How do drugs administered during labour affect bf?

[alexpolismum]

I have been wondering about this issue a lot recently.

Going on my own experience, I have given birth twice, and they were very different experiences.

The first was a horrendous 13-hour stretch with lots of pain relief, followed by a real struggle to get breastfeeding going.

The second was fantastic. No pain relief, because it all happened so quickly (not because I didn't want any!), all over in 2 hours (much to the midwife's surprise!), followed by an easy start to breastfeeding. I did have some difficulties later on with bf, but that was several weeks later, unrelated to the birth.

The thing is, I'm not sure whether the 1st time it was more to do with my own inexperience, general exhaustion and the lack of support that affected bf, or whether pain relief also played a part.

I think the reason they can affect bf getting off to a good start is that we have evolved over centuries to give birth without medication and put the baby to the breast immediately - ie this is how it would work "in the wild" and so all our hormones, body chemistry etc (and the baby's instincts and hormones) is set up for that situation.

So if you have had pain relief which has made the baby sleepy for example they may not be reacting as well as they could do to the stimulus of being put to the breast. Equally if the mother's hormones are out of balance due to a stressful birth or if the mother and baby are not allowed that skin to skin cuddle within the first few minutes.

This is just a vague notion though based on what I have heard, so it may be all wrong, but it does make sense. It's also not to say that unless you have a "perfect" natural birth and skin to skin immediately that breastfeeding is going to go horribly wrong, it's just that is most likely the very best setting for it to begin.

just an anecdote really but when i had ds, i had no drigs during labour (similar situation to you - not because i didn't want any). ANyay he was bloomin' feeding all through the night, when the midwife checked onme about 4am to ask if he'd fed i said bloody hell yes - every half hour, she asked what pain relief i'd had and i said only gas an air and she knowingly smiled and said that explains it then! now that's something you don't get told in antenatal classes!

however saying that i had dimorphine with dd and she fed very easily and quite a lot through the first night (but nothing like as much as ds). i guess it depends how long before the birth you have the drugs - which of course you won't be able to plan!

I had pethidine and an epidural with ds, and then went straight up to surgery for 90 minutes so couldn't have skin-to-skin immediately. Initial feeding was a nightmare because he was too sleepy and just dropped off after a couple of gulps.

Gas and air with number two (same reasons as everyone here!) and she took a full feed immediately.

No difference after a few days, though.

I had similar experience to DreamsInBinary. I had pethadine and epidural and my ds was very sleepy (as was I) after a long and traumatic birth.

He did not take to the breast straight away. We both slept through the first night and the midwives told me off for not waking him up for a feed-as a new mum I had no idea that I should have!
Anyway, I personally feel that the pethadine definitely affected us getting off to a good start with bf.

I am 37 wks pg with dc2 and will certainly not be having pethadine or similar during labour.

Good luck TOK

I think that pethadine affected my first. I really struggled to establish a good supply as he was so sleepy the first few days (mw said not to wake to feed so I didn't). I also passed out for 6 hours straight after the birth so didn't feed straight away. I gave up after 8 weeks of struggling.

But I also had an epidural and pethadine for dd and she crawled up me and latched on straight away. I still found it hard to bf her without pillows etc and although it was easier than the first time I still struggled.

Third time round i had an emcs. Ds was very sick, in scbu, didn't even see him for over 24 hours so no skin to skin. He was on loads of drugs, oxygen and a blood transfusion. He wasn't fed at all for 2 days and then he was tube fed ebm starting at 1ml an hour. He was given a dummy. I didn't even try to feed him myself for 5 days but he latched on straight away and is really good at it. I have turned into one of those women I used to envy who can sit and feed in a cafe whilst eating and feed walking about. The odds were very much against bf but he wa the easiest of the lot.

I can't help feeling that there is a certain level of circularity to the arguments - i.e. if you end up having lots of drugs it is usually because you have a very long and difficult labour. If you have a long and difficult labour there is a high chance that you are exhausted and the baby may have been in distress, so is it the drugs that then make bf harder to establish or the fact that you and the baby are exhausted and destroyed and need a bit of recovery time before everything can get going? I don't know.

With my first I was in labour for over 30 hours. It was ghastly. Despite having hoped for a fairly intervention free birth I ended up with every drug going and was pleading for more (3 shots of pethadine over a 12 hour period, gas and air and an epidural), and finally ended up having a section. DD1 was in distress, her blood gasses were low, heart stopping, passed merconium etc. I didn't hold her while I was stitched up (DH did), but as soon as I was in the recovery ward the midwives immediately helped me to hold her skin to skin and positioned her to start sucking, which she did very successfully. I think that after that initial feed we did then have a period of 6 hours or so when we both slept, but I think we both needed that recovery time. After that I never looked back with bf and had no problems.

DD2 and DS were both born by elective sections and both were tucked skin to skin inside my gown as soon as they were born and I was being stitched up. They both fed straight off in the recovery ward and continued to do so easily. Undoubtably it was an easier process with DD2 and DS, but then we weren't exhausted by a long and distressing labour. I also think that 2nd and 3rd time around bf is much easier as it is a familiar process and you know what you are doing.

I would never advise someone not to take the drugs in order to make bf easier. I think if you are unlucky enough to have a totally horrendous labour which merits the use of drugs you are likely to be in a much worse state if you haven't had the drugs.

Nelly, you are right that a long and distressing labour can affect the baby as well as drugs, but we do know the physiological impact of pethidine and similar drugs, and we do know this explains the effect on the baby's normal feeding behaviour - pethidine metabolises in the baby into another substance which damps down the baby's normal alertness and this can majorly reduce the impulse to feed and the instinctive behaviours that support feeding. This can take 3 days or more to overcome.

This is why skin to skin is even more important for these babies - mothers have to be pro-active in helping them to feed.

Telling mothers not to wake the baby is very poor care.

Innat - do you mean to say your antenatal class really didn't cover the effects of birth meds on the baby's feeding?! I find that astonishing. He wasn't feeding a lot because you'd had gas 'n' air - he would be unaffected by gas 'n' air (which passes in and then out of the bloodstream very easily with no build up) but he was feeding normally because you had had no opiate-type drugs.

Of course pain relief in labour should be available to all who need it, but it should always be known that it will affect the baby, sometimes for days.

i had pethadine then an emergency c section with ds- he fed in recovery and for the rest of the day- latched on fine!

Had planned section with dd and again fed well in recovey and the rest of the day!

Forgot to add: timing of the pethedine dose is important. If it's given long enough before the baby is actually born, its effects will be minimised. It's doses closer to the end of labour that cause the problems.

tiktok what you've said is what i was trying to say that ds was feeding normally because i hadn't had opiate-type drugs with him whereas i did with dd.

our antenatal classes did warn us that the drugs would make the baby sleepy. i was just unprepared as i'd thought dd had fed a lot after she was born but in hindsight that was nothing compared ds who fed every hour. although dd did do that tummy crawling thing and latched herself on which was totally amazing at which point the midwife said "stop i haven't weighed her yet!"

OK, Innat, I get ya

Bit at a midwife who would muscle in on a lovely intimate moment with the baby helping himself just to weigh him.....but that's what the world is like. Clearly, it was not a major set back

I certainly noticed a difference with DS1 (epidural, ventouse) who didn't feed for 2-3days (I didn't realised that he wasn't bf when I put him on the breast, I realised when he finally DID latch on - ouch!).

With DS2 I had some kind of morphine early on but then when it ran out, that was it and they wouldn't give me any more for at least an hour before he was born.

He came out struggling and wailing and latched on v. well and fed loads straight away.

"the midwife said "stop i haven't weighed her yet!"
She could whistle for her ! Why on earth the sudden need to weigh and measure ?