“Every birth is unique,” comments Teresa Pitman, author of Preparing to Breastfeed, who has over 35 years of experience as a La Leche League Leader. “Some labours 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 your baby is here, says Teresa, the next step is breastfeeding.
Your labour, birth and immediately after, can have a significant effect on your baby. “If a mother is alert and participates actively during her labour and birth, this helps to get breastfeeding off to a good start. Clearly, birth affects breastfeeding, even if interventions are sometimes necessary.”
Teresa explains that for many first-time moms, just thinking about the birthing process takes a lot of energy (and perhaps even concern), and breastfeeding may seem like something in the distant future. “But, preparing for labour and birth with breastfeeding in mind can make a big difference in how easily your nursing relationship gets started.”
Dr Daniela Krick, a gynae and obstetrician in the Western Cape, concurs. She shares the most common birth interventions, the potential impact, and what you can do.
Dr Krick explains that most inductions are for medical reasons (maternal or foetal) and require that your baby be born before full term gestation is reached. In other words, your baby could be premature. “Preemies have difficulties with latching, co-ordinated breath and swallowing, and may end up requiring cup or tube feeding.” Dr Krick adds that the type of induction may also impact the breastfeeding process. “There are various mechanisms to induce labour. One of the drugs used is syntocinon, which is synthetic oxytocin (a hormone that is a natural breastfeeding drug). When labour is induced or augmented with syntocinon, it can have negative effects on breastfeeding and there are quite a few different hypotheses as to the reason for this.”
Speak to your doctor about your options and only induce for a valid medical reason. “Try use other means of induction rather than syntocinon, such as stretch and sweep or vaginal prostaglandins,” suggests Krick.
Intervention: Assisted birth
This involves giving birth with the help of a device, for example forceps or a vacuum extractor. “Assisted birth with forceps or vacuum can cause swelling and bruising. I’m pretty sure if a baby could talk, she would complain of a decent headache,” says Dr Krick. Facial bruising and swelling may occur and these babies may be uncomfortable no matter how they are positioned at the breast. “Jaw movements and the suckling action can be painful due to bruising.”
“Try to avoid assisted deliveries by having a great birth assistant and trusting and working with your midwife and doctor when it comes to the second (pushing) stage of labour,” says Dr Krick. She adds that alternative birthing positions also work well, such as squatting or hands-and-knees position. “Avoid lying flat on your back both while labouring and during delivery.”
Intervention: IV fluids
Labouring women are often given fluids intravenously. This is necessary if you are having an epidural or being induced. Sometimes, this is put in place “just in case” it is needed in an emergency. “Too many IV fluids can cause tissue swelling, both for mom and baby.” The additional fluid may gather in your breasts, making them swell from overhydration, which can make latching difficult.
“Have an IV line only when medically necessary. Rather drink fluids and have light snacks during labour. If IV fluid is given, it is best to run it though an IVAC (a controlled volume delivery system),” says Dr Krick. “Avoid requiring medical interventions that necessitate the insertion of a drip (IV cannula).”
Intervention: Narcotic pain medications
Some narcotic pain medications can cross the placenta and enter into your baby’s blood stream. “If these are given close to birth, your baby may suffer the effects of the narcotic, such as drowsiness, and being lazy to breathe or feed,” says Dr Krick. “There are antidotes to most of these narcotics, but they don’t last very long in the blood stream. Your baby will need to be monitored carefully in case the antidote wears off before the narcotic is metabolised.” Dr Krick adds that very little of a narcotic actually ends up in your breastmilk, so it’s not that much of a worry. “However, rather avoid narcotics while you are breastfeeding and use alternative pain killers instead.”
Try to avoid narcotics completely. “In labour, employ emotional support, breathing techniques, positioning, warmth and massage as natural pain killers. Nitrous oxide gas or regional anaesthesia (epidural) are also alternatives.”
“There are conflicting reports on the impact of epidurals,” says Dr Krick. “Most of the problem seems to lie in the fact that moms with epidurals also need IV fluids, are not mobile (as you lie on your back or side, without being able to sit up and walk) and have a slightly higher risk of an assisted delivery.”
Dr Krick suggests that you have an epidural when necessary. “Contrary to anecdotal belief, an epidural does not lengthen labour or increase the chance of a C-section.”
Today, the rate of elective C-sections is high. The World Health Organization recommends the C-section rate should be under 15%. However, in most countries, it is 30% or higher. There are cases where a C-section is necessary − particularly when it comes to the health and safety of mother and baby. The problem with a C-section is the delay in bonding, says Dr Krick. “That first 30 to 60 minutes of your baby on your chest is crucial. We try hard to let the baby be on the breast while we are still closing up the C-section incision, but this isn’t always possible.” You will also have pain once the anaesthetic wears off, which can make having your baby on your chest uncomfortable. Painkillers can also make you feel groggy.”
“Only have a C-section when medically indicated,” says Dr Krick. “Use a facility that encourages and assists with early skin-to-skin, even in theatre (ask about the hospital’s policy). Let your partner be the “kangaroo” when you can’t, so your baby is used to lying on a chest, rather than a crib.”
Intervention: Mother-baby separation
The more time you spend in each other’s company the better, recommends Dr Krick. “You learn your baby’s hunger cues, and your baby has immediate access to milk.”
Choose a hospital that is “baby friendly”. “There is a specific baby-friendly hospital accreditation that some hospitals have. In general, ask the staff what the hospital’s policies are with regards to rooming-in.”
As Pitman shares: “Pregnant women are often not told about the possible consequences of birth interventions when it comes to breastfeeding. Epidurals and C-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.”
Producing milk takes time, adds Dr Krick. “Your baby needs very little in the first few days and you may not even know how much you are producing. Don’t feel that you can’t do it, or you don’t have milk, as your milk production only reaches its peak 72 to 96 hours after birth.” Dr Krick recommends that you speak to a professional, such as a doula, the nurses or a breastfeeding consultant. if you are worried. “Do what works for you, and never feel like you have failed.”
Kim Bell is a wife, mother of two teenagers and a lover of research and the way words flow and meld together. She has been in the media industry for over 20 years, and yet still learns more about life from her children everyday.