PowerPoint Presentation

The Maryland Department of Health and Mental HygieneHospital Breastfeeding Policy Maternity Staff Training ProgramBirth Practices and BreastfeedingSession 5

Larry Hogan, GovernorBoyd Rutherford, Lt. GovernorVan Mitchell, Secretary, DHMH

Read title and subtitle.1

Identify labor and birth practices that support breastfeedingRecognize birth practices that can interfere with breastfeedingDiscuss the importance of early skin-to-skin contactDiscuss ways to foster early initiation of breastfeeding Identify ways to support breastfeeding after a Cesarean birth

Objectives2

Labor and birth is a normal and healthy process. Instinctually and inherently women and infants have the ability to birth and breastfeed without much intervention. During this session we will identify birth practices that support as well as interfere with breastfeeding to better understand our role in providing evidence based care to the breastfeeding couplet. We will discuss the importance of skin-to-skin and early initiation of breastfeeding to improve exclusivity of breastfeeding and learn ways to help support mothers to be successful after medical interventions. 2

Support person or doula during laborEncourage comfortable birthing positions and ambulationFood or drink during laborEncourage non-medicated birthsKeep mother and baby togetherBirth Practices That Support Breastfeeding

Source: United States Breastfeeding Committee

The mothers confidence in her ability to birth leads to confidence in her ability to breastfeed. Research has shown that providing a mother with positive support and encouragement during labor builds confidence in her abilities, improves not only labor outcome, but also breastfeeding success . Research by Smith in 2010 showed positive, empowering attitudes from hospital staff support a mothers confidence and ability to birth and breastfeed her newborn. Too often hospital practices , without meaning to, undermine and discourage breastfeeding. Research has shown that, when women labor without a chosen support person to help and comfort them during the birthing process, this leads to feelings of dissatisfaction with the delivery, increased use of medications for pain management, and increased labor and delivery interventions, such as augmentation and cesarean deliveries.

Encouraging mothers to ambulate and labor in comfortable positions help a mother feel in control of her body and have been shown to aid in the birthing process. There is no evidence for the practices of restricting food, drink, or confining a woman to a bed in a supine position .

The use of medications during labor and postpartum to control pain, may improve the mothers comfort by providing relief during labor and aiding in her recovery process. But these medications also come with risks that may affect the course of labor and impact effective breastfeeding. These practices can undermine the mothers ability and confidence to breastfeed, and also affect the infants ease of learning to breastfeed. Women need to be informed of the potential negative influence of anesthesia on their infants behavior and breastfeeding initiation, so they can make an informed decision about pain management. Encouraging and supporting women in having non-medicated births has been shown to improve breastfeeding outcomes. Massage, hypnotherapy, and hydrotherapy are all effective non-medicated methods for pain management, that have no negative consequences for the mother or the baby.

Keeping mother and baby together after birth improves, not only breastfeeding, but the over all health of the infant. After birth, infants should immediately be placed skin-to-skin on their mothers chest and left there uninterrupted throughout the recovery period.

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Pitocin useLower Apgar scoresIncreased anxiety and painInhibits oxytocin releaseFluid retention

Overhydration with IV fluidsBreast edema Difficulty latchingIncreased newborn weight loss

Birth Practices That Interfere With Breastfeeding Success

Source: University of Maryland Upper Chesapeake Medical Center

Whenever possible, women should be encouraged to avoid unnecessary use of pitocin and IV fluids during labor. Research has shown inductions or augmentations of labor, before medically indicated, increase the risks of breastfeeding difficulties and the use of medical interventions, such as episiotomies, forceps use, and vacuum extractions. The use of pitocin and intravenous fluid during labor and delivery, can also have an impact on the mothers body after the delivery, and negatively effect breastfeeding. Intravenous fluids for labor should only be used for clear medical indications.

An association has been shown between low apgar scores with epidural use and infants with low apgar scores in turn exhibiting breastfeeding difficulties. A study done by Beebe in 2007 found that 1-minute Apgar scores of 3 were significantly more likely to occur after elective induction, than after spontaneous labor. A 2009 Global Survey by The World Health Organization (WHO) found that infants born to mothers whose labor was induced, had twice the risk of a 5-minute Apgar score of