Birth Practices on Breastfeeding – Part 2

So last week I shared with you some of what Linda Smith shared at the SD Breastfeeding Summit. It was a summary of how epidurals and other meds during labor and delivery can and do affect breastfeeding.

As I said in my last post, ANY medical intervention during birth can have an effect on breastfeeding and the breastfeeding relationship/ability of your baby.

Since approximately one in three mamas have a surgical birth (cesarean) in the United States today, it is extremely important for us to talk about the consequences of this statistic for those 33%. There are essentially three different kinds of cesarean: Elective (scheduled) without labor, Cesarean with labor, and Emergency.

An elective cesarean without labor has shown in several studies to increase infant respiratory problems and also decrease breastfeeding success (studies listed below). This makes complete sense to me. For one thing, if there isn’t any labor initiated by the baby, then baby obviously isn’t ready (baby is the one that releases the hormone that begins labor)! If baby isn’t ready, then there is a higher risk of respiratory problems – after all, the lungs are the last major organ to develop. If there are respiratory problems – you know – if the baby can’t breathe, then baby will clearly have a difficult time eating at the breast. That all seems like a no-brainer. Also, I have read several articles recently that talk about the hormones released in labor and how they are so important for baby (and mama). Without labor, baby and mama don’t get them. Even a little labor is better than none. So, bottom line: Elective cesareans without labor are risky to baby (and mama), particularly in the breastfeeding relationship.

Studies also show that any cesarean (even with a trial of labor) can have negative effects on breastfeeding.

Again, if you think about this, it really makes a lot of sense. First of all, according to the World Health Organization, we (the U.S.) are over double the acceptable level of cesareans based on their standards. They figure that 10-15% of all births should reasonably be surgical based on medical necessity. Anything over that is considered unnecessary.  

So, if you are one that needs a surgical birth, how can you minimize the risk of impeding breastfeeding?

Let’s think for a minute what happens during a normal cesarean surgery in this country (Please note I am not referring to medically emergent surgical births here. There are things that happen when a true emergency is happening that I’m not going to go into. This is a normal, non-emergent cesarean that I’m talking about). In the simplest of terms, during a surgical birth, mom is going to have an epidural or spinal block (remember what I said about epidurals last week?), a screen is going to be put up to ensure a sterile incision site, mom’s arms are going to be strapped down, doc will make incision through all layers of mom’s abdomen through her uterus, he will pull baby out of the uterus, clamp/cut the cord, baby will be lifted high enough for mom to see, then will be taken over to the warmer to get vitals, footprints, weight, APGARs, etc, etc, then baby will be swaddled tight with a hat on his head, dad may get to hold him for a bit, then after a kiss from mom and some snapshots he will be taken away to the nursery until mom has been sewn back up and is out of recovery. Obviously, there will be some variation of all of this depending on provider and facility, but you get the idea.

So to minimize the risk of jeopardizing breastfeeding, there are things that we need to be asking for and yes, demanding, from our care providers. Surgical births don’t need to be traumatic experiences where mom doesn’t even get to touch baby other than maybe a kiss until after recovery. One thing that we heard about a lot at the SD Regional Breastfeeding Summit was the importance of skin-to-skin contact with mama and baby. I’ll talk more about that later this month, but for now, just believe me that immediate skin-to-skin is of utmost importance. Dr Raylene Phillips actually showed a demonstration of what they are doing at her hospital in California for all cesarean surgeries, and it seems to me that it’s a really important, easy, and cost-free step that we can ask our hospitals and providers to begin taking.

It’s pretty simple, but basically instead of whisking baby away after he is born, therefore having a time of very stressful (for mama and baby) separation, they simply put a diaper on baby (to keep environment as clean and sterile as possible) and put him on mom’s chest while closing her up. Dad is right there and makes sure baby stays on mom’s chest, and baby is happy, can initialize breastfeeding on his own, gets all the warmth, love, oxytocin, and mama-bonding time that he needs. She said that this simple step has eliminated all kinds of things: Anesthesiologists are loving it because it makes their job keeping mom comfortable and stable SO much easier! Babies are obviously loving it, because they get their mommies and can just follow their instincts and go straight to the breast without the trauma of separation. Dads feel important, because they can actually do something instead of just watching the ones they love shivering and stressed because they don’t have their baby near them. Seriously – everyone wins!

So let’s start the conversation. If you are pregnant, talk with your provider about this! If you end up needing a surgical birth, you will be SO glad you did! If we all start talking to our providers and encouraging our friends to do the same, we can help make changes that affect everyone involved positively!

~Evie

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• Tita, A. T. N., Landon, M. B., Spong, C. Y., Lai, Y., Leveno, K. J., Varner, M. W., et al. (2009). Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. N Engl J Med, 360(2), 111-120.
• Kamath, B. D., Todd, J.K., Glanzner, J. E., Lezotte, D., & Lynch, A. M. (2009). Neonatal outcomes after elective cesarean delivery. Obstet Gynecol, 113(6), 1231-1238.
• Wiklund, I., Edman, G., & Andolf, E. (2007). Cesarean section on maternal request: reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers. Acta Obstet Gynecol Scand, 86(4), 451-456.
• Dewey, K. G., Nommsen-Rivers, L. A., Heinig, M. J., & Cohen, R. J. (2003). Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics, 112(3 Pt 1), 607-619.