NAVIGATING THE MAZEPerinatal Exchange

The Birth of a Breastfeeding Baby

and Mother
Judith A. Lothian, PhD, RN, LCCE, FACCE
ABSTRACT
In this column, the author describes the way in which the normal, natural process of labor and birth pre-
pares both mother and baby for breastfeeding. Birth practices including induced labor, routine interven-
tions, epidural analgesia, and separation of mother and baby disrupt the process of early breastfeeding for
mother and baby. Normal, natural birth sets the stage for uncomplicated breastfeeding.
Journal of Perinatal Education, 14(1), 4245, doi: 10.1624/105812405X23667
Keywords: breastfeeding, normal birth, childbirth education, breastfeeding preparation
READERS QUESTION
I wouldlike todomore topromote, protect, andsup-
port breastfeedinginmychildbirthclasses. I teachthe
benets of breastfeeding, the risks of not breastfeed-
ing, andtechniques for positioning, facilitating anef-
fective latch, and determining whether the baby is
getting enough milk. What else should I be doing
to prepare women for breastfeeding?
COLUMNISTS REPLY
Breastfeeding is an integral part of the childbirth
education curriculum. Childbirth classes should in-
clude discussion of the benets of breastfeeding for
mother and baby, the hazards of not breastfeeding,
and some how-to information. Many childbirth
educators encourage women to attend a breastfeed-
ing class and to talk with breastfeeding mothers.
Surprisingly, though, childbirth educators do not
always discuss the relationship between the birth it-
self and the early days of breastfeeding. We are just
beginning to understand and appreciate how wom-
ens bodies prepare for breastfeeding during preg-
nancy, how what happens during labor and birth
sets the stage for breastfeeding, and how the rst
minutes and hours after birth affect breastfeeding.
The way the birth proceeds powerfully inuences
the rst hours and days of breastfeeding. Normal,
natural birth sets the stage for problem-free breast-
feedingwhat nature intendedwhile a compli-
cated, intervention-intensive labor and birth set
the stage for problems.
Natures Perfect Breastfeeding Preparation
From the start of pregnancy, the preparation for
breastfeeding begins. The breasts enlarge, the areolas
darken, and the nipples become more erect. By the
fourth month, colostrumis produced. Milk produc-
tion and milk let-down will wait for the hormone
changes that come with labor, birth, and the delivery
of the placenta. The process is so well planned that, if
the baby is born prematurely, the milk the mother
produces is higher in fat in order to meet the babys
42 The Journal of Perinatal Education | Winter 2005, Volume 14, Number 1
special nutritional needs. Nature perfectly prepares
the mothers body for breastfeeding.
Nature also perfectly prepares the baby for breast-
feeding. The baby is borncompetent andcapable and
ready to breastfeed. He instinctively roots and sucks.
When placed skin-to-skin on his mothers chest, he
instinctively crawls and self-attaches to her breast,
in just the right way. He sees and smells, and these
senses help guide him to the breast. When held in
his mothers arms or placed skin-to-skin, he instinc-
tively throws back his head and opens his mouth
widethe perfect positioning for an effective latch.
Babies are born ready and eager to breastfeed.
Hormonal Inuences
The hormonal orchestration of labor and birth sets
the stage in a more immediate way for the process
of breastfeeding for both the mother and her baby.
During labor, surging levels of oxytocin are respon-
sible for increasingly strong and effective contrac-
tions. With rising levels of oxytocin and the
increasing pain that accompanies the strong con-
tractions, endorphins are released. High levels of
endorphins help women cope with painful contrac-
tions and contribute to their becoming more in-
stinctive and entering into an almost dream-like
state. As the baby moves down the birth canal,
very close to the actual birth, catecholamines are re-
leased. The surge in catecholamines creates an en-
ergy boost for the mother. Additionally, the baby
is born with high levels of catecholamines (Newton,
1987; Odent, 2003). The result is a bright, alert baby
and an energized mother ready to greet him.
Right after birth, these same hormones continue
to work their magic. When placed skin-to-skin on
his mother, the babys weight on her uterus, his
hand and head movements, and then his sucking
at the breast stimulate oxytocin release (Matthiesen,
Ransjo-Arvidson, Nissen, & Uvnas-Moberg, 2001).
Oxytocin facilitates the separation of the placenta
andkeeps the uterus contracted, preventingexcessive
bleeding. After birth, high levels of catecholamine in
the baby insure he is alert. High levels of endorphins
in the mother pass on to the baby in her breast milk.
Endorphins help make the transition easier for the
baby, facilitating relaxation and calm.
Prolactin and oxytocin are released in response
to stimulation by the babys sucking at the breast.
Prolactin is responsible for milk production, and
oxytocin for milk letdown. However, these hor-
mones are benecial in other ways. Prolactin is
sometimes called the love hormone. In animals,
it is responsible for mothering behaviors. Oxytocin
is responsible for the relaxed, sometimes sleepy,
calm feelings that accompany milk letdown. To-
gether, these two hormones keep mothers relaxed,
calm, and ready to care for their babies (Uvnas-
Moberg, 2003). In a very real sense, the birth of
a baby is also the birth of a motherthe birth of
a breastfeeding baby and mother.
Interference from Routine Interventions
Events surrounding the birth can sabotage natures
plan. Many of the birthing practices that are consid-
ered almost routine (induction, epidurals, separa-
tion of the mother and her baby) interfere in
powerful ways withthe hormonal orchestrationof la-
bor and birth and, ultimately, with breastfeeding.
The best way to insure that both the mother and
her baby are ready for birth is to allow labor to start
on its own. A baby that is even a little early is more
likely to have difculty with breastfeeding. Pitocin,
unlike naturally occurring oxytocin, does not cross
the blood/brain barrier. As a result, the pituitary is
not stimulated to release endorphins. Without the
pain-relieving help of abundant endorphins, women
who are induced with pitocin are more likely to re-
quire epidurals. Whenever an epidural is given and
all painis removed, naturally occurring oxytocinlev-
els drop, requiring increasing amounts of pitocin
(Lieberman & ODonoghue, 2002). Without high
levels of oxytocin and endorphins, a surge in cate-
cholamines does not occur as the birth becomes
imminent. The disruption of the hormonal orches-
tration of labor results in women giving birth with
relatively low levels of naturally occurring oxytocin,
endorphins, and catecholamines. Consequently, the
outcome of low hormonal levels is a less responsive
mother and baby (Odent, 2003).
The medication used in the epidural does, in
fact, get to the baby. We are just beginning to un-
derstand the neurobehavioral effects of this medica-
tion. It is not unusual for babies exposed to the
epidural to have difculty with latching on and
an uncoordinated suck/swallow response for hours
or days (Baumgarder, Muehl, Fischer, & Pribbe-
now, 2003; Ransjo-Arvidson et al., 2001). Another
Normal, natural birth sets the stage for problem-free
breastfeedingwhat nature intendedwhile a complicated,
intervention-intensive labor and birth set the stage for problems.
Breastfeeding | Lothian 43
unintended outcome of epidural analgesia is an
increased risk of instrument birth (Lieberman
ODonoghue, 2002). The trauma to the baby can
make it painful for him to assume the natural, in-
stinctive positioning for breastfeeding and can con-
tribute to a difcult latch. A signicant wake-up call
to all childbirth educators is the nding that from
26 to 41% of the women responding to the Listening
to Mothers survey were unable to identify specic
side effects of epidurals (Declercq, Sakala, Corry,
Applebaum, & Risher, 2002).
Newborn care practices also affect breastfeeding.
Vigorous suctioning can create oral aversion as the
baby protects himself by keeping his mouth shut
(Kroeger & Smith, 2004). Overstimulating the
baby with multiple assessment examinations, suc-
tioning, weighing and measuring, heel sticks for
glucose checks, eye treatment, and injections can
cause the baby to shut down. The result is a sleepy
baby that is difcult, if not impossible, to nurse.
Routinely separating babies from their mothers
for evaluation and bathing during the minutes
and hours after birth disrupts the babys ability to
nd the breast and self-attach (Righard & Alade,
1990). Bathing possibly removes the smell of the
amniotic uid, a guide to nding the nipple. These
birthing practicesinduction, epidurals, instru-
ment delivery, routine newborn care, and separa-
tion of the mother and her babycreate many of
the problems we see in the early hours and days
of breastfeeding.
Promoting Normal Birth
The typical problems that plague early breast-
feedingdifcult latch, sore nipples, sleepy baby,
and engorgementare rare when the mother has
had a normal birth and has not been separated
from her baby. Keeping the mother and her baby
together, especially in the skin-to-skin position,
goes a long way toward solving problems that
may develop. When the baby stays with his mother,
who responds quickly to early infant feeding cues,
nursing her baby frequently around the clock, en-
gorgement does not occur. Remaining in close,
physical contact with his mother, the babys tem-
perature, heart rate, and respirations are more sta-
ble. Additionally, the baby nurses more frequently
and more effectively (Anderson, Moore, Hepworth,
& Bergman, 2003). The result is a good milk supply
and a thriving baby.
Getting breastfeeding off to the best possible
start means choosing normal birth and selecting
caregivers and places of birth that promote, protect,
and support normal birth. Introduce women in
your classes to the six care practices that promote,
protect, and support normal birth (Lamaze Interna-
tional, 2003, 2004). Encourage them to:
1. let labor start on its own,
2. move freely and nd comfort in a variety of
ways during labor,
3. plan for excellent labor support,
4. avoid routine interventions,
5. give birth in nonsupine positions, and
6. hold their babies in the skin-to-skin position
immediately after birth and remain with them
in the rst hours and days after birth.
Some labors and births require medical interven-
tion. Encourage the women in your classes to keep
birth as normal as possible if complications arise
and medical interventions are needed. If labor is
complicated (e.g., when labor is induced for medi-
cal reasons, an epidural is required, or the birth of
the baby requires the use of instruments), it be-
comes even more important for the baby to be
held in the skin-to-skin position after birth. If birth
has been difcult for the baby, advise the women in
your classes to expect the early days of breastfeeding
to be challenging for them and their baby. Healthy
doses of both patience and condence will be
needed.
The U.S. Department of Health and Human
Services and The Advertising Councils (2003) me-
dia campaign to increase breastfeeding adopted the
slogan, Babies were born to be breastfed. We
might add, Mothers are born to breastfeed. Per-
haps the most important way for childbirth educa-
tors to promote, protect, and support breastfeeding
is to continue their commitment to promoting,
protecting, and supporting normal birth. Help
the women in your classes to know that a normal
birth gets breastfeeding off to the best possible start.
RECOMMENDED READING
To learn more about the relationship between birth
and breastfeeding, read Impact of Birthing Practices
on Breastfeeding: Protecting the Mother and Baby
Getting breastfeeding off to the best possible start means choosing
normal birth and selecting caregivers and places of birth that
promote, protect, and support normal birth.
44 The Journal of Perinatal Education | Winter 2005, Volume 14, Number 1
Continuum, by Mary Kroeger and Linda J. Smith
(Jones and Bartlett, 2004). This book is available
at the Lamaze International Bookstore and Media
Center (call toll free at 877-952-6293 or order on-
line at www.lamaze.org).
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Anderson, G., Moore, E., Hepworth, J., & Bergman, N.
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Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., &
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New York: Maternity Center Association. Also, re-
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Kroeger, M., & Smith, L. J. (2004). Impact of birthing
practices on breastfeeding: Protecting the mother and
baby continuum. Sudbury, MA: Jones and Bartlett
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Matthiesen, A. S., Ransjo-Arvidson, A. B., Nissen, E., &
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JUDITH LOTHIAN is a childbirth educator in Brooklyn, New
York, and a member of Lamaze International Board of Directors.
She is also an associate professor in the College of Nursing at
Seton Hall University in South Orange, New Jersey.
Breastfeeding | Lothian 45