If you are currently pregnant, the birth of your baby is probably one of the biggest events that you’ve ever had coming up.
Many women don’t realise that they have to prepare and make decisions, placing instead the responsibility of their care in the hands of the healthcare professionals looking after them.
And while this should lead to the best outcomes for mother and baby, the statistics tell us that in South Africa this is often not the case.
The effects of birth on both mom and baby are more far-reaching than most people may think. One of the areas most affected is breastfeeding.
Here’s how birth influences breastfeeding
According to the South African Demographic and Health Survey of 1998, approximately 88% of mothers initiated breastfeeding at birth. However, only 10% of babies were breastfed exclusively in the first three months of life, with less than 8% reaching the 6-month mark. This makes South Africa one of the countries with the lowest breastfeeding rates in the world.
Of course, there are many reasons for these low breastfeeding rates. Let’s take a look at how labour and birth influences breastfeeding
Before you proceed…
The purpose of this blog is to provide pregnant couples considering their birth options with information on birth and breastfeeding, not to cause anxiety and guilt feelings for those mothers in which all had not worked out the way they planned.
No matter how bad the start, from the very first moment after birth we have the power to do things differently. With perseverance from the mother, continuous skin-to-skin contact and good breastfeeding support, most babies hampered by a difficult birth experience will still be able to successfully breastfeed.
READ MORE: How to boost your milk supply
I’ve included a few pointers on firstly planning a breastfeeding-friendly birth, and secondly dealing with a difficult birth at the end of this blog.
All women want what is best for their babies and no one would deliberately make choices that are going to cause harm.
Some things are simply out of our control (and perhaps that is the first lesson to learn on your parenting journey).
The role of natural birth in breastfeeding
In her book ‘Gentle Birth, Gentle Mothering’, Dr Sarah J. Buckley takes an in-depth look at what happens in a woman’s body during labour and birth. On a personal level, this book was probably the source of information that had the most profound effect on my approach to parenting as both a midwife and a mother.
I want to encourage all pregnant women to read it as it offers wonderful insight into birth, bonding, sleep and breastfeeding.
A woman’s hormones during natural birth provide her with personal empowerment, physical strength and an intuitive sense of what her baby needs. It also kick-starts breastfeeding and breastmilk production.
Two of the labour hormones that may specifically influence breastfeeding are Oxytocin and Beta-Endorphin.
Oxytocin – the hormone of love
Oxytocin is the most powerful endorphin (or feel-good hormone) in the body, and is actually responsible for orgasms during sex. In labour, oxytocin is the hormone causing contractions.
Oxytocin levels remain high in both mom and baby’s bodies in the early days after birth. It assists with bonding and helps the mom to cope with the adaption to a new baby. Oxytocin is also excreted when a baby latches and sucks, causing the milk ducts in the breasts to contract and squeeze out breastmilk. It plays an important role in establishing a proper milk supply.
Beta-endorphin – the hormone of pleasure and transcendence
Beta-endorphin is a pain-relief hormone that the body excretes to help a woman cope with labour pain. In the hours after birth, beta-endorphin contributes to feelings of pleasure and ecstasy for both mom and baby. This may help the newborn baby to adapt to the stressful environment outside the womb. Higher stress levels in babies may contribute to breastfeeding and latching difficulties.
Baby’s cortisol levels
Cortisol is a stress and a steroid hormone that naturally rises in a baby’s body in the days before a woman goes into labour. This enables a baby’s body to better transition from the inside of the uterus to the stressful outside world. In an elective Caesar, a baby needs to do this without the support from cortisol. While most babies will quickly adapt, a few may struggle, which may influence their ability to breastfeed.
The influence of birth interventions on breastfeeding
There is a difference between ‘normal vaginal delivery’ and ‘natural undisturbed birth’. Routine practices like brightly lit birthing rooms, the display of medical equipment, hospital noises in the background, inserting IV lines and care by strangers are often the first spanners in the works. These inhibits a woman’s normal hormonal workings and may lead to other interventions that could have been prevented. Simple changes like dimming lights or drawing curtains and playing soft music to drown out background noises can go a long way towards positively influencing birth (and subsequently breastfeeding).
Various interventions have the potential to disturb birth. Remember that it’s always about measuring up risk versus benefit. For some women and their babies these interventions are indeed needed, while for others it will do more harm than good.
- Induction of labour (IOL) – According to the Coalition for Improving Maternity Services, first-time mothers have twice the likelihood of landing with a Caesarean section after an IOL compared to natural onset of labour. Induced labours are more painful, and more women will require pain relief medication. All of the above factors can negatively influence breastfeeding.
- Pethidine injections for pain relief – In most South African hospitals the opioid Pethidine is routinely offered to labouring women for pain relief. It is transferred to the baby via the placenta, and can make baby sleepy and less likely to latch in the early days after birth. It can also suppress breathing in a baby after birth and lead to admission to NICU. It may cause drowsiness and nausea in labouring women. Worst of all is that research has shown it to be ineffective for relieving labour pain.
- Epidural anaesthesia – Epidural anaesthesia is currently the most effective pharmacological method of pain relief in labouring women. However, epidurals disrupt birth processes in major ways, and typically go hand-in-hand with other interventions like instrument deliveries and caesarean sections. The effects of epidural anaesthesia on breastfeeding are not well studied. It’s also difficult to study. Many mothers with epidurals have also been exposed to opioid drugs like Pethidine, with its well-known effects on breastfeeding. Different drugs and different dosages are used for epidurals, which may have different effects. Overall, studies seem to link epidural anaesthesia to more feeding difficulties in the early days and to shorter duration of breastfeeding.
- Instrument deliveries – Instrument deliveries include suction and forceps births and usually follow complicated labours (where mom has already been exposed to other interventions). It may cause swelling and superficial injury to baby’s head, which is painful and will definitely impact on breastfeeding in the early days.
- Caesarean section – The majority of mothers delivering their babies in private sector hospitals in South Africa will do so via Caesarean section. Contrary to popular belief, a Caesar is statistically more risky for a low-risk mom and baby than a natural birth. A baby is often delivered 2-3 weeks before he would have come on his own, and there is a higher incidence of admission to NICU for breathing difficulties. Something many don’t recognize is the difficulty that a new mother faces when having to deal with a newborn baby while also recovering from major abdominal surgery. Due to all of the above, successful breastfeeding is more difficult after a Caesarean section.
Giving yourself the best chance for a good birth experience
If you are pregnant and planning a natural birth you should focus on the positive things you can do to boost your chances:
- Recognise that there is not one birth-option that will suit everyone. You need to do what is best in your circumstances.
- Choose your healthcare provider wisely. I especially want to encourage you to at least examine the option of birthing with a midwife. Midwifery-led care is the standard worldwide, with documented better outcomes for low-risk mothers and babies. If you choose to birth with a gynaecologist, make sure that you have a birth plan that you discuss in advance and that your doctor is supportive of your informed choices.
- Attending antenatal classes is a great first step, but you need to also choose an antenatal teacher knowledgeable about natural birth who will teach you proper pain relief and coping techniques for a natural birth. This is sadly not always the case. Proper birth preparation will often reduce the need for intervention.
- If you have the funds available, using a doula for your birth will make a tremendous difference to your birth experience.
- Locate a lactation consultant in your area that you can call after the birth should you experience any breastfeeding difficulties.
How do you cope with intervention?
- Remember you fall pregnant to have a baby, not to have a perfect birth.
- Debrief, talk to someone you trust, write it all down. It’s important to acknowledge your emotions, as negative feelings over your birth will also influence how you feel about yourself as a mother and may lead to postnatal depression.
- Most babies born after interventive births are able to successfully breastfeed. So do not obsess if this has happened. With a bit of patience, most problems potentially caused by birth can be overcome.
- Skin-to-skin contact and baby massage can help baby cope with any birth trauma.
- Take baby to a chiropractor, as Caesarean sections and instrument births may lead to malalignment in baby’s spine which can cause breastfeeding difficulty, cramps, colic and reflux in babies.
- If you had a suction delivery, position baby in a way that you prevent touching any bruising or swelling on baby’s head, as this can be painful.
- In the same way, you will need to find a position in which you can feed comfortably after a caesarean section (football hold is popular), or after a normal birth where mom has a tear or a cut (side-lying works wonderfully).
- Remember that birth is only one day – every day is the first day of the rest of your life!