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Thread: VBAC / EBAC Discussion #3

  1. #55

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    Debbie- Yeah i hasseled them too. I think they saw the fact that my milk hadnt come in as another reason to keep her, but yet i dont remember being called down to feed her till the 3rd day. I got one or 2 goes in and that was it. Wouldnt you think having the baby in my room and trying often might help get things started?? I dont know. All i can say is that i was stupid and un-educated and took the obs talk of big babies and stuck shoulders to heart. i wont make that mistake again, and i honestly dont know what they can say this time around to make me believe that a trial labour is not the right way to go.


  2. #56
    Debbie Lee Guest

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    Emz - TOTALLY with you there! As much as they want to harp on about the risks of a VBAC, they seem to forget the inherint risks of another caesar!
    As for keeping her because your milk hadn't come in... OMG! That's a reason to have you with her as much as possible!
    I kick myself too because if I'd just stuck up for Gabby (and for myself), we may have gotten better results with BFing and bonding. Who knows?
    We live and learn, hey? Next time is gonna be different!

  3. #57

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    BF is sooo much harder to establish after a csec anyway, as the body doesnt release the hormone needed to stimulate milk production until labour. so if you dont labour before the csec ( when they book you in at 38 weeks) it is very difficult to get the milk production going.
    AS for taking your baby away for 3 nights THEY DONT HAVE THE RIGHT TO DO THIS UNLESS YOUR BABY IS VERY SICK................. Fight hard, dont let them make you another statistic. ( try not to be so nice)

  4. #58

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    interesting thread...
    both my boys were c/section (now 15 and 9) and they were both horizontal cut
    15 yo was c/section after 22 hours labour, 9 yo was planned c/section
    My husband and I have discussed vbac, (his elder sister and even his mum had vbac without problems) so I'm open to the idea....my concern is my age (I'm 34) and have had minor heart complications in the past
    I'm following this topic with interest

  5. #59

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    Quote Originally Posted by mumofbundlezofjoy View Post
    BF is sooo much harder to establish after a csec anyway, as the body doesnt release the hormone needed to stimulate milk production until labour. so if you dont labour before the csec ( when they book you in at 38 weeks) it is very difficult to get the milk production going.
    AS for taking your baby away for 3 nights THEY DONT HAVE THE RIGHT TO DO THIS UNLESS YOUR BABY IS VERY SICK................. Fight hard, dont let them make you another statistic. ( try not to be so nice)
    I have to disagree with the BF issue here. I had it tough with my first mainly because I had no idea what I was doing. but we made it to 3 months. With my second I had so much milk but he was sick and the meds he was on made him tired so I expressed for 10 months and now my youngest who is almost 17 months old is still being breastfed and has fed fantastically right from the start even though he was also in SCN for 4 nights and I chose not to be woken at night to feed him so he had a bottle overnight for thise first few days and it never bothered him..

    So no I don't agree that a c/sec can effect breastfeeding.

    and Debbie lee and emz. I am not sure of the situation but you do know that low blood sugars can make your baby very sick. I knew when both Jacob and Isaac were born that they would have low blood sugars and would need heel tests as it was all explained to me after I asked what would happen after the birth. Isaac was lucky his sugars picked up very quickly. Jacob had a bit more trouble with his levels coming up.. GD is something that does effect the baby and they don't keep them in special just because. they are in there because they need it!

  6. #60

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    If you have a c/s you likely have an epidural and that has effects on breastfeeding, not to mention there can be a delay as to when the baby is put to the breast. Of course this is not for 100% of women but your chances ARE greater of bf probs. I'm busy atm but here's one article, you'll find lots if you google:

    New study links epidurals and lower breastfeeding rates

    11 December 2006

    Women who had epidurals during childbirth were more likely to have breastfeeding problems in the first week compared with women who had no analgesia

    Epidurals given during labour are associated with decreased rates of breastfeeding, a study involving a University of Sydney researcher has found.

    The large study of Australian women found women who had epidurals during childbirth were more likely to have breastfeeding problems in the first week compared with women who had no analgesia. They were also more likely to give up breastfeeding before six months.

    Dr Siranda Torvaldsen, from the University of Sydney, and her colleagues studied 1280 women who had given birth in the Australian Capital Territory in 1997. Of these women 416 (33%) had an epidural during the birth of their baby, 172 (41%) of whom also had a caesarean section.

    Dr Torvaldsen said although most (93%) women breastfed their baby in the first week, epidural anesthesia was significantly associated with difficulty breastfeeding in the few days after birth, and with partial breastfeeding in the first week after delivery.

    The women who had epidurals were also twice as likely to completely stop breastfeeding before six months compared with women who used no analgesia (after controlling for maternal age and education).

    Seventy-two percent of women who had no analgesia were breastfeeding at 24 weeks, compared with 53% who received pethidine or epidurals containing bupivacaine and fentanyl (an opioid).

    The authors conclude that this study adds to the growing body of evidence that the fentanyl component of epidurals may be associated with difficulty establishing breastfeeding.

    The article, titled Intrapartum epidural analgesia and breastfeeding: a prospective cohort study, is published today in the open access journalInternational Breastfeeding Journal.

    Contact Dr Siranda Torvaldsen tel: 02 9036 3181 or 0407 070 504 email: [email protected]
    I dont have time to copy/paste but here is Henci Goer's article on GD which I am pretty sure is in the GD forum: http://www.hencigoer.com/articles/
    Last edited by BellyBelly; January 19th, 2007 at 02:13 PM.
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  7. #61

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    Nic- I am aware that low BSL's are not good for bub. I'm asking why is it not possible to have the baby with you, and BSL's taken in your room or with you taking bub to the nursery IF they are constantly coming up fine. Abby had perfect sugar levels so i didnt see a need for her to be there after the initial few hours.

    As for c/s and BF.... well im not saying either way, all i can say is that i know 6 ppl including myself that have had babies in the last year. 5 were c/sections and all 5 had serious problems with establishing breast feeding, all 6 babies ended up on the bottle. Im also sure that lots of ppl that have had c/s have gone on to BF just fine. Depends on the woman and the baby and most of all, IMO, it depends on the support and education she receives. (and lets not forget about self education! something ill be doing a LOT of this time around)

  8. #62
    Debbie Lee Guest

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    I am not sure of the situation but you do know that low blood sugars can make your baby very sick.
    Oh for sure, Nic... but it's not a reason for the baby to be removed from the mother and put in special care. I was told that she was being taken down there due to lack of staff... not because she HAD to go down there. They can do the heel pr!cks just as efficiently up in the ward as they can in special care. I'm under no illusions that it's something worth their attention - for sure. However, I was also told that they don't test every single baby... just the babies born in high risk cases. So the midwife told me that they don't know if more babies are born with low blood sugar levels aswell. That's why I'm upset. Our bonding, my BFing etc. we all affected because they were short staffed....

    Also.... emergency caesars can affect milk supply. It's a fact. Everyone is different tho... and it may depend on what happened before the surgery. I think after 5 days of agony due to being induced, my body was tired and took a bit of time to produce milk. Perhaps having Gabby with me for the first night may have helped that? I don't know... wasn't an option I was given tho.
    I also distinctly remember asking if the caesar would affect my BM supply and the nurse told me that no it wouldn't. I was so upset when I was told at a later date that, yep, in fact the epidural and the caesar probably didn't help my chances.
    Last edited by Debbie Lee; January 19th, 2007 at 02:18 PM.

  9. #63

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    one on c/s too - gotta run now.

    How a Cesarean Can Interfere with Breastfeeding

    Breastfeeding is more difficult after a cesarean for many reasons. These include maternal pain and fatigue, delayed access to baby, increased supplementary feedings, separation of mother and baby, blood loss causing anemia, mechanical problems in feeding, interference from medications, etc. Fortunately, although these can place significant barriers in front of the cesarean mom, many women manage to go on and breastfeed their child anyhow, in spite of the difficulties.

    Maternal Pain, Stress, and Fatigue

    Mothers who have had a cesarean tend to initiate breastfeeding less often than mothers who have had a vaginal birth. Most women plan to at least 'try' to breastfeed, but after a cesarean, many change their minds as the physical toll of the cesarean saps their physical and emotional resources. They may be groggy from drugs, woozy with pain, and exhausted from labor, surgery, and significant blood loss. Suddenly breastfeeding may seem overwhelming and too much trouble, or they may be too 'out of it' to try very effectively. In this situation, bottlefeeding often seems easier and more convenient.

    Stress clearly can affect people strongly, and women who have had a difficult labor and then an unexpected cesarean (or women who have a bad cesarean experience) may be especially susceptible to stress-related breastfeeding problems. Dewey (2001) found that maternal stress interfered with the release of oxytocin, the hormone responsible for milk ejection reflex. It also found that stressed newborns were more likely to be weak or too sleepy to latch and suckle effectively.

    Research clearly shows that after a cesarean, fewer women initiate breastfeeding at all, or give up within the first month. DiMatteo (1996), Perez-Escamilla (1996), Samuels (1985), Weiderpass (1998), Menghetti (1994), Ever-Hadani (1994), Mansbach (1991), and Dewey (2001) all show that women who had a cesarean had lower breastfeeding rates.

    Delayed Access to Baby

    Nursing your baby as soon as possible after birth ensures the jumpstarting of hormonal processes designed to ensure milk supply, and aids in the physical recovery afterwards. Studies show that the most critical issue for breastfeeding success after any birth is early and frequent breastfeeding (Asselin and Lawrence 1987, Sozmen 1992, Samuels 1985). Research shows that breastfeeding works best if the first nursing takes place within the first hour after birth. Unfortunately, even in vaginal births many hospitals are hard-pressed to meet this standard, but delays tend to be especially long after a cesarean.

    Although a few women are able to nurse their babies right on the table during surgery, most are told to wait until they are in the recovery room. This means a delay of almost an hour, and sometimes more. Although not ideal, this is not insurmountable. But a few misguided hospitals still have the outdated practice that forbids breastfeeding even in the recovery room, so their babies must wait even longer to nurse for the first time. In addition, many women are so groggy from drugs after the surgery that they are not able to nurse for many hours after that as well. All of these delays can add up.

    Women who have a cesarean tend to receive their children much later than if they had had a vaginal birth, and in some places, the delay can be many hours. Dasgupta (1997) found that although their hospital had adopted guidelines stipulating that cesarean babies should be nursed for the first time within at least 4-6 hours, not a single baby in their hospital was nursed within this time period.

    This delay in first nursing can cause critical differences in hormone levels (Nissen, 1996) and impact milk supply. It also helps delay the appearance of mature milk (Chapman and Perez-Escamilla 1999, Vestermark 1991), putting the baby at risk for dehydration or excessive weight loss after birth, which often leads to supplementary formula. All of this combines to undermine a woman's confidence and desire to breastfeed.

    Because breastfeeding is very much a function of supply and demand, early and frequent breastfeeding is EXTREMELY important for establishing breastfeeding. Studies show that the more the first nursings are delayed, the higher the rate of problems (Mathur, 1993). Similarly, frequent breastfeeding (every 2-3 hours or so) in the first day is VERY important in helping the mature milk to come in more quickly.

    The more feedings of colostrum (the early milk) that the baby receives, the more immunological protection the baby gets. In addition, early and frequent breastfeeding can help lessen or treat a baby's tendency towards hypoglycemia and jaundice, problems common after birth scenarios that lead to cesarean. So not only does early and frequent nursing promote earlier 'mature' milk and greater milk supply, it also is protective against many of the problems babies can face after difficult pregnancies or births.

    Supplementary Feedings

    Many cesarean babies are given bottles of formula routinely (Vestermark 1991), which research clearly shows also lowers the rate and duration of successful breastfeeding (Samuels 1985, Hill 1997). Blomquist (1994) found that, "Infants given a supplementary feeding had 4x the risk of not being breastfed at 3 months." Cronenwett (1992) found that "30% of mothers whose babies received bottles in the hospital reported severe breastfeeding problems, as compared with 14% of those whose babies did not."

    Chapman and Perez-Escamilla (1999) also found that exclusive formula-feeding before onset of lactation was a strong risk factor for delayed onset of lactation (mature milk coming in late), which can lead mothers to think they 'don't have enough milk' and stop breastfeeding. Yet many hospitals still have policies requiring routine bottles, or nurses who aggressively insist that a postpartum bottle is necessary to 'prevent hypoglycemia' or 'test the baby's ability to suck and breathe at the same time.'

    Even pediatricians rarely understand just how much supplementary feedings can interfere with breastfeeding. Freed (1995) studied over a thousand pediatricians and pediatric residents, and found that "Only 64% of practitioners and 52% of residents knew that supplementing during the first few weeks of life may cause breast-feeding failure." Thus the culture and traditions of hospitals and their personnel regularly promote supplementary feedings without recognition of just how harmful these can be.

    When the mother's access to the baby is delayed, the baby is often given a pacifier to soothe it and keep it quiet in the meantime. Even when 'only' a pacifier and no supplementary bottles are given, research shows that breastfeeding can still be affected. Righard and Alade (1997) studied the effect of pacifier use on breastfeeding duration. They found that, "The breastfeeding rate at 4 months was 91% in the nonpacifier group and 44% in the pacifier group." The findings of Righard (1998) and Victora (1993) also support that pacifiers can interfere with breastfeeding. So not only should routine supplementation be abolished, but routine pacifier use should also be avoided whenever possible.

    One circumstance that can sometimes necessitate supplementary feedings is when the baby loses a great deal of weight after birth and does not regain it quickly. In some cases, this is truly worrisome and indicative of problems, but in other cases, it can be caused by the policies of the hospitals themselves. Many women are given IV fluids during birth, sometimes excessively, and especially so before epidural or spinal anesthesia. Some of this may transfer into the baby and make him appear larger than normal at birth.

    Henci Goer (The Thinking Woman's Guide to a Better Birth) documents that this overload of fluids "also result[s] in a transfer of water into the baby's tissues. This extra fluid inflates the baby's birth weight and the subsequent weight loss after birth. Doctors and others often gauge breastfeeding adequacy by how fast the baby regains her birth weight, so this misleading weight loss may lead a doctor or mother to mistakenly conclude that breastfeeding is inadequate" or that supplementary feedings are needed. Because of this, many babies are given supplementary feedings that seem necessary at the time but which are actually caused by the interventions used on the mother.

    Although supplementary feedings should be avoided as much as possible, sometimes circumstances or medical conditions really do necessitate them. If they must be done, research shows that doing them by non-bottle means preserves breastfeeding more often than if the baby is given a bottle. Mathur (1993) found that 87% of babies who had 'prelacteal feeds' by spoon went on to total breastfeeding, while only 33% of babies who had prelacteal feeds by bottle went on to total breastfeeding. So why aren't hospitals avoiding bottles when supplementation truly is needed?

    Many hospitals strongly resist non-bottle supplementation options because they are not aware of other options, are not trained or encouraged in other options, or are stuck in old, rigid protocols. Many different types of non-bottle options are available, including syringes, cup feeding, finger feeding, eyedroppers, spoon feeding, supplementary nursing systems, etc. Further information on these alternatives can be found below, and also online at www.breastfeeding.com, www.lalecheleague.org, and www.promom.org.

    Separation of Mother and Baby

    Research shows that rooming in (having baby stay in the room with you instead of staying in the nursery) also increases breastfeeding rates. This is probably because the baby nurses more often (stimulating milk supply) and gets less supplementation. Because some hospitals do not permit women who have had a cesarean to have their babies room in with them, this can negatively affect breastfeeding rates.

    For example, Mathur (1993) found that 68% of women whose babies were not separated from them practiced total breastfeeding, versus only 35% of women whose babies were separated from them. Flores-Huerta and Cisneros-Silva (1997) found that 61% of those who had 'joint lodging' breastfed exclusively for the first month, while only 42% of those who did not room together breastfed exclusively in that time. Samuels (1985) also found that keeping the infant in the room during the hospital stay encouraged breastfeeding rates. Rooming in makes a difference!

    Some nurses offer to take the baby to the nursery for the night in a well-meaning gesture to help the mother recover better. But Anderson (1989) found that women who roomed in with their babies used less pain medication and slept just as well as those whose babies went to the nursery. In addition, the babies' blood pressures were lower, they cried less, and their vital signs stabilized more quickly.

    Anderson (1989) also noted that secretion of prolactin (an important hormone in milk supply) is 10x higher at night, and therefore nursing frequently at night "may be more important than daytime in the establishment of lactation." Frequent nursing at night is much more likely if the baby rooms in than if it goes to the nursery, where the nurses may or may not call the mother for a feeding, and sometimes give surreptitious bottles. Although well-meaning, taking the baby to the nursery for the night for "respite" care often exacerbates problems with low milk supply.

    Many women also report that sleeping with their babies in the hospital bed (once they are aware and responsible after anesthesia) makes life after a cesarean much easier. It is easier to get the baby ready and into position when it's time to nurse, and they tend to nurse the baby more often and respond to its hunger cues more quickly when baby is right beside them. As long as safety precautions are followed and the mother is not too drugged, sleeping with the baby after a cesarean can work very well.

    Since frequent feedings are an important part of establishing milk supply in a timely manner, rooming in is an important part of helping cesarean mothers breastfeed more easily, and sleeping with the baby in your arms can help even more.

    Anemia From Blood Loss

    Research shows that women having a cesarean lose about twice the amount of blood as women having a vaginal birth. If a woman experiences excessive blood loss during surgery, she may experience anemia afterwards, which can interfere with milk supply significantly (Willis and Livingstone, 1995). Yet few doctors are aware that anemia can affect milk supply, and few check for it or treat it aggressively afterwards.

    More women may be anemic postpartum than doctors recognize. Bodnar et al. (2001) found that 27% of women were anemic postpartum, and that the rate of anemia rose to 43% among non-Hispanic black women. Yet much of this anemia goes unrecognized and untreated.

    Henly (1995) studied the relationship between anemia and insufficient milk syndrome in 630 first-time mothers. They found that 22% of the mothers were anemic, and of the anemic women, about 20% reported symptoms of insufficient milk syndrome. These mothers breastfed fully for a shorter period of time and weaned earlier as well. The authors summarized their study by saying, "This study suggests that anemia is associated with the development of insufficient milk, which in turn, is related to duration of full breastfeeding and to age at weaning."

    Women most at risk for anemia postpartum include those who were anemic prenatally; those whose babies were born by cesarean; those who experience a hemorrhage during or after birth; those with certain placental problems like placenta previa, accreta or abruption; women carrying multiples; those with a history of prior post-partum hemorrhage; those with uterine atony; and heavy women (because of extra blood vessels feeding extra tissue). Bodnar (2001) found that minority women and women from low socioeconomic groups may also be at greatly increased risk for anemia.

    Although surgeons and nursing staff should be on alert for anemia in all women post-surgery, sadly this is a condition that is often missed. Even when it is caught, problems with breastfeeding are often not connected to it. If you experience dizziness, weakness, fainting, or extreme fatigue after your cesarean, strongly request that your iron levels be checked. Early treatment can prevent or minimize problems with milk supply and speed your recovery significantly. Iron supplements (herbal or traditional) and modifying food intake to include more iron and folic acid can usually take care of the problem if it is caught early enough.

    Mechanical Issues

    Cesarean surgery also makes positioning the baby for nursing more painful. The usual 'cradle' nursing position can be painful after a cesarean, since this places baby against an abdomen that has just been traumatized. Placing a pillow over the incision may help cushion it sufficiently, but for some women even this places too much pressure on a tender area.

    Many nurses tell women to nurse lying down instead, which some cesarean moms do find to be easier. However, others find this position quite difficult, especially when they have to turn over in bed in order to nurse on the other side. Well-endowed women often find nursing while lying down especially challenging.

    The football hold is a great hold for post-cesarean nursing, as the baby is not against the incision at all, the mother can sit up (which makes controlling the baby's head and latch easier), and the mother can see to latch the baby on easier. For more information on the football hold or any other nursing position, see the "help" videos at www.breastfeeding.com.

    However, some mothers even have difficulty using the football hold. Simply put, a cesarean presents yet another level of physical challenge to the new and unfamiliar task of breastfeeding, and the pain factor can be a significant deterrent for many women.

    Type of Anesthesia

    The type of anesthesia used for the cesarean can also influence breastfeeding rates. Several studies (Lie and Juul 1988, Mathur 1993, and Albania et al, 1999) have found that breastfeeding rates are significantly higher after regional anesthesia (epidural or spinal) than after general anesthesia.

    This may due to a number of causes. Albania et al. speculated that the difference was probably due to faster mother-baby bonding after regional anesthesia. Since mothers who have general anesthesia tend to take longer to wake up and are often more groggy and 'out of it' afterwards, they may be less inclined to nurse, or to nurse right away. Many women who have experienced cesareans by general anesthesia also report feeling less connected to their babies, and may thus be less devoted to the idea of nursing. Also, because of the delay in access after a general, many of these babies also receive supplementary feedings in the nursery before the mother gets them.

    There may also be physical influences on the baby and mother which may affect nursing. General anesthesia tends to reach the baby strongly, and may depress his/her responses after birth for some time. This may make the baby harder to rouse for nursing, resulting in baby getting nursed less often (creating less demand for the milk supply). Drugs may also result in the baby being less effective at suckling, which would make his nursing less efficient too. Regional anesthesia results in lower doses of the various drugs crossing the placenta to the baby, so although baby may still be affected, he may not be affected as strongly as after general anesthesia.

    Whether the cesarean was scheduled or unplanned also may make a difference in 'delayed onset of lactogenesis.' Chapman and Perez-Escamilla (1999) found that women who had scheduled cesareans experienced delayed lactogenesis (mature milk coming in later) at a much lower rate than women who had unscheduled or emergency cesareans. This may reflect the type of anesthesia, the amount of medications the baby received, the amount of separation of mother and baby after the operation, or many other factors.

    Inhibition of Newborn Suckling Responses by Medications

    Although many women are told that pain medications (and particularly epidurals) do not reach or affect the baby, research shows that they do have some effect on babies, although authorities debate how significant these are. The weakness of much of this research is that they often do not include unmedicated control groups, and rarely do they consider feeding ability as an outcome. Thus, it is difficult to know how strongly babies really are affected by medications.

    For years, lactation consultants have believed that pain medications affect the baby more than OBs and anesthesiologists believe they do. In particular, they find that babies of highly medicated labors tend to have trouble getting started with nursing. Walker (1997) states:

    Staff nurses and lactation consultants have noted that many babies whose mothers receive labor analgesia, including epidurals, have difficulty performing a cluster of behaviors necessary for successfully initiating feedings at the breast. They have difficulty latching to the breast, are unable to sustain sucking once latched on, have inefficient or uncoordinated sucking leading to little milk transfer and low intake, have difficulty arousing or staying awake, and exhibit poor cueing to feed. Thus, these babies gain slowly or not at all, and many lose excessive amounts of weight during the first week following birth. Mothers of these babies may present with sore nipples, low milk supply, secondary engorgement, plugged milk ducts, and blocked areas of the breast.

    Riordan et al. (2000) used a scoring system to evaluate the effect of medications on neonatal suckling in 129 vaginally-delivered babies. Babies of medicated mothers scored lower in suckling effectiveness than babies of unmedicated mothers, and the scores were lowest in the group that received both epidurals and IV drugs. The overall breastfeeding duration to 6 weeks postpartum was not significantly affected, but even so the authors concluded that:

    Labor medications impair suckling in the early postpartum period. Therefore, lactation consultants should be concerned that breastfeeding mothers who have received labor medications may become discouraged, especially if they are discharged before effective breastfeeding is established. If mothers lack adequate support at home or did not receive follow-up care, babies with poor breastfeeding behaviors are at greater risk for dehydration, jaundice, and poor weight gain.

    If these effects occur in babies that were born vaginally, what about the effects on babies who went through a long and highly medicated labor and then were exposed to even more drugs for a cesarean? Only further research will tell for sure, but it is likely these babies are affected even more strongly.

    Righard and Alade (1990) found that sucking problems were more common in babies whose mothers had received Demerol. Walker (1997) reviewed a series of studies to determine the effect of labor medications on critical neonatal breastfeeding behaviors and time to first 'successful' breastfeed. She found that IV narcotic medications such as Demerol, Stadol, and Nubain did affect breastfeeding by depressing or delaying behaviors such as rooting and sucking. The longer the infants had been exposed to the medications, the more the feeding behaviors were affected, and generally speaking, the longer until the first 'successful' breastfeed. She noted that every single study reviewed "demonstrated that maternal medication had some effect on the breastfeeding behavior of the baby."

    The effects of epidurals are harder to measure. We do know that epidurals affect newborn behavior, especially in alertness and in disorganized movements (Sepkoski 1992). However, Walker's review found NO studies on epidurals that specifically mentioned breastfeeding as an outcome. Of the studies that do measure behavioral effects of epidurals, designs of the studies do not permit adequate analysis of effect on components that might affect breastfeeding. The truth is no one has really studied the issue adequately, so no can say for sure that epidurals do or do not affect breastfeeding behaviors!

    Instead, epidural studies examine the behavior of the newborn on behavioral assessment scales, but even these studies have major weaknesses, according to Walker. Most studies use dissimilar drugs and dosages and measure differing behaviors, so comparisons are difficult. Very few include a non-medicated control group, and even fewer include assessments of infant behavior after 24 hours postpartum, let alone assessment of breastfeeding behaviors. Walker urgently advocates for more well-controlled studies with these parameters.

    Walker did find 2 studies (Murray 1981 and Sepkoski 1992) which had unmedicated control groups and behavioral assessments for longer than 24 hours postpartum:

    [Both studies] showed clear depression in motor abilities of medicated babies. Both studies also showed medicated babies exhibited poor state control. The developmental agenda for healthy term infants is that of increasing differentiation and control of states. Medication may delay the process and interfere with the baby's ability to gain control over and modulate state changes in the first 24-48 hours. Drug induced interference may account for the anecdotal descriptions of 'sleepy' babies (babies unable to exhibit enough state control to breastfeed effectively) and further prolong the period of state disorganization.

    Walker further notes that the most common drugs used in epidurals are known to cross the placenta. Bupivacaine "enters the maternal blood stream rapidly from the epidural space. It then crosses the placenta so that a measurable concentration is present in the fetal circulation within 10 minutes of administration." Narcotics (such as Fentanyl) that are commonly added also "show significant placental transfer." In a few studies reviewed for her article, some infants were affected by labor medications for as long as a month after birth (Sepkoski 1992).

    A very recent article (published after the Walker article) compared the effect of 'caine family of drugs on newborn breastfeeding behaviors. 'Caine family drugs are the anesthetics typically used in epidurals; bupivacaine is the drug most frequently used. In this small study, 10/10 (100%) of the babies of non-medicated mothers initiated instinctive breastfeeding behaviors and successfully self-attached and suckled. The results were far different for the babies of the medicated mothers.

    Only 2/6 (33%) of the babies who received a pudendal block (using mepivacaine) successfully self-attached and suckled, and only 3/12 (25%) of the group exposed to epidural bupivacaine, narcotic, or combo of these successfully self-attached and suckled. Although the study is extremely small, it certainly seems to indicate that medication can affect instinctive breastfeeding behaviors. (Read more about the study in the article by Henci Goer at http://www.parentsplace.com/expert/b...406529,00.html.)

    In summary, research clearly shows that IV narcotic pain meds can affect breastfeeding behaviors. While the effect of epidurals on breastfeeding cannot be conclusively analyzed, it is likely that there is reason for concern. This too, may be another reason why breastfeeding can be harder after a cesarean.

    Lactation Supply Inhibition Due to Medication

    Some medications may inhibit milk production. For example, if a woman has had her labor induced or augmented with Pitocin, its anti-diuretic properties may inhibit milk production. This tendency towards fluid retention may make the mother's milk tend to come in late, may make the mother excessively engorged or have difficulty resolving the engorgement, and the baby may have a harder time latching on because of this engorgement.

    Certain specific labor or postpartum medications may also suppress breastfeeding. Hirose (1997) found that postoperative extradural buprenorphine decreased the amount of breastfeeding and infant weight gain for 11 days after a cesarean. Although this study needs to be replicated, the authors suggested that extradural buprenorphine suppressed breastfeeding after cesareans.

    Many women are given Duramorph in their epidurals during the cesarean to help with post-operative pain. Duramorph and similar drugs are associated with a high incidence of itching (pruritis), and women are often given Benadryl or other antihistamines to lessen the itching. Unfortunately, antihistamines tend to "dry you out" and may interfere with milk supply if given in high amounts, or may make the baby drowsy and less responsive to nursing.

    Many mothers report anecdotally that Magnesium Sulfate can interfere with establishment of breastfeeding. Mag Sulfate is a medication used to help women with pre-eclampsia prevent seizures and other problems. Most women report that its effects are most unpleasant, and the stress from being on this drug alone can probably interfere with breastfeeding.

    Many women are given diuretics after birth to help deal with significant swelling/edema. Women who have had pre-eclampsia, women who have been induced with pitocin, and women who have had lots of extra IV fluids tend to have the worst problems with edema after the birth. To help women get rid of these extra fluids, some doctors prescribe diuretics. However, this can also interfere with breastfeeding supply.

    Birth control pills can also decrease milk supply. Traditional estrogen-only pills are known to decrease milk supply significantly, yet many doctors remain unaware of this problem and prescribe them anyhow. Combined estrogen/progestin 'mini-pills' can be safely used during breastfeeding by most women, but few doctors know that if these are prescribed too early postpartum, they can also inhibit milk supply. Generally, it is safest to wait at least 6-8 weeks before starting the mini-pill, and even then a few women have noticed that it inhibits their milk supply (Breastfeeding Answer Book, 1997).

    It's clear that medications given during labor and birth can affect the baby's suckling response and feeding behaviors (see above), and it's also clear that medications given to the mother can also affect her milk supply.
    Kelly xx

    Creator of BellyBelly.com.au, doula, writer and mother of three amazing children

    BellyBelly Birth & Early Parenting Immersion - Find out how to have a BETTER, more confident birth experience... guaranteed!
    Want To Be A Doula? Everything You Need To Know

  10. #64

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    Were your babies put on heart and oxygen monitors as well? both of mine were, As far as I knew it was a common thing for c/s babies and babies from mums with GD.

    I hope I am not offending anyone here but I just think that sometimes we blame ceaseareans for alot of things. Who knows if things would have been different if you had a natural.

    Anyways I have to go now as well.. I will be back tonight to read the articles

  11. #65

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    Were your babies put on heart and oxygen monitors as well? both of mine were, As far as I knew it was a common thing for c/s babies and babies from mums with GD.
    same I was informed as soon as we knew I had GD that Jack would require special care, in fact I was flown from Rokhampton 9 hrs north to Townsville becuase of this very reason he would require special care to monitor his sugars for 24 hrs, I was under the impression this is the norm in most hospitals, I was flown to brisbane at 28weeks and told the same thing, so I knwo the royal brisbane has the same policy

  12. #66
    Debbie Lee Guest

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    Nic - I wasn't offended but just wanted to clarify my situation
    Gab wasn't put on any monitors. She was only gavage fed through a tube (tho I don't remember being asked??). So I'm tipping there's different levels. Perhaps Gabby's blood sugar wasn't critically low so it wasn't such an emergency?

    Casears are blamed for a lot of things but that's because they do cause a lot of problems. They are major surgery after all. The more I have been reading about them, the more I realise exactly what my body (and Gabby's body) actually went through.

  13. #67

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    Nic-Im not blaming my c/section for Abby being away from me for 3 nights, nor do i know if my BF experience would have been better if it were a natural birth.

    anyway... back to my question: Does anyone know if Obs will let a GD mum on needles attempt VBAC?

  14. #68

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    With proper monitoring i think it would be ok, but alot of OBS just dont want to risk upping their insurance these days, and wont let anyone do anything risky... Childbirth can be risky!! LOL.

    You'd just have to talk to your ob is my guess.

  15. #69

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    Thanks Simone. The only issue is that i dont really have an Ob. I was "given" one when pregnant (public system) and id rather not have anything to do with him again! lol He was a very rude, horrible snob.

    How do you go about getting an Ob? We now have private health cover. Think i might book in to see my GP (very supportive) and see what he says as i was thinking of going with him and a private midwife for most of my pregnancy care and the midwife to be at the hospital for delivery. Can i do this?

    Sorry if im asking so many silly "der!" questions. Im only just starting to consider my options as we start TTC next cycle.

  16. #70

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    i never had to look for an OB as such, my GP i went to for everyday stuff was also an OB i discovered with my first child!! he was great

    Not sure what you would be able to do...

  17. #71

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    emz do you have private cover?
    Kelly xx

    Creator of BellyBelly.com.au, doula, writer and mother of three amazing children

    BellyBelly Birth & Early Parenting Immersion - Find out how to have a BETTER, more confident birth experience... guaranteed!
    Want To Be A Doula? Everything You Need To Know

  18. #72

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    Quote Originally Posted by emz View Post
    How do you go about getting an Ob? We now have private health cover.
    she now does kelly

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