Inductions & Labor Medications
Labor induction may result in increased desire for an epidural, longer duration of labor, and increased risk of c-section.
- Epidurals are associated with elevated maternal temperature and may result in a potential risk of complications to the newborn. This concern may result in a septic work-up for the newborn which typically interrupts skin-to-skin and delays the initial breastfeeding.
- Longer labor is associated with higher stress hormones, maternal exhaustion and less likelihood of initiating and maintaining breastfeeding.
- Long labor, urgent c-section, and physical and emotional stressors are all related to delayed lactogenesis.
- C-sections increase maternal pain and bleeding which negatively impact breastfeeding.
It is not uncommon for a patient undergoing an induction of labor to have intravenous (IV) access. Maternal fluid increase from IV fluid in labor/delivery has been associated with fetal volume expansion. For the newborn, this results in greater fluid loss after birth and this may be perceived as excessive weight loss during the hospital stay. Excess weight loss is common in breastfed newborns and is associated with delayed lactogenesis and suboptimal breastfeeding behaviors.
Supplemental feedings of breastmilk substitutes are often administered in response to newborn weight loss, despite breastmilk recommendations from the American Academy of Pediatrics.5, 26, 27
The evidence is mixed as to whether labor induction via IV administration of oxytocin suppresses endogenous oxytocin associated with breastfeeding outcomes.47
Labor Pain Medications
The sucking reflex of a healthy, term newborn delivered without the use of narcotics or anesthesia typically peaks around 30 minutes after birth. This is the optimal time to begin breastfeeding. Medication for pain relief, including anesthesia, may interfere with breastfeeding for the following reasons:
- Newborn and mother may be sleepy
- Newborn’s ability to suck, swallow and breathe may be disorganized
- The newborn's rooting and sucking reflex may be depressed
Meperidine is not recommended as a pain medication during labor. Use during labor can interfere with breastfeeding and may cause sedation in the newborn.28
The serum half-life of nitrous oxide is short and nitrous oxide is not expected to be absorbed by the infant. There are no contraindications of nitrous oxide to breastfeeding.
Butorphanol has poor oral absorption so it is unlikely to interfere with the breastfeeding infant. However, there may be concern with high, repeated doses of intravenous or intranasal doses of Butorphanol during breastfeeding so other alternatives should be considered.
There is inconsistent evidence regarding whether or not epidurals interfere with breastfeeding. However, the side effects of having an epidural may have an impact on success:
IV Fluids are administered prior to the epidural and are infused throughout the duration of the epidural. This may result in overhydration. Excess fluid creates several breastfeeding challenges:
- Engorged breasts
- Difficulty with latch
- The excess fluid may show up in the newborn, resulting in an exaggerated weight loss in the initial postpartum period