How Do Birth Practices and Experiences Affect Breastfeeding?

By Katie Black

Note: The information contained in this article is for educational purposes only and should not be taken as medical advice.

Much of the talk around breastfeeding is centered on it being a mom’s decision and initiatives often focus on motivating women to choose breastfeeding. But we know it’s not that simple.

In order to breastfeed, a lot of different things need to fall in place. For starters, she and her baby must be physically able and wanting to, her financial and work situation need to support it, and she needs to have the time and energy, just to name a few things.

Too often women blame themselves when breastfeeding doesn’t go how they hoped or planned, even if the issues are out of their control. A factor that can be overlooked is how the birth went and the role healthcare teams play in establishing breastfeeding.

It might come as no surprise that birthing practices are under-researched, and so are their effects on breastfeeding. However, we do know that different practices and experiences can influence the breastfeeding process. Some are indirect, like perineal injuries from tearing linked to postpartum depression. Here are some other ways…

Induced labor

In the U.S., around 31% of labor is induced. There are a bunch of reasons for recommending inductions - both medical and nonmedical. But they do have an impact on breastfeeding. To understand how, we first have to understand spontaneous labor (labor that starts on its own).

In the time leading up to labor, a mom’s body passes antibodies to her baby to help protect against infection when they’re in the world. Babies gain weight and strength, develop the ability to suck and swallow, and their lungs mature. The hormone prostaglandin increases which softens the cervix. A rise in estrogen and a decrease in progesterone in moms bumps up their sensitivity to oxytocin.

During labor, the rising levels of oxytocin lead to even stronger contractions. The cervix thins and dilates. Lots of endorphins are released to help with the pain. As the baby moves down the birth canal, catecholamines (like dopamine and adrenaline) are released, giving an energy burst to the mom. The baby will also have high levels of catecholamines, creating an alert newborn ready to meet the world.

Right after birth, hormones continue to help with breastfeeding. When placed skin-to-skin on their mom, the baby's weight, hand and head movements, and sucking the breast stimulate oxytocin and prolactin release. Then, prolactin triggers milk production, while oxytocin causes milk letdown. High levels of endorphins pass through breast milk, making the transition easier for the baby.

What happens when labor is induced?

Pitocin (synthetic oxytocin) is often used to induce labor. But it doesn’t cross the blood/brain barrier, so the pituitary is not stimulated to release endorphins. Without that pain relief, women are more likely to need an epidural. Epidurals can mess with natural oxytocin production, so even more pitocin may be needed.

Pitocin induced contractions get stronger more quickly which can make labor more difficult to manage, and increase the need for using instruments. The uterine muscle can’t completely relax between contractions, increasing stress on the uterus and the baby. That can bump chances of issues like exhaustion and tearing for the mom, and less oxygen supply for the baby. These added risks often make continuous electronic fetal monitoring necessary, which can disturb movement. Plus, there may not be a surge in catecholamines right before birth, leading to a less responsive mom and baby.

Some studies suggest disturbing oxytocin like this can delay lactation, or decrease supply. The whole labor process can also be more stressful, with more complications causing stress hormones like cortisol to interfere with milk production and letdown. And since less endorphins are transferred via breast milk in these cases, the baby misses out on the calming, pain relief benefits.

Elective inductions are inductions that don’t have a medical reason. Elective inductions increase the risk of giving birth to a baby that is near-term. Near-term infants are physiologically and developmentally less mature than full-term infants and have a higher risk of temperature instability, hypoglycemia, respiratory issues, apnea, and bradycardia (slow heart rate), and jaundice. They also have more difficulty with managing suck, swallow, and breathing which can hurt their ability to nurse within the first 24 hours post birth.

If your goal is to breastfeed, unless your doctor gives a clear medical reason for induction, you’ll have a better chance of success if you wait for spontaneous labor.

Assisted vaginal birth

Assisted vaginal birth (AVB) means instruments like forceps or a vacuum are used to help with birth. AVBs make up about 3% of births in the U.S..

In order to suck, swallow, and breathe in coordination, newborns use six of their 12 cranial nerves, 22 bones connecting at 34 sutures, and 60 muscles. These nerves pass through foramen (holes in bone) between the segments of the cranium. During assisted labor and birth, the baby’s skull faces pressure that can affect bone alignment, the cranial and thoracic nerves, and the brain/central nervous system structures. All this can really affect the newborn’s ability to breastfeed.

Some of the nerves, what they’re made of, and what they control are:

The trigeminal nerve

Sensory fibers from the palate, tongue, lower jaw, nose.
Motor fibers that control muscles used in chewing.

The facial nerve

Sensory fibers from the palate, part of the tongue, and tear ducts.
Motor nerves that stimulate the facial muscles, lips, cheeks, and jaw.

An infant’s suck response is partly triggered by receptors in the lips and palate while motor fibers of the facial nerve are involved in rooting, latching, and sucking.

The glossopharyngeal nerve

Sensory fibers from the posterior palate and tongue which control the gag reflex.
Motor fibers that control chewing muscles.

If a newborn needs to be suctioned or intubated, this may trigger the sensory fibers making them gag. Their gag reflex can become oversensitive which in turn can make getting a deep latch harder since the tip of the nipple almost hits the hard–soft palate in normal breastfeeding.

The vagus nerve

Motor fibers to the larynx, heart, lungs, trachea, and gastrointestinal tract.
Sensory fibers from the heart, lungs, trachea, bronchi, larynx, pharynx, gastrointestinal tract, and external ear.

The vagus controls breathing and heart function, so if it’s disturbed, that could mess with suck-swallow-breathe coordination.

The spinal accessory nerve

The spinal accessory nerve controls the sternocleidomastoid and trapezius muscles and is involved with head position, and keeping the airway open.

This study found newborns experience physical trauma in up to a quarter of AVBs. The majority of trauma is superficial scalp or facial bruising and buildup of blood under the scalp. With AVBs, serious complications are pretty rare. However, there are chances of issues like:

Jaundice, 5%-15%
Cephalhematoma: buildup of blood under the scalp (mostly from vacuum), 1%–12%
Facial or scalp lacerations, 10%
Retinal hemorrhage (mostly from vacuum), 17%-38%

Babies with jaundice are more lethargic so have a harder time nursing which in turn can make their jaundice worse. Jaundice is a common reason for supplementing with formula.

Moms with AVBs are at an increased risk of tearing, so skin-to-skin contact and breastfeeding may be delayed while she’s being taken care of.

Getting off to a rocky start is concerning for moms who hope to breastfeed, but nerve damage and bruising generally heals within a few weeks. Moms will need extra support from skilled professionals if they’re struggling to breastfeed after an AVB.

C-section

Studies are showing women who deliver by c-section delivery are less likely to breastfeed, more likely to have a delay in breastfeeding initiation, and more likely to stop breastfeeding early compared to those who give birth vaginally.

There are many factors that could be at play for these differences:

There’s a lower chance of moms and babies having skin-to-skin contact right after birth, and a smaller likelihood for breastfeeding to be attempted within 24 hours post delivery. Breastfeeding within the first hour is an important predictor of whether breastfeeding will continue.

Moms who deliver via c-section often have a delay in lactogenesis, or make less milk within the first few days. They think this is because of stress or c-sections disturbing the normal hormonal processes that allow lactation.

When surgeons lift the baby’s cranium from the uterus it may put too much pressure on the hypoglossal nerve. This nerve has fibers that control tongue movement and is important for sucking and swallowing.

Pain medication may make the mom and baby groggy and too “out of it” to start or establish breastfeeding.

There are also higher chances of infection and uterine hemorrhage in moms, plus higher odds of respiratory distress and hypoglycaemia in babies. The more health complications for mom or baby, the less likelihood of breastfeeding.

There may be a longer, more difficult recovery time making breastfeeding physically or emotionally difficult for the mom.

Women who deliver via c-section may find breastfeeding more painful compared to women with vaginal deliveries, especially for planned c-sections (when you don’t go into labor beforehand).

Epidural

The data on how epidurals affect breastfeeding is mixed and we can’t draw strong conclusions. That being said, there are definitely some concerns.

Researchers think the medications can affect a newborn’s ability to suck and latch onto the breast, with studies linking latch issues and epidurals.
The medications can also cause moms to develop a fever during labor. Fevers are linked to lower Apgar scores in the newborn, and potentially more health problems that could make breastfeeding harder for them.

Like mentioned earlier, medications can also interfere with a mom’s hormones like oxytocin which can make the birth more difficult, and affect milk letdown and supply.
The medications may affect the newborn’s alertness and muscle control.
They can make labor longer, possibly leading to the mom being too exhausted to start breastfeeding.
Epidurals are linked to higher rates of vacuum and forceps delivery (the effects of which are listed under the assisted vaginal birth section above).
More IV fluids are given with an epidural to help with the side effect of low blood pressure. A lot of IV fluids during labor can cause engorgement, painful breast swelling after delivery, or edema, which is a more severe version of it.

The possible effects from pain medication also differ from each other based on type and dose. For example, this study found that participants who were given a higher dose of fentanyl had a harder time with breastfeeding, and were more likely to stop breastfeeding at six weeks compared to the other groups who just got a numbing agent or a smaller fentanyl dose. The babies from that group also had lower neurobehavior scores on average. But this study was small and limited, so a lot more research is needed.

Also, being in too much pain can be traumatizing for a mom and lead to worse health outcomes overall.

Newborn care practices

What happens in the first hour and day after delivery is very important for breastfeeding. These newborn care practices can affect the likelihood of success.

Separating babies from their mothers for evaluation and bathing during the minutes and hours after birth.
Delaying starting breastfeeding in the first hour.
Suctioning may cause a negative reaction where the newborn keeps their mouth shut, making a latch all but impossible.
Overstimulation by exams, tests, or procedures may cause the newborn to shut down or become too sleepy to nurse.
Tight swaddling.

Maternal care practices

Some common practices in modern labor and delivery can affect a mom’s motivation and capacity to breastfeed. Things that will undermine her confidence or make her feel like she's not in control can have a big effect on how the birth and breastfeeding goes.

Some of the maternal care practices that can indirectly affect breastfeeding are:

Letting her labor alone.
Not letting her be mobile which can increase pain and stress.
Making her stay in a specific labor position can prolong labor and lead to more intervention.
Withholding food or drink.
Intravenous fluids administered.

It’s very important women feel listened to and supported during the whole birthing process since extra stress can increase the chances of a traumatic birth. It’s especially important for healthcare workers to give clear, medical reasons if any of the care practices above are needed.

Interestingly, this study suggests that a mom’s perception of how the birth went may affect breastfeeding beyond what practices or interventions were used. So if a mom reported feeling satisfied with the care she received, that was associated with better breastfeeding outcomes.

There are a lot of strong opinions out there on the best birthing practices. But care should always come down to what you and your healthcare team decide is best. Birth is unpredictable and while there are things you can be aware of or try to avoid to increase your chances of breastfeeding, don’t beat yourself up if delivery doesn’t go to plan. At the end of the day, you and your baby’s safety should be the top priority.

Sources:

https://www.sciencedirect.com/science/article/abs/pii/S1526952307002954

https://www.sciencedirect.com/science/article/pii/S0002937822025832

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235056/

https://www.sciencedirect.com/science/article/abs/pii/S0266613821001972?via%3Dihub

https://pubmed.ncbi.nlm.nih.gov/16306734/

https://pubmed.ncbi.nlm.nih.gov/27121239/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531382/

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-0876-1

https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-022-00492-7

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9597165/

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03137-x