Thursday, November 12, 2015

Breastfeeding, Pitocin and Epidurals; a new look

Did you know there are predictable stages babies move through during the first hour after birth? First they rest. This is soon followed by searching for the voice they have been listening to in the womb. As soon as they have identified her voice, from among a myriad of new sounds, they are driven to raise their faces and gaze into their mother’s eyes attaching the familiar voice to the unfamiliar face as they begin bonding outside of the womb. Once satisfied, they move on to innate behaviors meant for finding their food source and receiving immune boosting, brain stimulating colostrum. By pushing with their feet and knees on mom’s tummy they wriggle and squiggle their trunks up to find the swell of her breasts. They head bob or bump on mother’s chest breathing in her smell. Their eyes search for the bull’s eye of her darkened areola. Then they open their mouths or push out their tongues getting ready to taste. They explore her nipple with their hands; squeezing it in their tiny grasp. Giving themselves tactile information. Then they move their fist to their mouth, sucking the flavor of mother off their hands, and filling their intestinal tract with the good bacteria they need to promote internal health. Finally they latch on and taste the colostrum. After several uncertain tastes they get down to business and suck deeply; flooding their bodies with oxytocin; the love and bonding hormone.

These behaviors are repeated whenever a baby is born. Not just a human baby but every mammal baby has a repeatable, quantifiable process. What happens to this process when a mother is given an epidural or Pitocin during labor and should we care? Ethnographic Researcher, Dr. Brimdyr, PhD, CLC, and her team of obstetricians, lactation consultants, nurses, midwives and anesthesiologists wanted to find out. In their newly published study they divided sixty-three low risk mother/baby dyads into two groups; medicated and un-medicated. All the pairs were filmed during the first hour of life. Then the team of researchers did what ethnographers do; they studied the pairs to watch for clues. Ethnographers observe and analyze “symbols” that their target users use. In this case the predictable innate behaviors which initiate bonding and breastfeeding in human babies; a basic survival skill.

So what did they find out? Both IV Pitocin, the most used labor induction or augmentation drug, and Fentanyl, a drug in the typical epidural, significantly impact a baby’s abilities to move successfully through the normal first hour of life behaviors. The amount of medication and the length of time the mother was receiving these drugs were also found to be significant. The more mothers had, the longer they were on them, the greater the impact on the babies’ abilities. The worst case was the typical 2015 birth scenario in U.S. hospitals, long Pitocin induced labors with an epidural for pain management over an extended period. This study shows a direct correlation; a direct impact on skills considered basic survival behaviors.
These mothers were given fentanyl via an epidural which we have been told for many years doesn't reach the baby. Still we can see a correlation between amount fentanyl and poor survival efforts by the babies. 
In my observation as a doula I believe those caring for and about the new baby; mom, nurses, midwives and doulas, also have an internal innate clock ticking from the moment of birth which further complicates matters. I have certainly felt it inside myself. Our intuitive senses are telling us if the baby is struggling to complete the tasks on the normal timeline. Unfortunately what happens next is very damaging to the programming process. Babies who are “helped” through assertive positioning, holding of heads, and nipples being pushed into their mouths, or faces being shoved onto breasts, are not only unable to complete the correct programming but have an incorrect program laid down in their systems. This often takes many tech support trips to a lactation consultant to uninstall.  Meanwhile mothers are in their homes spending many weary hours pumping while quietly shedding lots of tears. They incorrectly assume they are the ones to blame; there must be something wrong with them. It takes a very strong mother not to give up on breastfeeding. Not just for this baby but for any future siblings as well.

So should this be a cause for concern? We know these stages lay down the initial programming for successful breastfeeding. Other studies have observed a connection between moving through these steps in an hour and ultimately being a successful breastfeeding mother/baby dyad for at least 6 months. Exclusive breastmilk for the first 6 months is recognized by the World Health Organization and the American Pediatric Association as providing the best start for babies’ bodies and brains. Studies have now shown that even just one bottle of artificial human milk can alter the microbes reproducing in an infant’s gut. Cutting edge research is showing us our intestinal flora balance is tied to many diseases. Further consider other ways we may be inadvertently installing wrong programs in our children. We know babies are flooded with hormones as they leave the womb. One of these is adrenalin; fueling their drive to survive. It creates a hyper-alert state where sensory information of all kinds is heightened. This is initially needed but adrenalin is very draining to our systems. The system is designed to down regulate within an hour. Oxytocin and endorphins, the hormonal antidote to adrenalin, are released during suckling changing their body and brain chemistry. So what happens to an infant’s brain when it continues to be bathed in fear flight hormones beyond an hour? What happens when our babies’ bodies are wired to assume this level of adrenalin should be their baseline? What programs could we be installing for life?

Although this study was small the results are important and point in the direction for a much larger study to be done and a review of the true risk of these drugs to babies. For many years I have heard doctors, nurse midwives, labor nurses and anesthesiologists telling mothers there is very little risk to their babies. The only risk they perceive is in the here and now. Their responsibility for this new life ends soon after birth. Their risk assessment is grounded in a fear of doing nothing about other known risks, such as, going too long past the due date or a labor lasting too long. But when we consider the now known impacts to breastfeeding and breastfeeding’s impact to life-long health the true risk comes into clearer focus. Projected, possible risk, is like looking into a crystal ball. No one can know the true risk for any individual baby of either saying yes or no to Pitocin and or an epidural but at the very least mothers need to have good quality evidenced based information of the total picture to make their decisions.

"It is crucial for new parents to be aware of the risks of intrapartum drugs, and medical professionals have an ethical obligation to inform parents of such risks, especially when these drugs are so prevalent in Labor & Delivery. The implications of this study are huge."
Dr. Brimdyr, lead researcher

To see the study: