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Sally Parkin: Photos by Mick Watson
Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.
Ruth’s first baby was born in a hospital with a doctor she’d met only once before. During labor, the doctor became concerned that there was some meconium (the name given to the stool that the baby passes before birth) in the amniotic fluid. This can be a sign of stress and can cause problems for the baby if inhaled into his lungs.
As soon as her son was born, Ruth (from B.C., Canada) recalls, the cord was clamped “and he was passed off to the doctor and a resident for examination. They did a very invasive check of his airway. He had not aspirated anything, he was fine, but the experience made him very reluctant to open his mouth widely to latch on for the next two or three days.”
Ruth was determined to breastfeed, but says it was a struggle. “He eventually did get it and became a happy nursing baby and toddler. I didn’t connect the dots until many years later when I was watching a film at a La Leche League conference and saw a baby’s reaction to deep suctioning. That’s what had happened to my son! No wonder he was reluctant to open his mouth. Finally it all made sense.”
Every birth is unique. Some labors are fast and intense, lasting just a few hours while others may take days before the baby is finally born. Some births proceed with minimal help and intervention; others need skilled assistance or even surgery to ensure that mother and baby are healthy.
Once the baby is here, the next step is breastfeeding. But what happened during the labor, birth and immediate postpartum period can have a significant effect on the baby’s readiness and ability to breastfeed.
The founders of La Leche League recognized this and included as one of the ten concepts in La Leche League’s philosophy the idea that “Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.” That doesn’t cover all of the possible interventions, of course, but makes the point that birth affects breastfeeding.
Let’s look at some of the common birth interventions and possible side effects.
Women in labor are often given fluids intravenously. It’s necessary if the mother is having an epidural or being induced with Pitocin/Syntocinon (an artificial hormone used to jump-start labor), for example. Or an IV may be put in place “just in case” it is needed in an emergency.
After the baby is born, some of the fluids will migrate into the mother’s breasts. While it is normal for the breasts to feel full and engorged around the second or third day after birth, when these additional fluids are also present, breasts can become painfully swollen and tender, and the baby may find it very difficult to latch on. Pumping is sometimes suggested as a way to remove some of the milk, but that can actually increase the amount of fluid in the breast tissue. With the additional stimulation you may make more milk than your baby needs, increasing your risk of engorgement and mastitis, especially if you go for several hours without feeding or pumping.
The baby absorbs some of the fluids before birth. His birthweight will reflect those extra fluids, and after he gets rid of that fluid in the first day or two, it will look as though he has lost a lot of weight. That weight loss may be worrying to the mother and her medical caregivers, and supplementation may be recommended. Some researchers have suggested that the baby be weighed again on day two and that weight be used as the baseline for calculating weight loss and gains.
Epidural anesthetic has many advantages over some of the methods used to deal with the pain of labor in the past. It allows the mother to be awake during labor and birth, and it does not depress the newborn baby’s breathing as some of the narcotic medications do. Like all interventions, though, it does have risks.
Researchers have found that the medication given in an epidural does pass through the umbilical cord and into the baby. The effects on the baby can vary considerably depending on the length of time the epidural is in place, the amount of medication given, and on the type of medication. Several studies have found that the babies tend to have more difficulty in latching well and breastfeeding effectively when the mother has received an epidural. However, with good help such difficulties can usually be overcome.
Ann had an epidural during her labor with her first son, and suspects it was the cause of some of their early breastfeeding challenges. “I could get the nipple into his mouth, but then he wouldn’t suck. He didn’t seem to know what to do with it. The nurse told me to stroke him under his chin to stimulate sucking but it didn’t work very well. I was doing breast compressions* to try to get milk into him and hand-expressing as well.” When he was about a week old, though, her son seemed to “wake up” and started to breastfeed more effectively and vigorously. “From that point on, it was good. But I was pretty worried in those first few days.”
Today, in many countries, the C-section rate is more than 30%. Having a surgical birth can make breastfeeding more difficult in many ways, since intravenous fluids, anesthetics, pain-relieving medications and antibiotics are all routine parts of a C-section. The mother may also find it difficult to figure out a comfortable position for breastfeeding because of her incision. Antibiotics given during the procedure can cause an overgrowth of candida albicans (the yeast that causes thrush in baby’s mouth and on mother’s nipples) leading to sore nipples. And in fact, studies show that mothers who have C-sections are less likely to breastfeed.
Sherrie Jo was diagnosed with pregnancy induced hypertension (PIH) during her first pregnancy, and when her blood pressure rose to a concerning level, labor was induced. During labor, she was given magnesium sulfate, to help keep her blood pressure lower. “No one explained that one of the side effects of this drug was dehydration, which significantly interferes with milk production,” she says. “I went home with a baby who seemed to latch well and who wanted to nurse. Within 24 hours of being home, she was pretty lethargic. I wasn’t producing milk.”
Sherrie Jo contacted a local La Leche League Leader who discussed using a supplemental nursing system (SNS)**. The home health nurse visited and told Sherrie Jo she’d need to feed the baby with a bottle, but was happy to help with an SNS when Sherrie Jo asked. “She told me most moms don’t want the hassle and bother, they’d rather give a bottle. Anyway, the SNS did the trick. My milk finally came in with leaps and bounds by day seven.”
Sherrie Jo’s story points out the importance of good breastfeeding help in overcoming the difficulties that may result from birth interventions. Her LLL Leader helped her be more aware of her options, and the home health nurse was able to help her implement her plan.
Pregnant women are often not told about the possible consequences of birth interventions when it comes to breastfeeding. Epidurals and Cesarean sections may still be the best option in many situations, but if mothers are prepared for possible breastfeeding difficulties and have good help, the challenges can be overcome.
One of the most important strategies for managing any birth-related breastfeeding problems is keeping mother and baby skin to skin. This helps to stabilize the baby and prompt his inborn breastfeeding instincts. Another essential step is to make sure that milk is being hand expressed (before the milk “comes in”) or pumped (after the milk comes in) if the baby is not able to nurse effectively.
For many first-time mothers, just thinking about the birth takes up most of their energy!
Breastfeeding seems like something in the distant future, rather disconnected from the birth. But preparing for labor and birth with breastfeeding in mind can make a big difference in how easily your nursing relationship gets started.
This technique can help your baby to breastfeed actively and take more milk.
- Hold your breast with one hand—thumb on one side, fingers on the other.
- Wait while your baby breastfeeds actively (his jaw is moving all the way to the ear). When he is no longer swallowing, squeeze your breast firmly. Hold it squeezed until he stops nursing actively and then release.
- Rotate your fingers around the breast and repeat step 2 as needed on different areas of the breast. Go gently—this should not hurt.
This is a bottle with thin tubes that attach to the nipple. When the baby sucks at both the breast and the tube, she gets milk from the bottle while the suckling stimulates the mother’s breast.
How you give birth and what happens in the hours and days immediately afterwards can make a big difference to getting breastfeeding started. Birth and Breastfeeding is a 16-page booklet that outlines what you can do beforehand, during labor and immediately after birth to help you and your baby get off to the best start possible with breastfeeding.
Teresa Pitman has been a La Leche League Leader for 35 years. She is one of the co-authors of the LLLI books The Womanly Art of Breastfeeding and Sweet Sleep and is the author of 16 other books. She is the mother of four grown children and the grandmother of eight.