The Effect of Epidurals and Synthetic Oxytocin on Breastfeeding
When someone makes the decision for pain management, they are told (or at least, they should be) what the risks are, how it works, and what the benefits will be. When someone is offered an induction, they should be told the same. But in those discussions, do they include the possible effects that analgesia and synthetic oxytocin in labour may have on breastfeeding? Probably not. So here I am to share a bit of information on it.
I’m all about informed consent, benefits and risks, and making the right decision for you. I’m not suggesting that everyone should have an unmedicated birth - there are many nuances around that. However, it’s not a small decision to choose an epidural, and perhaps not as casual as it is presented to be. (possibly the casual presentation comes from the high rate of epidurals in BC, with only an average of 16% of birthing parents choosing to birth unmedicated (Perinatal Services Statistics). Along with the risks to the birthing person themself, there is evidence to support that it may have an effect on the baby as well as breastfeeding.
In a recent study (Takahata 2023), mothers who chose to have epidural anaesthesia during labour were seen to have:
lower milk supply in the early postpartum period
lower breastfeeding rate at 4 months postpartum
The effect of epidurals on the reflexes of babies can be a factor in lower milk supply during early postpartum. According to Ransjo-Arvidson 2001, babies whose mothers have received epidural anaesthesia during labour are at risk of having:
lower sucking reflex
lower breast massage-like movement reflexes (this can help nipples become erect and make it easier for babies to latch)
higher temperature (possibly leading to management of temperature away from the mother instead of precious time skin to skin)
more prone to crying (possibly leading to less settled time to explore at the breast)
It is widely accepted that the use of an epidural in labour (especially if given earlier in labour) can slow down the frequency of contractions, leading to the likelihood of needing synthetic oxytocin. There is fairly new information to support that oxytocin can have a negative effect on babies, as it passes the blood/brain barrier. It can specifically affect their reflexes at birth, along with their suck/swallow/breathe patterns, which are vital to effective milk transfer. According to Zhou et al 2022, babies who have received medium or high doses of synthetic oxytocin in labour can show signs of:
delayed head raising and turning after birth
delayed movement to the breast
delayed locating of the areola
delayed licking of the nipple
suckling at the breast for less time
less breastfeeding sessions in the first 24h after birth
Previous studies have shown that synthetic oxytocin can reach the fetal brain through both the placental barrier and the fetal brain-blood barrier, which can interfere with the development of the fetal endogenous oxytocin system (their natural oxytocin), and can overall lead to changes in neonatal behaviour. (Davison, 1999).
We know that milk production is a supply-and-demand system, and so it stands to reason that delayed reflexes and responses in newborns after birth and in the first 24h of life can significantly impact milk supply (because of a less effective transfer of milk), which can lead to:
higher chances of supplementation, which in turn decreases milk supply if the breastfeeding parent isn’t pumping or hand expressing to encourage supply
lower rates of continuation of breastfeeding
higher rates of depression and anxiety in parents (Tucker, 2022) because of low milk supply
In mothers who have low milk supply and depression/anxiety, they can have higher cortisol levels, lower oxytocin levels, decreased amount of sleep, and less self efficacy, which overall can be a difficult space to be in when trying to learn how to feed a baby at the breast… and the cycle continues.
Regardless of the choices someone makes during their birth process, it is highly recommended across each of the studies I have seen to seek support in lactation especially if someone has had synthetic oxytocin or an epidural during labour.