CG How Inducing Labor Can Influence Breastfeeding Outcomes -

How Inducing Labor Can Influence Breastfeeding Outcomes

The word “induction” can be scary for any new mom. Not all inductions are medically necessary, so it’s important for you to have all the information you need to make an informed decision. Factors such as your health and your baby’s well-being influence the decision about whether to induce labor or wait for it to start on its own. Your healthcare provider should consider each case individually. This is a time for you to ask questions, advocate for yourself, and make sure you understand why your healthcare provider might recommend an induction.

What is an induction? An induction of labor is when your healthcare provider starts your labor artificially.^1,2,3,4,5
What does it mean to wait for labor? When your labor starts on its own naturally.^1,2,3,4,5
Is it normal to go past my due date? First babies are often born around 41 weeks without any interventions to induce labor. Only 5% of babies are born on their due date.^1,2,3,4,5
- 50% of pregnancies go longer than 40 weeks and 5 days
- 25% of pregnancies go longer than 41 weeks and 3 days
- 10% of pregnancies go longer than 42 weeks

Factors to Consider:^1,2,3,4,5

Research has shown that using oxytocin (Pitocin) to induce labor decreases the odds of exclusive breastfeeding at 3 months.
Recent evidence shows that mothers were more satisfied with their birth experience if they had the choice to wait for labor instead of being induced.
Recent research suggests inducing labor around 41 weeks instead of continuing to wait for labor to start on its own, can help to reduce stillbirths and NICU admissions, especially for first time mothers.
The risk of cesarean birth may be similar or higher, depending on the study, for mothers undergoing routine induction at 39 weeks vs. waiting for labor to start spontaneously.

Medical Reasons for Why an Induction May Be Needed:^2,4

Health issues such as heart, lung or kidney problems with mom
Diabetes (gestational diabetes or diagnosed before pregnancy)
Placenta concerns (such as placenta previa)
Restricted or poor fetal growth
Decreased amniotic fluid
Uterine infection
Chronic problems with high blood pressure
Water breaks before labor begins
Approaching 2 weeks beyond due date and labor has not started

What are Not Medical Indications for an Induction?

“Big Baby” in an otherwise healthy pregnancy
“Induction at 39 weeks is always safe”
“Pregnancy after 40 weeks is dangerous”
Mom is tired of being pregnant
Mom wants to pick baby’s date of birth
Healthcare provider/hospital scheduling conflict
IVF
Geriatric pregnancy or age 35 at delivery
Short or petite mothers

What are Risks with Induction?^1,2,3,4,5

Please know that some of these risks are possible with pregnancy and delivery in general.

Increased pain and use of epidural analgesia
Infection of mom and/or baby
Fetal distress
Uterine rupture
Jaundice in baby
Breastfeeding difficulties
Hyperstimulation of uterus
Cesarean birth
Heavy bleeding
Complications from anesthesia
Risk to future pregnancies
Risk of future placenta problems

Questions to Discuss with Your Healthcare Provider about Inducing Labor:

Why are you suggesting induction?
What is my Bishop Score (test showing how likely it is that your cervix will dilate)?
What medication for induction will you use and what are the possible side effects to me and my baby?
What instruments will you use?
What are my options if induction does not work?
How long do you anticipate it will take from the start of induction until active labor?
How long do you try induction before recommending a cesarean birth?
What can I do in the meantime to try to start labor naturally?

What can Help my Labor Start on Its Own?^2,4

Nipple Stimulation
- Nipple stimulation releases oxytocin
- You can do this manually by rolling your nipple between your fingers or using your breast pump for a few minutes at a time
Sex
- Seminal fluid contains prostaglandins that can help soften the cervix
- Orgasm can stimulate contractions
Movement
- Walking, low intensity exercise, using a birthing ball, and more
- “Motion is lotion”

What interventions Could Be Used to Induce Labor?^2,4

Prostaglandin Medications
- Can be administered orally or vaginally
  - Cytotec- given orally or vaginally and cannot be reversed or removed
  - Cervidil- placed vaginally and can be removed if there are any negative side effects
- They are used to soften or “ripen” the cervix
- They can sometimes stimulate contractions
Cervical Balloons
- A balloon is placed inside the cervix and filled with saline to cause mechanical dilation of the cervix
Pitocin Medication
- Artificial oxytocin given through IV to slowly create a strong contraction pattern
Breaking Water
- A tool with a small hook is used to break the bag of water, which creates more pressure on the cervix

What To Expect:

If you are induced, other interventions may be required to ensure the safety of you and your baby.

Continuous electronic fetal monitoring
- To monitor how your uterus is responding to the medications being given and to monitor baby and make sure that baby is tolerating the induction
IV Fluids
- Which means you will be tethered to an IV pole and not able to be as mobile
Blood pressure cuff, frequent blood pressure checks

Breastfeeding Challenges After an Induction

You could have more trouble breastfeeding after an induction. If you’re having an induction, see an International Board Certified Lactation Consultant (IBCLC) soon after birth, especially if you face some of these challenges.⁶

After induction you may:

Be tired, especially if the birth was long or difficult
Engorgement from IV fluids
May have limited mobility if you received an epidural or had cesarean birth

After induction your baby may:

Be sleepy
Have difficulty latching
Have difficulty suckling

Breastfeeding After an Induction⁶

Practice skin to skin with baby right after birth and frequently afterwards
Make sure baby is feeding every 2-3 hours, wake to feed if baby is sleeping longer
Room in with baby in the hospital
If your baby is struggling to latch, hand express your milk and offer it to your baby with a spoon, cup, or syringe
If baby is still struggling to latch, you will need to pump every 3 hours until your baby starts latching

Getting help from an International Board Certified Lactation Consultant (IBCLC) can help you overcome many of these concerns. Because every birth and breastfeeding journey is different, an IBCLC can create an individualized plan to help you and your baby to succeed.

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

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