When you start preparing for birth, you may take a prenatal labour and delivery class, you might read some books about labour and delivery, ask friends about their experiences or you might hit the internet to find out about what you can expect.
You might be surprised to learn that your birth can affect the start of your breastfeeding relationship. Sometimes, events unfold differently than we had planned or hoped for. This holds true for birth. You may find your birth going a different way than you planned. The evidence shows us intervention free births are more likely to be followed by successful breastfeeding. However, we also know that when interventions are used it’s still absolutely possible to successfully breastfeed but that it may require additional support.
Interventions can be actions taken to initiate or speed up labour or the birth process. Some common labour and birth interventions include (but are not limited to) the following:
- Epidural and pain medicines
- IV fluids in excess
- Vacuum extraction
- Forceps extraction
- Pitocin & other induction medications
- Cesarean section
- Rigourous oral suctioning (of baby after delivery)
- Separation of you and your baby after birth (NICU, surgery etc)
You can plan ahead and choose some of these interventions in advance of delivery or you can make the decision(s) in the moment. Whatever you do, you deserve to make informed decisions. All possible labour and birth interventions should be discussed with your primary care provider whether that's your midwife or your OB. This discussion needs to happen before you give birth. You deserve to be informed of the possible risks. That's the only way you can make your own informed decisions.
So let's talk a little more about some of the birth interventions and how they can affect breastfeeding.
It's important you give birth in whichever way is going to make you feel safest. For some, that means pain medications. If that's what you choose, you should still know how it can affect breastfeeding so you can be prepared and get breastfeeding off to a strong start.
Labouring and delivering with pain medications such as an epidural, have the ability to interfere with breastfeeding initially. If narcotics are used during labour, your baby may have a harder time with their first latch. This is because the drugs cross the placenta and your baby will be drowsy from the medicines immediately after birth.
Do not let this sleepiness stop you from doing skin-to-skin contact right after birth. Skin to skin is strongly encouraged to get breastfeeding off to a good start. It regulates your baby's temperature and nervous system. It releases oxytocin in both of you which helps your milk let-down/flow. A sleepy baby may take up to 1 hour to find the breast and latch. This is perfectly acceptable! There is no rush to immediately get them onto the breast. The medications will wear off in time. In the meantime, spend time getting to know each other.
Induction is medically started labour which happens for many reasons. Sometimes induction is started with artificial oxytocin known as pitocin which can possibly interfere with your body's production of oxytocin which is required for your milk let-down. The evidence is not strong and is somewhat conflicting. Spending time skin to skin after birth will help support your body's release of oxytocin.
There are many other medications that are used to bring on labour. They don't appear to directly interfere with the start of breastfeeding. However, often when labour is induced, several interventions may follow (IV, pain medications, instrument delivery) which could then have an effect on the start of breastfeeding.
IV fluids, while common practice for hospital based births, can inflate babies weight. This is because some of the fluid transfers into your baby's body before they are born. This results in an incorrect weight because they are now carrying excess fluids.
Just like you will begin peeing out the excess fluids after delivery, so will your baby. Because your baby is peeing out the excess fluid, the weight loss can exceed what is considered normal. Depending on the hospital, staff may be quick to intervene with formula supplementation without first assessing how breastfeeding is going.
IV fluids may also worsen engorgement after delivery because your body is still working to eliminate the excess fluids while also increasing the volume of your milk. Excess engorgement not only creates discomfort for you, but it can make latching your baby difficult.
Tools such as forceps and vacuum may cause some soreness and bruising in your baby and can affect how they latch. They may prefer one side over the other or one position over another. Spending time together skin to skin will help with their pain relief and support their ability to latch. Be mindful of which positions your baby feels most comfortable in (and ones you are comfortable in too!) and focus on those. It’s also helpful to work with a lactation consultant as well as a bodyworker (chiropractor, osteopath, physical therapist etc) after an instrument delivery if you’re noticing your baby is having challenges.
So how can you get breastfeeding off to a good start?
I would suggest you find intervention free birth stories. Ina May’s Guide to Childbirth was a book I loved when I was expecting my first. This can help you prepare for delivering without the use of interventions if that's what you want.
Talk to your primary care provider about the use of interventions and the risks associated with each one. You should be presented with unbiased, evidence based information to make your decisions. If you're wanting an epidural, talk to your care provider about getting uninterrupted skin to skin contact immediately after birth.
You can get breastfeeding off to a good start by investing in a birth doula to help support you through your labour and delivery.
Weigh your options about where you might be able to deliver (hospital, birth centre or home). If you want access to multiple interventions then a hospital is the way to go but if you don't, then a birth centre or home birth might be worth considering if you have that option.
An excellent way to get your breastfeeding relationship off to a strong start is to take a prenatal breastfeeding class written by a lactation consultant or work privately 1:1 with a lactation consultant before birth. Most lactation consultants provide prenatal consults to help walk you through what to expect and answer all of your questions.
Beake, S., Bick, D., Narracott, C., & Chang, Y. S. (2017). Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review. Maternal & child nutrition, 13(4), e12390. https://doi.org/10.1111/mcn.12390
Bonyata, Kelly. (2018, January 15). Establishing and maintaining milk supply when baby is not breastfeeding.Kellymom.com. https://kellymom.com/ages/newborn/nb-challenges/maintainsupply-pump/
Campbell, S.H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core Curriculum for interdisciplinary lactation care.Jones & Bartlett Learning.
Newman, J. & Pitman, T. (2014). Dr. Jack Newman’s Guide to Breastfeeding. HarperCollins Publishers Ltd.
Wilson-Clay, B., & Hoover, K. (2017). The breastfeeding atlas (6th ed.). Manchaca, Tex.: LactNews Press.
Alex Wachelka (Lactation Consultant) is the founder of Motherhood Blooms Lactation™. She is passionate about helping others feel validated and heard during their infant feeding experience because she herself faced a challenging time breastfeeding her firstborn. Her experience reaching out for support led her to learn more about breastfeeding and lactation and discovering a passion she didn't know she had. She went back to school with a very young infant to train in lactation so she could help others feel confident and successful in their infant feeding journey.
Connect with Alex: