How do birthing choices affect breastfeeding?

Choosing how to give birth is a deeply personal decision, influenced by many factors, including medical advice, personal preferences, and sometimes the unpredictability of labor itself. But how do these choices impact breastfeeding? As a lactation consultant, I’ve worked with countless mothers, and one common question I encounter is whether the way a baby is born affects breastfeeding success. The answer is yes, birthing choices can significantly influence breastfeeding outcomes. Let’s explore the evidence.

1. Mode of Delivery: Vaginal Birth vs. Caesarean Section

Vaginal Birth: Research shows that babies born vaginally are more likely to initiate breastfeeding within the first hour of life. This is often referred to as the “Golden Hour,” a critical period when a baby’s natural reflexes are most active. Early initiation is associated with longer and more successful breastfeeding outcomes. The process of vaginal birth also helps in colonizing the baby’s gut with beneficial bacteria from the mother, which can support the infant’s immune system and overall health, potentially influencing breastfeeding success.

• Caesarean Section (C-Section): While C-sections are sometimes necessary, they can present challenges for breastfeeding. Studies have found that mothers who undergo C-sections are less likely to initiate breastfeeding early and may experience delays in milk production (lactogenesis II). This delay can be due to various factors, including the effects of anaesthesia, maternal pain, and separation of mother and baby for post-surgical care. However, with the right support, many mothers can overcome these challenges and go on to breastfeed successfully.

2. Use of Epidurals and Pain Management

• Epidurals: Epidural anaesthesia is a common form of pain relief during labour, but its impact on breastfeeding is complex. Some studies suggest that epidurals may be associated with delayed onset of lactation. The reasoning is that epidurals can interfere with the hormones (like oxytocin) involved in labour and breastfeeding. However, the evidence is mixed, and the impact can vary depending on factors like the dosage of medication and the mother’s overall health. Importantly, pain management is crucial for a positive birth experience, and many women who receive epidurals go on to breastfeed successfully with proper support.
• Pain Relief Methods: Non-pharmacological pain relief methods, such as water births, hypnobirthing, and the use of birthing balls, tend to have less impact on breastfeeding. These methods allow mothers to stay more alert and active during labour, which can promote early breastfeeding.

3. Labor Interventions: Inductions, Augmentations, and Assisted Deliveries

• Induced Labor: Inducing labour, often with synthetic oxytocin (Pitocin), can affect breastfeeding. Some studies suggest that induced labour can lead to longer, more painful labours, potentially increasing the need for pain relief methods that may interfere with breastfeeding. Additionally, induced labour is sometimes associated with higher rates of C-sections, which, as mentioned earlier, can impact breastfeeding.
• Assisted Deliveries: The use of instruments like forceps or vacuum extractors can sometimes be necessary to assist in delivery. While these interventions may be lifesaving, they can lead to birth injuries in the infant, such as bruising or swelling, which might make it uncomfortable for the baby to breastfeed initially. However, these challenges are usually temporary and can be managed with appropriate support.

4. Skin-to-Skin Contact and Rooming-In

• Skin-to-Skin Contact: Regardless of the mode of delivery, immediate and uninterrupted skin-to-skin contact between mother and baby is crucial for breastfeeding success. Skin-to-skin contact helps regulate the baby’s body temperature, heart rate, and blood sugar levels, and it promotes the release of oxytocin in the mother, which facilitates bonding and milk ejection. Numerous studies highlight that skin-to-skin contact within the first hour post-birth significantly increases the likelihood of successful breastfeeding.
• Rooming-In: Allowing mothers and babies to stay together in the same room (rooming-in) rather than separating them for routine care can enhance breastfeeding success. Studies show that rooming-in helps mothers recognize and respond to their baby’s hunger cues more promptly, leading to more frequent and successful breastfeeding sessions.

5. Impact of Maternal Health and Birth Experience

• Maternal Health: A mother’s overall health and the circumstances surrounding birth can also influence breastfeeding. For example, women with certain health conditions, like gestational diabetes or high blood pressure, may face more challenges with breastfeeding, especially if the baby is born preterm or with low birth weight. Supportive care and guidance are crucial in these situations to establish and maintain breastfeeding.
• Birth Experience: The emotional and psychological experience of birth can also impact breastfeeding. A positive birth experience, where the mother feels supported and empowered, can enhance her confidence in breastfeeding. Conversely, a traumatic birth experience may lead to difficulties with breastfeeding, highlighting the need for emotional and psychological support postpartum.

Birthing choices, whether vaginal birth, C-section, or the use of pain relief methods, can have a profound impact on breastfeeding. However, it’s important to remember that every mother’s journey is unique. While certain birthing choices may present challenges, they do not determine the outcome of breastfeeding. With the right support, education, and resources, most challenges can be overcome, leading to a fulfilling breastfeeding experience.

References

1. DiGirolamo, A. M., Grummer-Strawn, L. M., & Fein, S. B. (2008). Effect of Maternity-Care Practices on Breastfeeding. Pediatrics, 122(Supplement 2), S43-S49.
2. Moore, E. R., Anderson, G. C., Bergman, N., & Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews, (5).
3. Declercq, E., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2013). Major Survey Findings of Listening to Mothers III: Pregnancy and Birth. Journal of Perinatal Education, 22(2), 9-16.
4. Beilin, Y., Bodian, C. A., Weiser, J., Hossain, S., Arnold, I., Feierman, D. E., … & Holzman, I. (2005). Effect of labor epidural analgesia with and without fentanyl on infant breastfeeding. Anesthesiology, 103(6), 1211-1217.
5. Rowe-Murray, H. J., & Fisher, J. R. (2002). Operative intervention in delivery is associated with compromised early mother-infant interaction. BJOG: An International Journal of Obstetrics & Gynaecology, 109(8), 937-947.
6. Crenshaw, J. T. (2014). Healthy Birth Practice #6: Keep Mother and Baby Together—It’s Best for Mother, Baby, and Breastfeeding. The Journal of Perinatal Education, 23(4), 211-217.

This blog is a detailed examination of how birthing choices can influence breastfeeding, supported by evidence from peer-reviewed journals. Remember, every birthing experience is unique, and with the right support, most mothers can successfully breastfeed, regardless of the circumstances surrounding birth.