August is the month dedicated to increasing awareness about the benefits of breastfeeding for mothers and babies and to making commitments to support, protect, and promote the best feeding option for infants. Breastfeeding provides optimal health, nutritional, immunologic and developmental benefits to newborns as well as protection from postpartum complications and future disease for mothers. In 1991 the World Health Organization and UNICEF introduced the WHO Baby-Friendly Hospital Initiative outlining Ten Steps for birth facilities and maternity care professionals to follow to ensure that mothers and babies get the best start after birth for initiating and continuing breastfeeding. Since then, evidence has been mounting showing that the likelihood of initiating and continuing breastfeeding is determined even before the baby is born.
In 2003 the WHO and UNICEF established that birth practices impact breastfeeding. New guidelines recommended that to maximize the establishment of successful breastfeeding, women in labor regardless of birth setting, should have access to the following birth care practices:
- Care by staff trained in non-drug methods of pain relief and who do not promote the use of analgesic or anesthetic drugs unless required by a medical condition;
- Care that minimizes routine practices and procedures that are not supported by scientific evidence including withholding nourishment, early rupture of membranes, use of IVs, routine electronic fetal monitoring, episiotomy and instrumental delivery; and
- Care that minimizes invasive procedures such as unnecessary acceleration or induction of labor and medically unnecessary cesarean sections.
Minimizing the use of drugs and interventions reduces the odds for complications including infection, increased pain, stalled labor and abnormal fetal heart tones. Recommendations also emphasized that care givers should respect women’s choices:
- Care should be sensitive and responsive to the specific beliefs, values, and customs of the mother’s culture, ethnicity and religion;
- Women should have access to birth companions of their choice who provide emotional and physical support throughout labor and delivery;
- Women should have the freedom to walk,move about, and assume the positions of their choice during labor.
Supporting women in labor with this model of care is more likely to lead to an uncomplicated vaginal birth.
In 2009 the Centers for Disease Control published the CDC Guide to Breastfeeding Interventions, confirming that hospital birth practices have a significant impact on the initiation and continuation of breastfeeding. The report states that the use of medications during labor and cesarean birth have a negative effect on breastfeeding. So does the separation of mother and baby after birth and during the hospital stay.
The CDC found that a woman’s birth experience exerts a unique influence on both breastfeeding initiation and later infant feeding behavior. Although the hospital stay is typically very short, events during this time have a long and lasting impact. Medications and procedures administered to the mother during labor affect her infant’s behavior at the time of birth, which in turn affects her infant’s ability to suckle in an organized and effective manner at the breast.
Use of analgesics, epidural anesthesia and cesarean birth have a negative effect on breastfeeding, making it more difficult for mothers to initiate nursing and establish a successful breastfeeding pattern before leaving the hospital.
Babies are more likely to be breastfed and for a longer period of time if they have early skin-to-skin contact. With a cesarean babies are more likely to be taken to the nursery for observation and monitoring for potential problems during the first hour of life, the “golden hour” when breastfeeding is best initiated. Babie are also more likely to spend time in a newborn nursery than rooming in with their mothers. The separation seems to have an impact on the mother’s initial ability to respond to and care for her infant. When mothers and babies are together, skin-to-skin, babies cry less, it improves the mother’s perception of her infant, and enhances her confidence in her mothering skills.
Some hospitals like San Francisco General in California, a Baby-Friendly designated facility, have established pro-breastfeeding cesarean guidelines to increase the number of mothers who successfully initiate breastfeeding. Operating room policies now include routine skin-to-skin contact as soon as possible and within 90 minutes after a cesarean delivery. Babies who experience skin-to-skin in the operating room are better able to latch on to the breast and less likely to receive formula before discharge.
Birth practices for labor, birth, and postpartum can facilitate or hinder the initiation, establishment, and continuation of breastfeeding. According to a CDC report many birth facilities have policies and practices that are not evidence-based and are known to interfere with breastfeeding. Maternity care providers have an obligation to care for women and newborns in a way that provides both with the best possible health outcomes.
UNICEF-U.K. , Care Pathways for Breastfeeding
U.S. Surgeon General’s Call To Action to Support Breastfeeding
CIMS, Breastfeeding Is Priceless. A Coalition for Improving Maternity Services Fact Sheet