I am also going to preface this discussion by saying that I believe it is important for every mother to do her own research about birth. Begin to learn what kind of birth you are hoping for. As you begin to learn more about birth, you will begin to lean towards the place where you would like to give birth and the kind of provider you would like to attend your birth. You will begin to put together a birth plan of sorts which may include your wishes regarding medications and procedures during your birth.
I believe that we can only plan so much. We go into labor, do the best you can to achieve the kind of birth you desire and at the same time, be open to birth unfolding the way that it needs to. There is no judgement about birth and procedures. How can I judge. I am not you, nor am I at your birth. My goal with todays show is to discuss the various birth interventions and how they might affect your breastfeeding experience.
There are quite a few birth interventions, that may not be necessary but that do increase your risk factor for having breastfeeding difficulties. Moms want to know this information ahead of time. Anything that causes your baby to be born early, under stress, need to be separated from you, under the influence of medication themselves, increases their risk of jaundice, or infection has the potential to make it more difficult to ease into breastfeeding the early days. Anything that causes you to leave your birth experience with a lot of excess fluids, pain from tearing or stitches, pain from cesarean surgery, needing to take pain medication, can affect the early hours and days of breastfeeding.
We would like to avoid this as much as possible as we find that moms can get easily discouraged when breastfeeding is difficult in the early days. It can be quite emotional to struggle to feed your baby. It is quite emotional to be separated from your baby, to need to supplement, to see them in the NICU. As a lactation consultant, myself and my peers work with mothers all the time who get off to a hard start – one that they did not plan on.
Let’s go over some commonly seen interventions that may affect your birth-
Planned induction – If you are healthy and your baby is fine, try not to induce labor. If your body is not ready yet, inducing labor puts you at greater risk for additional birth interventions. The more this happens, the greater the risk of affecting early breastfeeding. The reasons for this: Perhaps your baby is born too early and has a weak suck because of his gestational age. Perhaps your contractions are too strong because of the labor induction. The pain meds you get to deal with the labor contractions can affect your baby, cause them to not deal with labor too well and create a situation where they need to be born quickly, either by forceps or by cesarean section.
How you are able to labor – If you are a healthy pregnant mom, and there is nothing getting in the way of you being upright and mobile during your labor, you will want to avoid laying in bed for too long. Being active, having the freedom to use the toilet, change positions, walk around,, all these help to move your labor along and enable you to best work along with your contractions. Laying in bed, on your back for too long, can cause fetal distress and failure to progress. Pushing out a baby on your back, increases the risk factor for you having an episiotomy. It also places you in a position that your uterus is compressing the blood vessels that supply the placenta with oxygen. Too little oxygen and stronger contractions sometimes puts a baby into fetal distress. Failure to progress, extreme and uncoordinated uterine contractions and fetal distress, all puts you at an increased risk factor for you to have medications that your baby may not handle well. They also increase the risk for you having a cesarean section.
Fasting – Unless there is a medical reason that prohibits you from eating or hydrating during your labor, it is best to keep up your energy. Labor is hard work and the body needs energy to work effectively. Dehydrtion can mean more painful contractions and slow your labor. Fatigue combined with a slower labor may make a mom who otherwise did not want pain medication, feel like she needs medication because she is losing her stamina to work along with her labor.
4. Dehydration –
If you are dehydrated, you are more likely going to need IV fluid. Some women on IVs experience fluid overload. Extra fluids in your body tends to cause edema which can cause engorgement of your breasts. This can affect your baby’s ability to latch on properly. Engorgement can affect your overall milk supply.
Pitocin is a common method of induction. It is a medication that causes stronger more painful contractions, typically stronger than you would naturally have had. This usually increases the need for you to have further intervention – some pain medication. It also has the potential to make yr body retain more fluids, which means more engorgement, which, again can have a negative effect on breastfeeding.
Pain medications commonly given such as demerol and stadol all affect the perception of pain. They affect women differently. While they usually do provide pain relief, they also cause some women to hallucinate. These drugs do cross the placenta and can affect the baby. It may make babies too sleepy to show an interest in eating. It may slow down their central nervous system affecting their ability to breastfeed well. When your baby is too sleepy to eat, has no desire to eat or has difficulty achieveing a good latch and transferring milk, they lose weight are at risk fo jaundice. Jaundice babies are more likely to need to be separated from you, supplemented with milk other than getting directly from the breast and all this affects your milk supply.
Along with the above mentioned analgesics some moms choose to or some moms need to have anesthesia. Common choices are epidurals and spinals. Because there are various medications given during an epidural it is unknown to what degree your baby will be affected by this medication.
Episiotomy: If your bottom is sore, you sit back farther on your tailbone. This can affect your ability to properly position your baby, which may lead to sore, cracked, bleeding nipples – as well as a slow growing baby who cries all the time.
Cesarean section is major abdominal surgery – for which it is likely that you will need pain medication for at least several or more days after the surgery. Not being able to walk easily or move your body easily after having a baby can make the early days of breastfeeding more difficult. If the pain medication is making you sleepy, you might find it difficult to confidently hold your baby, stay awake while feeding your baby or get into a comfortable position feeding your baby. Any mom who has a cesarean section needs to be extra careful in keeping her incision site clean to avoid getting an infection.
Overall, studies show that a mom who has a vaginal delivery of a full term baby, without any medication or birth interventions and no mother baby separation, lots of time together skin to skin, tends to have an easier time with the early breastfeeding.
I felt it is important to share this information and incorporate birth intervention into our series on Birth Matters, because how you labor, how you birth has an impact on the early days of breastfeeding. A lot can happen in the very first day and we want you to give yourself the best chance possible to decrease breastfeeding challenges. When I meet with moms after their birth, they will frequently tell me that they had no idea that medication given to them during their birth might affect their babies ability to breastfeed. Not ever having done this before, they didn’t really fully understand that when babies are separated from their mothers, when babies are born a little early, when babies are supplemented in the early hours after breastfeeding, all these actions can make breastfeeding challenging. Who knows if things could have been different. However, the difference to me is, that they would have known they might have challenges and they also would have known these are reasons to learn what they can do as far as prevention and what they can do to help themselves when they do have challenges. Some moms are just so exhausted and become depressed easily that they go to bottlefeeding so quickly because they just feel that if they don’t start off breastfeeding easily or if their babies are separated or if their babies get bottles, that it is too late for breastfeeding.
I have said more challenging. I have never said not doable. As I work with moms on a regular basis who work through these challenges. They do need to understand that it might not be easy or quick, however, many moms will go on to enjoy a wonderful breastfeeding relationship with their baby.
You may want to listen to Episode #132 where I talk about what you can to do help yourself if your baby is not breastfeeding or is not breastfeeding well. This is a great show which will give you specific advise on what you can do if you are struggling with breastfeeding. You can be proactive and help reduce further risk factors for greater breastfeeding challenges.
In todays show notes, I will give a link to a great handout I have that is titled: If your baby is not breastfeeding, or breastfeeding well, or you are advised to supplement:
Lori J. Isenstadt, IBCLC
Lori Jill Isenstadt, IBCLC is a huge breastfeeding supporter. She has spent much of her adult life working in the maternal health field. Once she became turned on to birth and became a childbirth educator, there was no stopping her love of working with families during their childbearing years. Lori became a Birth doula and a Postpartum doula and soon became a lactation consultant. She has been helping moms and babies with breastfeeding for over 25 years. Lori founded her private practice, All About Breastfeeding where she meets with moms one on one to help solve their breastfeeding challenges. She is an international speaker, book author and the host of the popular itunes podcast, All About Breastfeeding, the place where the girls hang out. You can reach Lori by email at: [email protected] or contact her via her website: allaboutbreastfeeding.biz/contact
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