Child birth interventions and breastfeeding

What you may not know about various childbirth interventions and their potential effect on breastfeeding-and some alternatives

IV fluids

The issue with this mainly comes in the form of breast edema due to the fluids administered by IV. IV fluids are often given to counteract the low blood pressure that is a common side effect of epidurals and spinal blocks. They can also be given to administer antibiotics and medications. The IV fluids can cause fluid retention in the breasts which can impede milk engorgement, bloat breasts and flatten nipples making latching more difficult. This article by best for babes outlines a few reasons IVs could be given and some of the issues they can cause. http://www.bestforbabes.org/booby-traps-series-what-your-cankles-want-you-to-know-about-breastfeeding

What you can do: If you are conscious and able to drink, request to drink your fluids. Express your wishes to minimize the fluid push especially after delivery. If you do require fluids be aware of the effects they can have and that time will resolve many of the effects.

The epidural

While the epidural is generally a baby and breastfeeding safe pain relief option, there are things that go along with it that can and do have effects on breastfeeding. Mainly, as outlined above, the IV. However, there are also some associated risks to breastfeeding when the epidural contains the drug fentanyl at concentrations over 150 micrograms.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595306/

What you can do: Find out what type of epidural you’ll be getting and see if you can request a lower dose (less than 150 micrograms) of fentanyl.

Opiate based pain relief

These pain relief options can cause infant sleepiness, difficulty latching and suck discoordination.

What you can do: Choose a non-opiate pain relief. Entonox or TENS or even an epidural.

The C-section.

One of the ways c-sections can disorient babies is in the normal mode of birth the mother’s sweat and colostrum smells like the amniotic fluid. Babies born vaginally and without trauma may do a breast crawl toward a familiar scent. With a C-section (and other medical modes of delivery) the baby is cleaned up and wrapped before being handed to the mother (if possible). The scent is not present in great enough quantities and it may be some time before the baby latches on. In addition, c-section mothers may have later onset milk production so early initial latching can be important.

What you can do: Ask for a swab to be soaked in your amniotic fluid when the doctors do the initial uterine incision. You can wear this around your neck and the baby will be better able to orient toward your breasts.

Instrumental deliveries:

Forcep and vacuum extraction are sometimes necessary yet unplanned options. They can both cause stiffness and soreness in the infant’s neck which can lead to latching difficulties.

What you can do: If the infant appears in pain while trying to latch beyond the first few days you should certainly seek help. A lactation consultant, chiropractor or cranial osteopath may be of help here. In many cases though this will resolve itself given time and patience.

Blood loss

While this isn’t technically an intervention it should be mentioned as it can have a large impact. A significant blood loss can be linked to a pituitary infarction which can cause the hormone cascade that triggers lactation to be interrupted. Milk production never gets started. This is supposedly rare, but I think there’s a big difference between rare and under diagnosed. I’ve read stories from a lot of women that had traumatic, high blood loss labours, never produced milk, and certainly didn’t get an MRI or investigative blood work to see what the cause was. Even if a pituitary infarction doesn’t occur, a large blood loss can impact breastfeeding by way of anemia and your bodies resource management. As milk is made from blood, a shortage of blood can cause a shortage of milk. If you are producing milk it is possible to increase your supply eventually.

What you can do: If you are aware that you have lost a lot of blood, get your iron levels checked. If you are producing milk, drink fluids and eat well and it is something that will resolve itself in time.

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4 Comments

  1. My understanding of why an IV is an issue during childbirth is also because it can dilute the hormones in your blood. Do you think that could potentially cause a problem after birth as well?

    Reply
    • That’s a good point. I’m not actually sure how much it would take to dilute things. I believe the hormone concentrations are already on a parts per thousand (more likely a parts per million) level, so a few liters of saline working itself through your blood to your kidneys isn’t likely to do much in that case. I’d suspect in a more normal situation with normal concentrations of hormones that it would be much less of an issue than if you were, say, having borderline hormone concentrations. From my understanding of it, after birth, things like prolactin (assuming the hormone cascade is triggered appropriately) are typically in excess of what is required to activate lactation. Lactogenesis II generally takes 30-40 hours after birth (or placental detachment and resulting hormone cascade) to fully activate so I’d imagine that someone having fluids pushed on them for that amount of time might actually be quite ill and have compounding factors. It could have an effect on the trace hormones like cortisol, but as not much is known about how they function, who knows!

      I know in my personal experience with excessive IV’s after birth, I had an EMCS with a spinal block. I have naturally low blood pressure (usually around 100/70) and with the spinal my blood pressure dropped even lower (as it does). I had 1 IV in me going into the EMCS but afterwards, in efforts to increase my bp, I was filled so full of fluid that the cannulae basically kept falling out, so by the time the last one had fallen out I’d had 3 put in me to try and get my blood pressure up. They were amazed at my ability to sit up and talk with 70/50 bp. I developed edema of the breasts as a result (though I didn’t know at the time, I just wondered where my nipples had got to).

      Reply
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