Utjecaj poroda na dojenje
Vrlo zanimljiv tekst o porodnim praksama i kako utječu na dojenje
www.llli.org/docs/lad/ChildbirthandBreastfeeding.rtf
CHILDBIRTH
How childbirth can affect breastfeeding
Ideally, childbirth goes according to plan and the baby is delivered naturally, in a safe, relaxed environment celebrating the positive power of normal childbirth. Breastfeeding begins as a natural progression from the satisfying calm after the birth.
For many mothers, the experience can be very different: the labor and delivery may be long and painful or surprisingly short; mother and/or baby may be affected by medication administered during the birth; the baby may be whisked away for special care, or the mother may have surgery or some other intervention. These and many other factors can all impact the start of breastfeeding.
LLL believes that a mother's active participation in childbirth can influence what happens during birth and afterwards. A critical point from this concept is that our focus on childbirth is in relation to breastfeeding. We know that when a mother is awake, aware, and actively involved she is better able to avoid procedures or interferences that can compromise the initiation of breastfeeding. It is important to recognize that “alert and active” does not refer just to an “ideal” birth experience:
- Women can learn about birth options and getting breastfeeding off to a good start during pregnancy by taking childbirth classes and attending LLL meetings.
- Mothers can be actively involved in making decisions before and during labor and delivery.
- Mothers can remain alert through most medical procedures.
- Challenges during the birth can make some mothers especially determined to breastfeed their babies.
- With support and information, a mother can get off to a good start with breastfeeding, even if her delivery experience was not what she would have wished for.
Although some medical procedures may be performed routinely, and perhaps at times unnecessarily, at other times medical intervention can be lifesaving. When a mother understands more about the physiology of natural childbirth and early breastfeeding, she has more knowledge of what to do to minimize the effects of any interventions.
Mothers make the best decisions they can with the information and medical advice available to them. Sometimes, after having a baby, they may think of or learn of other alternatives and wish they had made different decisions. Our role as Leaders is to help a mother make sense of her birthing and breastfeeding experience, which may influence her choices when she has her next baby.
If a mother shares with us that she is unhappy with her birth experience, we cannot assume it was avoidable. We help mothers see how they can make breastfeeding work even after a cesarean birth, a medicated birth, an induced birth. This focus is important because we want to help mothers move from any feelings of regret, disappointment, or guilt to the positive feelings that come from bonding with their babies and having confidence that they can breastfeed and meet their babies’ needs. Your support through active listening can help a mother to move from her childbirth experience to making decisions about her present breastfeeding situation.
Remember that a mother may need time to deal with grief over a birth experience that was different from what she expected. If you think that a woman needs more support than you are able to give, or if the type of support she needs is outside your ability, you can refer her to others in your community, such as health care providers, other professionals, or support agencies/organizations.
Alert, active participation in the birth experience
The list below shows some of the options that may help mothers to experience alert, active participation in birth. An expectant mother can:
- Seek information (such as through childbirth classes, reading on her own, or by watching DVDs or videos showing active birth and exercises) that will help her learn about birth and ways to relax and be engaged and involved throughout her labor.
- Learn about different birth attendants (e.g., obstetrician or midwife) and how their childbirth philosophy may impact the birth experience. For example, a midwife might use more of a woman-centered approach to birth, while an obstetrician may be more medically oriented. However, some midwives may be more geared to medical birth, and many obstetricians believe in natural birth.
- Get to know her health care provider and ask questions so that she understands her provider’s approach to childbirth.
- Consider her options for birthing in a place where she will feel safe and relaxed, whether at home, in a birth center, or in a hospital.
- Learn if there is a local facility that has earned the designation of UNICEF Baby Friendly Hospital.
- Find out, when planning a birth center or hospital birth, about their policies regarding breastfeeding.
- Verify if there are any routine labor and delivery procedures, such as an enema or fetal monitoring, in her chosen place of delivery.
- Learn about specific medical interventions possible during birth and their potential impact on breastfeeding.
- Plan, when opting for a home birth, what her options are if there arises an emergency situation that necessitates moving to a hospital.
- Make a birth plan well before the birth and discuss it with her birth partner and health care providers.
- Consider employing a birth attendant (doula) to support her during the birth and in the early days with her baby.
- Build a support network of LLL Leaders and mothers in the Group.
A mother's childbirth experience may affect the start of breastfeeding and the early days with her baby. For example, a difficult labor or medications used during a cesarean birth may make the baby sleepy for several days or decrease the effectiveness of the baby's suck. A premature delivery is likely to affect every aspect of the baby's behavior and care. During labor, procedures such as an enema or routine fasting can affect a mother's self-confidence and well-being. There may occasionally be a good reason for these procedures; mothers can ask for information to help determine if a procedure is necessary. A mother’s partner, friend, or relative who will be at the birth can be an advocate for her wishes.
INTERVENTIONS AND MEDICATIONS
The effect of interventions on the birth experience
This section discusses possible interventions that can ultimately affect the start of breastfeeding. Make use of The Womanly Art of Breastfeeding, The Breastfeeding Answer Book (if available), LLL pamphlets and other publications in your Group Library to learn more about how birth experiences affect the start of breastfeeding.
Often childbirth interventions can have a cascading effect: a seemingly small initial intervention can have consequences that may lead to more interventions. Even something that seems innocuous, such as inactivity during labor or being confined to bed, can interfere with the normal progress of childbirth and trigger a series of interventions. The list of procedures in the section “Induction” demonstrates some of the ways in which one intervention can lead to another.
However, Leaders need to be sensitive to the needs and feelings of mothers requesting support. Information about interventions and their effect on birth and breastfeeding can help us understand a mother’s situation and determine how to help her. This information may not be helpful to share with a mother, though, and could make her feel judged or criticized for her birth choices. It may be appropriate to indicate that more information is available if a mother wishes it; too much information at once may be alarming and create anxiety.
We encourage mothers to avoid unnecessary intervention, and, at the same time, we acknowledge that there may be valid medical reasons for specific procedures. In some situations, it can help a mother to know what she might expect if labor is induced, if she has a medicated or cesarean delivery, and to understand the possible consequences that can impact breastfeeding. Of course, not all interventions can be avoided, but knowing what to expect can help a mother be prepared to spend additional time and effort to help her baby breastfeed.
Induction
Induction, or artificially starting labor, is an option offered to many women in late pregnancy. Augmentation, or speeding up labor, may happen when labor has started but contractions are weak or have slowed down. Induction and augmentation methods may include:
- Stripping or sweeping the membranes - a procedure where a health care provider puts his or her fingers into the cervical opening and rotates them 360 degrees. This is done to facilitate the release of prostaglandins from the membranes and from the cervix, and to help the cervix to soften. This method may not be effective at starting labor and does have the potential to cause the bag of waters to break earlier than would happen naturally.
- Breaking the waters (amniotomy) - a procedure where thehealth care provider tears a small hole in the amniotic sac in hopes that the pressure of the baby’s head on the cervix will stimulate or improve contractions. Without the protective cushion of the amniotic fluid, the baby’s head may be subject to greater pressure during contractions. The umbilical cord may be more likely to become compressed, resulting in oxygen deprivation and consequent respiratory distress, which may necessitate a cesarean birth. Cord prolapse (the umbilical cord enters the birth canal ahead of the baby) is also more common after amniotomy. Moreover, unruptured membranes often cushion not only the fetal head but also the mother's perineum, allowing for gentler stretching and reducing the likelihood of tears. The combination of rupture of the cushioning bag and oxytocin-augmented contractions often leads to more rapid and forced stretching of the perineum and so to more tears. If labor does not begin using this method, other interventions may become necessary.
- Prostaglandins - substances that are naturally produced by the body and act to soften the cervix and the lower part of the uterus; there are now several synthetic versions, supplied as a gel, pessary/vaginal suppository, or pill. Depending on the method of administration, the prostaglandin can sometimes be removed should contraction strength become overwhelming. Prostaglandin induction often leads to additional interventions, including oxytocin to augment the stimulation to the uterus. Prostaglandin induction increases the risk of assisted delivery and cesarean birth.
- Misoprostol (cytotec) - a synthetic prostaglandin that was approved for use in gastrointestinal problems. It is sometimes used in childbirth to initiate uterine contractions, administered at specific time intervals either orally or placed against the cervix. This method of induction is more effective at softening the cervix than prostaglandins, and is much cheaper. It may increase the risk, however, of overly strong contractions and fetal heart rate abnormalities. Once given, its effects cannot be stopped.
- Oxytocin (Pitocin/syntocinon) - a synthetic version of a natural hormone released from the mother's pituitary gland, given in tiny amounts to induce labor and augment contractions. This can have the effect of generating longer, more intense contractions of the uterus. It can interfere with the flow of oxygen-rich blood through the placenta to the fetus, usually leading to fetal monitoring to assess the condition of the baby. When labor is induced with synthetic oxytocin, an intravenous drip is set up,possibly restricting a mother’s mobility (although drips are often connected to a stand on wheels that the mother can move around with her). Oxytocin induction may be more likely than a spontaneous labor to result in a vacuum-extraction or forceps delivery or a cesarean birth due to fetal distress from overly strong uterine contractions. This method of induction can increase a baby’s risk of being born in poor condition, and increase the likelihood of newborn jaundice. Increased fluid from the drip may cause a number of problems, including excessive edema of the breasts in the early postpartum period, making latching difficult. Oxytocin induction can have the potential to cause problems with breastfeeding initiation due to the disruption of the mother’s natural hormone levels, especially if used in conjunction with epidural anesthesia.
To minimize the effects induction can have on breastfeeding, a mother might consider natural methods of promoting contractions such as nipple stimulation, sexual intercourse (if the amniotic sac is still intact), acupressure or acupuncture, and walking or sitting during labor instead of lying prone. She should check with her health care provider before beginning a course of action.
Women tend to have harsher, stronger, significantly more painful contractions with chemically induced or augmented labors, which may make the mother feel she needs pain relief. Two common types of pain relief are analgesics (oral or intravenous pain medication) and anesthesia (such as an epidural). An induced or augmented labor can lead to a positive birth experience without further intervention; however, additional intervention is more likely to occur if the labor has not begun spontaneously. A woman considering an induction before her due date needs to know that a late preterm baby (37-39 weeks) may have some of the same types of problems breastfeeding as a very early preterm baby (such as weak or uncoordinated suck, and sleepiness at the breast).
