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Regina Woodley- Lactation Consultant, Educator, Doula, and Herbalist in Huntsville, AL and surrounding areas
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Unexpected Factors That Affect Breastfeeding

12/9/2015

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There are many, many factors that play a part in whether breastfeeding will be easy or fraught with difficulty.   I wanted to point out a few things in your labor that aren't normally seen as related to breastfeeding that could make a difference in your experience. 

Epidural
Contrary to popular opinion, an epidural is anything but risk-free.  Just like any intervention, there are side effects.  A study finds that babies lost more weight after an epidural, probably because of the fluids required (see IV fluids below).  Babies lost an average of 226 g after an epidural and without one the loss was only 142 g!  I've never heard of this side effect being explained by the anesthesiologist before the epidural was given.  This could be the reason a study found a relationship between epidural use and less mothers breastfeeding at 1 month.  Perhaps when milk production is reduced at the beginning, the frustration of breastfeeding doesn't seem as worth it.  This is especially important to consider if your baby is even slightly preterm, you've had milk production problems before, or you have any complicating factors such as previous breast surgery.

Induction
Starting labor artificially should only be done when there is a clear medical reason.  It can make breastfeeding more difficult for a variety of reasons.  Both mother and baby don't have the benefit of the normal hormones of labor, leaving them more tired and feeling worse than they otherwise would.  It also means the baby may be premature and not have a completely mature nervous system, enough body fat, or be strong enough to nurse efficiently.  If there is a health reason to induce early, be proactive in meeting with a lactation consultant.  You may need to pump and/or supplement your baby for at least a little while.

I have other posts on induction here and here.

Antibiotics
Often women are given antibiotics in labor if they are positive for the GBS bacteria or if their water has broken.  Although GBS infection is relatively rare, the use of antibiotics should be weighed against your other risk factors because the consequences could be deadly for your newborn if he develops the infection.  Most babies who are treated in labor would not have developed the infection anyway. 

Currently, there is no evidence that there is benefit to giving antibiotics vs. treating a non-GBS infection that develops later.  The way this can affect breastfeeding is that when the balance of bacteria are disturbed by the antibiotics yeast can take over and thrush can develop on mother's nipples and baby's mouth.  This is an infection that is common these days and difficult to get rid of unless both mother and baby are treated at the same time.  Keep in mind these treatments are not without their own side effects, like sores in baby's mouth.  It should be clear by now how one intervention in the natural process-even if warranted-leads to other problems down the road.

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IV Fluids in Labor
Studies clearly show that IV fluids will cause the baby to weigh more at birth, and then that leads to it looking like they're losing more weight than they really are.  That extra weight is just water from the IV. 
This drop in weight could lead to advice to supplement with formula, which can be a hard thing to recover from. 

Another reason that IV fluids could hurt breastfeeding is that it causes swelling in mom's breasts.  This makes it difficult for baby to latch onto, sort of like trying to bite a beach ball.  There are some other less common problems, like cause low sodium in the baby.

Swaddling
It is standard practice in most hospitals to swaddle babies tightly.  We know it's important to keep babies warm, so it seems like a good idea.  Evidence is plentiful now, however, that babies actually do much better in several ways when they are skin-to-skin.  Not only does mom's chest keep the baby warm, but mom produces milk better with the skin contact.  In studies swaddled babies were the coldest and drank the least amount of milk!

Cesarean
Mothers who have a Cesarean delivery (and about a third do) have many challenges after the birth.  It is surprising to many when their milk is delayed in "coming in".  After a vaginal delivery a mother can expect her milk to start being produced in greater volume around day 3, but after a Cesarean it's often more like day 5.  This can be frustrating and could lead to supplementation if the baby loses too much weight.  Often, babies born by Cesarean are not able (because of medical problems or because of hospital procedure) to nurse during the first hour after birth, which is known to be important for preventing breastfeeding problems.  There are also problems created by IV fluids, antibiotics, and presence of the wound site which makes it difficult in the first days and weeks especially. 

The good news is that there are solutions to problems a new mom may be experiencing.  A doula or lactation consultant will have ideas to make the process easier.  With a lot of determination many women have pushed through a difficult labor to establish a long-term nursing relationship.  These are just some things to consider when thinking about your birth plan and breastfeeding goals.

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Is Pitocin Oxytocin?

6/19/2015

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Oxytocin is a multipurpose hormone our bodies produce at times of pleasure.  It makes us feel good.  Specifically, it makes us feel connected, bonded, and it's called the "love hormone".  It plays an important role in birth, lactation, and sex, as well as sharing a meal with a friend or receiving a hug.  In babies, it is involved in brain development.  They grow up to become social creatures partly because of oxytocin.

When it was discovered that one effect of oxytocin was to produce uterine contractions the obvious use for a synthetic version was clear.  The oxytocin molecule is actually not very complicated, so laboratory versions were produced to help start and speed up labor.

Today, synthetic oxytocin, called Pitocin, is used extravagantly to induce and augment labor.  Pitocin and oxytocin are spoken of interchangeably, but they are not the same thing.  It seems like such a wonderful thing to be able to create useful contractions with the drip of an IV.  There are questions, however, that have either not been adequately answered or not even asked about its effects.

The Blood/Brain Barrier
Oxytocin made by the body is produced mostly in the brain.  There is something called the blood/brain barrier which keeps some molecules in the blood stream out of the brain.  When Pitocin is given it is through an IV, so although it acts on the uterus it doesn't affect the brain.  This can make it harder for a new mother to adjust to motherhood.  The oxytocin that would normally be released increases mothering behaviors.  Could this lack of oxytocin in the brain contribute to postpartum depression and lack of bonding between mother and baby?  It's certainly something to be considered.

Effects on Baby
We know that Pitocin does not have the same effect as oxytocin.  For instance, oxytocin is released in small pulses, which is why contractions only happen every 3-20 minutes for only about a minute.  Pitocin is released in a more steady drip, causing contractions to be stronger, longer, and closer together.  This is what the goal of an induction or augmentation is, after all.  These increased contractions can be too much for the baby to handle.  Sometimes the uterus can even become so stimulated that it can't relax.  Without the breaks between contractions that allow blood flow to be restored the baby is in danger of being stressed and being rushed for an emergency C section. 

Contractions and Only Contractions
When mice who didn't have oxytocin were studied they showed much less maternal behaviors than normal mice.  This includes not being able to feed their pups.  The strange thing is, they were able to deliver their pups normally.  This lets us know that oxytocin has a role in labor, but it's not the hormone that kicks it off.  Our modern understanding is that proteins from the baby's lungs begin the complex labor process once they're ready.  Ironically, modern obstetrics is using it for the one thing it does NOT do, which is begin labor!  This explains why so many inductions actually fail.  Your chances of a successful induction improve with a favorable cervix, which Pitocin does not do.

Long-Term Consequences
There are definitely consequences to both mom and baby in labor with Pitocin, but what about effects in the long run?  In Oxytocin Pathways and Evolution of Human Behavior by Carter, there are startling if not altogether unexpected consequenses of oxytocin given in large doses, especially at a young age. 

"There also is increasing evidence that the effects of exposure to exogenous oxytocin are not
necessarily associated with increases in positive sociality. In prairie voles a single low-dose oxytocin
injection given on the first day of life facilitated pair-bond formation in adulthood. However, high
doses of oxytocin had the opposite consequences, producing animals that preferred an unfamiliar
partner (Bales et al. 2007b). Repeated exposure to oxytocin early in life in pigs also disrupted
subsequent social behavior, under some conditions producing piglets that were less capable than
normal animals of appropriate and reciprocal social interactions (Rault et al. 2013). Oxytocin
given intranasally to prairie voles during adolescence also did not reliably facilitate social behavior
and, once again, at some doses disrupted the tendency of this species to show a partner preference
(Bales et al. 2013). "

This brings to mind the seemingly anti-social behavior many of us have noticed in the younger generation.  Could the huge doses of Pitocin around the time of birth interfere with brain development?  Perhaps the reliance on technology is a byproduct of a reduced ability to connect with other people.  It's at least plausible enough to consider.

Pitocin use in labor has been associated with autism, and those with autism show changes in their oxytocin receptors.  Since we know oxytocin acts on behavior, it wouldn't be surprising.  Labor where Pitocin was used increases a baby's chance of autism.  It's especially pronounced in boys, where the risk is 35% greater.  Hopefully these implications will be studied further.  It is important to remember that our bodies are very complicated, and adding a large dose of a hormone at a very sensitive time should definitely only been done if it has been thoroughly studied and the benefits outweigh the risks.

I'm not saying that an induction or augmentation is never warranted, or even that Pitocin isn't the best choise for it.  I mainly wanted to point out that PITOCIN IS NOT OXYTOCIN.  It's a drug, and should be used with the same level of informed consent as any other. 

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    I'm a natural childbirth educator, lactation consultant (IBCLC), and doula in Athens, AL.  Here is where I put healthy recipes, current research, and helpful articles for pregnancy, postpartum, and life in general.  Check back often!

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