal changes takes place.
Oxytocin levels begin to rise, and this drives contractions. As the baby passes through the birth canal – the moment of birth – a woman’s body is flooded with the highest levels of oxytocin.
When her baby is placed skin to skin on her stomach or chest, a mother begins the bonding process. It is largely unseen, but it increases the chances she will initiate and continue to breastfeed successfully.
When a woman has an elective c-section, her oxytocin levels remain unchanged. In many hospitals, early breastfeeding and skin to skin contact are also less likely to happen after a c-section, as babies are separated from their mothers, even if only for a short time.
Research has shown mothers who gave birth by c-section had different hormonal patterns of oxytocin and prolactin compared with those who birthed vaginally. The women who had vaginal births had significantly more oxytocin pulses than those who had c-sections.
It stands to reason women who have c-sections have less opportunity to initiate breastfeeding. They have lower levels of oxytocin, as well as the attendant effects of having surgery, such as pain, restriction of movement and so on.
Less opportunity to initiate breastfeeding can result in less nursing, and therefore even lower levels of oxytocin. This prevents the milk-ejection reflex from occurring and causes breastfeeding to cease altogether.
What Can Be Done?
Sven Wellmann, vice-chairman of neonatology at University Children’s Hospital Basel, is leading a project in which women who have elective c-sections will be injected with drugs to bring on contractions before surgery.
The theory is inducing contractions will trigger hormones that will help women to initiate breastfeeding.
The drug used to induce contractions in pregnant women is called Syntocinon, or Pitocin. It is a synthetic form of the oxytocin our bodies produce, but it works in a similar way. The drug causes oxytocin cells in the uterus to contract, which causes labour to begin.
Presumably, once labour is under way, surgeons would then perform a c-section with the expectation mothers will be more inclined to initiate breastfeeding because they have experienced mild labour.
Synthetic Oxytocin Versus Natural Oxytocin
There is a lot of controversy around the use of synthetic oxytocin to induce or augment labour in women.
Several studies have linked synthetic oxytocin exposure to reduced lactation and diminished feeding behaviour in newborns.
Another factor is science can’t determine whether or not synthetic oxytocin crosses the blood-brain barrier and, if it does, whether the brain responds to the artificial oxytocin by increasing or decreasing its release of natural oxytocin.
Oxytocin works largely as a result of a process called feedback. As contractions continue and increase, and nerves are stimulated in the vagina, the brain receives signals to increase its release of oxytocin. If synthetic oxytocin is given, and then a c-section is performed, this feedback is absent.
Recent studies have also looked at the connection between lactation and synthetic oxytocin with the use of epidural anaesthesia (often used for c-section). In this Swedish study, women who were augmented with synthetic oxytocin and had an epidural were three times less likely to initiate breastfeeding in the first four hours after birth, and twice as likely to feed babies with formula by the time they left hospital.
A large meta analysis of research looked at breastfeeding rates after c-section in over 550,000 women. It found no differences in early breastfeeding initiation between women who had emergency c-sections and those who birthed vaginally. The data showed, however, early breastfeeding rates were far lower in women who had an elective, or planned, c-section before labour began.
This information is significant. It shows us clearly labour has a role to play in the initiation of breastfeeding. Research shows oxytocin and prolactin levels are different in mothers who give birth vaginally compared with those who have c-sections.
What Does This Mean For Women?
We know spontaneous labour before c-section has positive benefits for mothers and babies. The natural rise in labour hormones has been seen to promote early breastfeeding rates in mothers.
Inducing labour with synthetic oxytocin, particularly if an epidural is placed, appears to have a negative effect on early breastfeeding initiation. It remains to be seen if the Swiss research project demonstrates a positive effect on breastfeeding initiation when women are induced before a c-section.
All mothers should be supported and encouraged to initiate breastfeeding soon after birth, regardless of how they have given birth. Care providers can ensure mothers and babies are given optimal conditions after c-section – particularly elective surgery – to ensure breastfeeding is initiated as soon as possible.
