The importance of breastfeeding to infant health cannot be overemphasized.  The Academy of Breastfeeding Medicine Position on Breastfeeding states, “suboptimal breastfeeding practices are unequivocally associated with a greater risk of infant morbidity and mortality not only in developing countries, but industrialized countries as well.” The Academy of Breastfeeding Medicine (2008)  “Optimal breastfeeding,” is defined as exclusive breastfeeding from birth to about 6 months of age and continuing until age 2 or beyond, with appropriate and adequate complementary foods.

Ideally, an infant is able to breastfeed within the first hour after birth.  ILCA (2005).  During this window of time, the infant is in a quiet alert state and is receptive to initiating latching and breastfeeding.  There is evidence to suggest that initiating breastfeeding within the first hour after birth may have a large impact on a parent’s ability to optimally breastfeed.  In one study, in rural Ghana, initiation of breastfeeding within the first hour after birth, prevented 22% of neonatal deaths, in the first four weeks of life. Edmond, Zandoh, Quigley, Amenga-Etego, Owusu-Agyei and Kirkwood (2005) Because optimal breastfeeding is so critical for infant survival in developing countries, this study suggests that initiation of breastfeeding in the first hour of life may be important for supporting optimal breastfeeding practices.

Planning ahead for a birth experience that allows parent and infant to initiate breastfeeding in this first hour may have a large impact on the parent’s ability to exclusively (optimally) breastfeed.  It is important to consider birthing and postpartum practices that affect the parent’s and infant’s ability to be awake and receptive to initiating breastfeeding during this opportune time.  Epidurals, cesareans, inductions and routine hospital procedures are all negatively associated with initiating early breastfeeding.  With optimal breastfeeding in mind, it is beneficial to avoid these common labor and birth interventions.

There is evidence to suggest that pain medication given to a laboring individual may affect the feeding reflexes of the infant, potentially leading to a delay in initiating breastfeeding.  According to Wiklund, Norman, Uvnas-Moberg, Ransjo-Arvidson and Andolf (2009) significantly fewer babies exposed to epidural anesthesia suckled the breast within the first 4 hours of life.  In another study, Jordan S, Emery S, Watkins A, Evans JD, Storey M and Morgan G. (2009) found lower breastfeeding rates associated with epidural anesthesia and drugs administered for induction of labor.

These studies and many others suggest a negative association with labor drugs and early breastfeeding initiation.  It is important to consider these issues when planning for labor and birth.  One study showed no association between epidurals and infant feeding behaviors.  Radzyminski (2003) The result of this study may be attributed to the ultra low doses of bupivacaine and fentanyl used for these epidurals.  If individuals chose to use labor analgesia, it may be beneficial to encourage their use of ultra low dose epidurals.

Labor analgesia can also increase the risk of cesarean births.  Cesarean births are associated with delayed lactogenesis II (when the mature milk, “comes in”) which can contribute to excess weight loss in the infant and the need for supplementation.  Cesarean births are increasing in the U.S., often due to failed inductions and elective cesareans.  Inductions can also lead to late premature infants who were not quite ready to be born.  These infants have many problems related to their premature status, including feeding problems.  Meier PP, Furman LM, Degenhardt M. (2007) Research shows that, pre-term birth and cesarean birth negatively affect early (with-in 2 hours of birth) breastfeeding status. Orü’ E, Yalçin SS, Madendağ Y, Ustünyurt-Eras Z, Kutluk S, Yurdakök K. (2010)

Other factors in the birth environment that may impede breastfeeding initiation are routine separation of parents and infants and hospital procedures that interfere with early skin-to-skin contact.  The early hours after birth are precious and should be protected.  The International Lactation Consultant Association (ILCA) has developed evidence-based guidelines for breastfeeding management during the first 14 days of life, in order to establish exclusive breastfeeding.  These include facilitating breastfeeding within the first hour after birth, providing for continuous skin-to-skin contact until after the first feed, and delaying routine procedures until after the first breastfeeding.  ILCA (2005)

One birth intervention that may have a significant positive impact on the infant’s ability to breastfeed is the use of a doula.  Doulas offer experienced support and comfort measures for the laboring parent and have the skills to help them to initiate early breastfeeding.   The laboring parent has natural pain reducing hormones which are suppressed by the use of epidurals and cesarean sections.  The doula supports the parent’s natural pain relieving responses to labor.  “The doula’s presence decreases labor length, significantly decreases cesarean sections, means less use of pain medicine and gives greater breastfeeding rates.” Klaus and Klaus (2010)

©Laura Spitzfaden 2010 revised 2012