Expectant moms have more labor choices than ever before. Labor induction is common after 39 weeks, and sometimes sooner if there is a medical reason. At this point in time, over 60% of new mothers choose to have an epidural for pain control. An online search will yield a wide range of opinions about the safety and effectiveness of medications for induction of labor and pain management. Many of these opinions are based on research, but are often conflicting. It can be difficult to sort out which options offer the best fit for you and your baby.
At one extreme, some natural childbirth proponents say any intervention can put both mother and baby at risk. In reality, intervention does not always go as planned and can lead to more intervention. At the opposite end, advocates of medicalized birth would prefer to schedule deliveries and experience no discomfort.
The American College of Obstetricians and Gynecologists issues practice guidelines for all things related to labor and delivery. For labor induction information, click here.
For the ACOG fact sheet on pain management options during labor and delivery, click here.
As any expectant mother knows, baby gets what mom gets in many cases. There is a lot of speculation about the impact on baby for both labor induction and pain management during labor. As already mentioned, opinions go from one end of the spectrum to the other. At one time, there was even a question if labor induction could cause autism. This has been disproven.
As a lactation consultant and registered nurse, I believe strongly in every new mother’s right to choose what is best for her and her baby, knowing every situation is unique. Parents often ask me to help them find the information they need to make the best decision possible.
Early breastfeeding, within the first hour after birth, plays a critical role in breastfeeding success. This is the biological norm for human babies and their mothers. Labor choices can have a significant impact on early breastfeeding.
Here are some things we know:
- Labor induction can be related to a delay in milk “coming in”.
Induced labor is often longer than naturally occurring labor, which can increase fatigue and stress. Over-hydration from IV fluids can cause fluid retention, breast swelling and difficulty with latch. Ineffective milk removal can result in a delay in the increase in milk production that normally occurs at 30-40 hours after delivery.
The risk of cesarean is higher with induced labor. The physical stress of a cesarean, results of prolonged IV fluids, and potential for mother-infant separation and delayed breastfeeding can all contribute to a delay in increased milk production.
The baby can absorb extra fluids, leading to a greater than normal weight loss. If the excess weight loss is from extra fluid, this is really not a problem for the baby. However, supplementation may be recommended because greater than normal weight loss is often an indication of poor feeding. Unnecessary supplementation can jeopardize breastfeeding success.
- Pain medications can cause a delay the baby’s ability to breastfeed.
Pain medications that are given as an injection or through your IV can have a sedating effect on you and the baby, and can make it difficult for the nurses who are monitoring the baby to know if the baby’s change in activity and heart rate are the result of medications or a problem.
Epidural pain medication does affect the baby. The longer a mom has an epidural, the greater the chance her baby will experience side effects like difficulty coordinating feeding behaviors and sedation. Fentanyl, a drug often used in epidurals, has a half-life of 13 hours. Babies may be sleepy or have difficulty feeding for the first 24 hours of life or longer. Once delivery has occurred, the amount of medication your baby will receive through breastfeeding is much lower than medication that is received prior to birth.
- Pain medications can make it more difficult for a new mother to respond to her baby at birth.
Side effects of an epidural can include numbness and weakness for several hours. This temporary challenge can make it difficult to comfortably position yourself and the baby for breastfeeding. Less commonly a mother will have back pain for several days, or a spinal headache. Fluid retention can last for two weeks or more. In speaking with mothers who have had both medicated and unmedicated labors, overwhelmingly they say their recovery was much faster from the unmedicated labor.
Write Your Birth Plan
Pain management is a very personal decision. Not everyone wants the same kind of labor or has the same expectations for labor support. Communicating your wishes early to your healthcare team can help them to support you throughout your labor, especially during times when you may have difficulty making decisions. For a customizable birth plan, click here.
Becoming well informed about your choices and the potential for impact on early breastfeeding will help you to decide what is best for you and your baby. Knowing what to expect in the first few hours following birth allows you to recognize potential problems and take appropriate action.
Some babies breastfeed well at delivery, but have difficulty with later feedings. Babies are often sleepy on the first day. If your newborn does not breastfeed well on the first day, your midwife, doula or labor nurse may encourage you to hand express or pump your milk and spoon feed your baby until breastfeeding becomes frequent and effective. You may be advised to visit a lactation consultant for follow-up breastfeeding support after you are discharged.
Learning to breastfeeding takes time, so be patient with yourself and your baby. Take advantage of all of the support that is available to you to get breastfeeding off to the best start. Use the first few weeks at home with your baby to enjoy getting to know the new little person in your life and allow time for your body to recover. The first 2 weeks of breastfeeding are the most challenging, but it’s all uphill from there!