Birth professionals have long been aware that there is a connection between birth and breastfeeding, but in recent years experts are making this link more explicit and the inextricable nature of the two experiences is becoming clearer. Birth and breastfeeding exist on a continuum. They are not discreet events. As speaker and author Dia Michels says, “we need a new word—birthandbreastfeeding.” Human women are mammals and the same things that disrupt bonding and breastfeeding for other mammals also apply to women. Darkness, quiet, no disruptions/interruptions, safe, upright, mobile, easy access to food and drink as they choose….these things support healthy births for female mammals! In brief, a normal, healthy, undisturbed birth leads naturally into a normal, healthy, undisturbed breastfeeding relationship. Disturbed birth contributes to disrupted breastfeeding.
New mothers, and those who help them, are often left wondering, “Where did breastfeeding go wrong?” All too often the answer is, “during labor and birth.” Interventions during the birthing process are an often overlooked answer to the mystery of how breastfeeding becomes derailed. An example is a mother who has an epidural, which leads to excess fluid retention in her breasts (a common side effect of the IV “bolus” of fluid administered in preparation for an epidural). After birth, the baby can’t latch well to the flattened nipple of the overfull breast, leading to frustration for both mother and baby. This frustration can quickly cascade into formula supplementation and before she knows it, the mother is left saying, “something was wrong with my nipples and the baby just couldn’t breastfeed. I tried really hard, but it just didn’t work out.” Nothing is truly wrong with her nipples or with her baby, breastfeeding got off track before her baby was even born!
Problems with breastfeeding often start before baby is born. According to Linda Smith, BSN, FACCE, IBCLC, co-author of the book Impact of Birthing Experiences on Breastfeeding (2004), birth practices that impact breastfeeding include:
- Mechanical forces of labor (positioning of baby, positioning of mother, etc.)
- Chemicals (drugs) used in labor
- Injuries to mother or baby
- Treatment of mother during labor
- Treatment of mother after birth
- Separation from mother after birth
- Procedures that alter behavior
Linda Smith also notes that a mother’s confidence and trust in her body’s ability to give birth is related to her confidence in her body’s ability to breastfeeding. There are several birth related risk factors for breastfeeding problems (please note that not all babies with risk factors will actually have problems):
- Induction of labor
- Epidural and/or narcotic medications
- Instrumental delivery (forceps or vacuum)
- Post birth suctioning of baby’s airway
Additional procedures that affect baby’s ability to breastfeed if they are done before baby’s first breastfeeding include:
- Separation of mother and baby for any reason.
- Weighing and measuring
- Vitamin K injection
- Metabolic tests
- Infant hypothermia
According to the Academy of Breastfeeding Medicine (www.bfmed.org), “unmedicated, spontaneous, vaginal birth with immediate skin-to-skin contact leads to the highest likelihood of baby-led breastfeeding initiation.” Immediate skin-to-skin contact restores the biologic continuum begun during conception.
When I was in graduate school, one of my professors used the following analogy to make a point and I now use it with my own students:
There is a river running through town. Daily, emergency workers are called upon to rescue people from the river who have fallen in and are floating downstream drowning. Day after day they pull the gasping people back to land until one of the workers suddenly realizes, “maybe we should go see what is happening upstream and try to stop these people from falling in to begin with?”
My professor then encouraged us to always remember to go “upstream” when working in the helping professions rather than only addressing the immediately presenting problem. Childbirth professionals are in an “upstream” position when it comes to protecting the birth-breastfeeding continuum!
For more about the value of keeping mothers and babies together following birth, check on Healthy Birth Practice Six: Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding from Lamaze.
If my mom were a platypus: what we can learn by studying mammal lactation, presentation by Dia L. Michels, La Leche League of Missouri Conference, November 2007.
Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Mary Kroeger and Linda J. Smith, Jones and Bartlett Publishers, Inc.; 1 edition (February 2004). ISBN-13 978-0763724818.
Mother-Baby Togetherness, presentation by Dr. Nils Bergman, La Leche League International Conference, July 2007.
The Power of Touch, presentation by Diane Wiessinger, La Leche League of Missouri Conference, November 2007.
Winning at Birth, presentation by Linda J. Smith, La Leche League International Conference, July 2007.
This article is adapted from “Celebrating World Breastfeeding Week and the Birth-Breastfeeding Continuum” by Molly Remer, MSW, ICCE, published in the International Journal of Childbirth Education, June 2008.