CG How Birth Interventions Can Influence Breastfeeding Outcomes -

How Birth Interventions Can Influence Breastfeeding Outcomes

During the final weeks of your pregnancy, your body is preparing for the birth of your baby. Hormones drive the delicate labor process and birth interventions can disrupt the natural progression of childbirth. Once an intervention is introduced, it can lead to other medical interventions that may ultimately put mothers and babies at increased risk of complications and breastfeeding difficulties. Because of these risks, interventions should be utilized only when medically necessary to ensure the best possible outcomes for both mother and baby.

What is a birth intervention?

A birth intervention is a medical procedure used to induce or augment (speed up) labor, manage pain, or assist with the delivery of your baby. While these interventions can be life-saving, they are not always necessary and can increase the risk of early separation from your baby, affecting skin-to-skin contact, the first latch, and breastfeeding outcomes. Additionally, mothers who receive interventions, particularly those delivering via cesarean section (c-section), often report increased pain after delivery, which can further impact breastfeeding outcomes.¹

In modern medicine, many medical interventions are available for use during childbirth, each with its own risks, benefits, and potential effects on breastfeeding. Some interventions may be standard practice at your hospital or by your provider, so it’s important to discuss your options with your healthcare team so that you are informed and so you can ask questions and advocate for the birth experience you want.

Common Birth Interventions

Continuous Electronic Fetal Monitoring

Labor can be intense and stressful for both mother and baby.

External Monitoring: During a hospital birth, external monitors are used to track the baby’s heart rate in response to contractions.²
- Monitoring can be done continuously or intermittently, depending on hospital and provider policies.
Internal Monitoring: If there are concerns, an internal monitoring device may be placed on the baby’s scalp for more accurate readings.²
Movement Limitations: Continuous electronic fetal monitoring (EFM) can limit your movement, although some hospitals offer wireless and waterproof monitors, allowing you to walk around and even shower while monitoring the baby.
Use of EFM: While continuous EFM is appropriate for high-risk labor, its widespread use has been associated with increased rates of instrumental and cesarean deliveries without improving infant outcomes.³

Inducing or Augmenting Labor: Medications or procedures are frequently used to stimulate contractions and help labor progress.⁴

Softening the Cervix: The first step often involves softening the cervix by:
- Vaginal insert or balloon
- Prostaglandin Gel
- Stripping the membranes
- Oral medication
Pitocin Administration: If contractions do not start on their own, Pitocin (a synthetic form of oxytocin) is given through an IV drip to aid labor progression.
Impact on Breastfeeding: Some studies suggest that artificial oxytocin can:
- Depress a baby’s natural sucking instincts
- Delay the release of the mother’s natural oxytocin, which is essential for breastfeeding.⁵
Rupturing the Amniotic Sac: If contractions are absent or not strong enough, the doctor may rupture the amniotic sac or “break your water.”

Induction and Breastfeeding: While the induction process itself may not cause breastfeeding difficulties, associated interventions and the “cascade” of additional interventions that may happen once one intervention is introduced, have been shown to impact breastfeeding initiation and outcomes.⁶

Pain Medications: Studies show that babies have more difficulty latching and suckling after delivery if mothers receive pain medications.⁷

Effects of Oral Medications: Some oral medicines and narcotics can lead to dehydration or weakened breathing in infants.
Epidurals
- Allow mothers to remain awake during delivery.
- Does not affect newborn breathing.
- Can impact the baby’s early instinctual behavior, making it more challenging to latch at the breast.
Lactation Delay: Women who receive pain medication during labor are at an increased risk of delayed milk production compared to those who deliver vaginally without pain medication.
Pain Management and Labor Progression: Various forms of pain management can slow the progression of labor, increasing the need for augmentation and risk of cesarean delivery.

Intravenous (IV) Fluids⁸

Standard Protocol: Administering IV fluids at the onset of childbirth is standard in most US hospitals.
Breast Swelling and Tenderness: While some swelling and tenderness of the breasts is normal after delivery, IV fluids can intensify this, making it more difficult for your baby to latch.
Breastfeeding and Expressing Milk: It is essential to breastfeed frequently. If your baby is having difficulty latching, initiate hand expression or use a breast pump during this time to avoid engorgement and mastitis.
Impact on Birth Weight: Intravenous fluids can affect your baby’s birth weight, making it seem like your baby has lost more than the accepted 7-10% in the first few days of life.
Concerns About Weight Loss: Concerns about excessive weight loss may lead to early supplementation.

Delivery Interventions⁹

Assisted Birth: An assisted birth involves using an instrument to help deliver your baby vaginally. This type of intervention has declined in recent years.
Types of Instruments Used
- Forceps: Smooth curved tongs placed around the baby’s head to pull them through the birth canal.
- Vacuum Extraction: A suction cup attaches to the baby’s head to assist in delivery.
- Both forceps and vacuum extraction guide the baby by pulling them out from their head.
Benefits and Risks
- Benefits: Can help avoid major surgery.
- Risks: May include temporary facial weakness, minor facial injuries, and skull fractures, which can hinder the baby’s ability to nurse during the first feedings or longer.

Episiotomy

An episiotomy is an incision to enlarge the vaginal opening to create more room for your baby to emerge.¹⁰ Once considered a routine procedure, an episiotomy is no longer routinely recommended. Some studies suggest an episiotomy puts women at an increased risk of tearing. There are reasons when an episiotomy may be needed, such as in the case of fetal distress or when an assisted birth is necessary.

Cesarean Birth

While cesarean sections (c-sections) can be life-saving procedures in certain medical situations, the rate of cesarean deliveries in the United States has risen to over 30% of all births.¹¹ Many experts express concern that this high percentage may be excessive, as it can lead to unnecessary risks for both mothers and babies. During a c-section, mothers typically require:

Intravenous fluids
An epidural
Antibiotics

Additional Risks: C-sections carry increased risks for both mother and baby, including¹²:

Separation of mother and baby after birth
Delayed skin-to-skin and breastfeeding initiation
Longer hospital stay
Increased pain and discomfort
Infection
Fever

Breastfeeding Challenges: Studies indicate that mothers who have a cesarean birth may be at a higher risk of not initiating, continuing, or meeting their breastfeeding goals.¹³

Preparing for labor and delivery during pregnancy is important, especially considering how various interventions can impact breastfeeding success. For most low-risk mothers, achieving an intervention-free birth is highly possible and is associated with the best breastfeeding outcomes. However, if your birth does not go as planned and interventions are necessary, breastfeeding is still possible. Remember, every journey is unique, and many mothers have overcome challenges to build strong breastfeeding relationships with their babies. Embracing flexibility and seeking the right support can empower you to achieve your breastfeeding goals, no matter the circumstances.

What If I Have Questions?

If you are interested in learning more, these Aeroflow classes expand on some of the topics discussed above:

Birth and Breastfeeding
Ultimate Breastfeeding Prep
The Brain-Boob Connection

To register for these classes, log into your portal or click here.

Want More Info?

For a directory of Aeroflow’s other Care Guides offering information on pregnancy, baby care, and more, browse our comprehensive list of titles:

https://www.hersourcehealth.com/aeroflow-care-guides/ ‎

References