Some (semi) good news, and some pretty danged bad news

Two items hot off the presses this week. Which should I start with? The (somewhat) good news, you say?



First, some research just emerged which relates to both birth and breastfeeding. The impact of IV fluids - mother's intrapartum fluid balance - on a newborn's weight loss had been studied, and a connection was found between mother who received more than 200 ml per hour and newborns who lost an "excessive amount of weight" (up to 10 percent is normal and to be expected) in their first days. It turns out that, as many have suspected, babies can take in some of that excess IV fluid themselves.

How does this impact breastfeeding? Neonatal weight loss that is greater than the norm frequently prompts formula supplementation, when in fact feeding issues have nothing to do with the excessive drop in weight; baby is simply shedding the extra fluid. Early formula supplementation is a major booby trap, so it's good to have a solid basis for avoiding it whenever possible.

It's also worth noting that IV fluids often have a second significant impact on the new breastfeeding relationship: mothers who have received IV fluids can also become extremely engorged, beyond the normal fullness of mature milk 'coming in', making it (a) much more difficult for baby's little mouth to latch on, and poor latching can lead to both inefficient milk transfer and degrees of discomfort for the mom that range from irritating to excruciating; and (b) severe, if temporary, discomfort for the mother.

This is not to say that there isn't a place for IV fluids, when necessary. But though it may not be thought of as a serious intervention in the way that we think of, say, internal monitoring or episiotomies, it is still an intervention, and should be considered carefully, both pros and cons. We now have evidence of another significant con, and it should be factored into the decision-equation.

And, the bad news. Up from 2008's figures, the U.S. cesarean rate climbed once again, from 32.3% to 32.9%. Yup, that's a new all-time high, rising nonstop for 13 years running. Unnecessarean has all the news and blues about that over yonder, check it out to commiserate and lament.

From the File Marked 'Duh'

I have a feeling this will be an ongoing series.

The topic for today, a succinct, to-the-point article from the BBC: "[D]rugs used during labor, such as those given to prevent hemorrhaging after birth, could lower the rate of breastfeeding." The specific culprits identified in this study, examining over 48,000 women, included drugs used to treat hemorrhaging, like our good old buddy synthetic oxytocin as well as ergometrine. Pain medication was also a factor: "The Swansea University team also confirmed high doses of painkilling drugs have a similar effect." The impact of these effects on mothers and children in Great Britain:

They found use of the drugs oxytocin or ergometrine to cut the risk of haemorrhage was associated with an overall 7% decline in the proportion who started breastfeeding within 48 hours of giving birth. Among women who were not given the drugs, two-thirds (65.5%) started breastfeeding within 48 hours of giving birth. But among those given a shot of oxytocin the breastfeeding rate was 59.1%, and among those who were given an additional injection of ergometrine the rate fell to just 56.4%.

This could mean that their initial attempts to breastfeed may end in frustration, and that many give up rather than persevering. The link between painkilling drugs and lower rates of breastfeeding has already been established, and has led to revised NHS guidance on the use of epidurals in labour. Lead researcher Dr Sue Jordan said more research was required, but based on the study's findings use of the clotting drugs could lead to up to 50,000 fewer British babies being breastfed every year. She calculated that this could mean an extra 1,000 children becoming clinically obese, and 3,000 developing childhood asthma . . .

Rosemary Dodds, policy research officer for the National Childbirth Trust, said women needed more support to start breastfeeding. She said: "A lot of women are not given enough information about the medications that might be given to them during childbirth, and women at low risk of bleeding may not need to take these drugs. It is important that women understand the risks and can give their informed consent before they go into labour."

Don't get me wrong, I'm glad this study came out. But is it really all that surprising, given everything we now know about the intricate hormonal process that is normal physiological labor, one component affecting the next, and in turn the next, and then the next, all in an incredible biofeedback system. Dr Michel Odent in particular has waxed positively rhapsodical about these miraculous mechanisms and the resulting "love cocktail" of hormones we are meant to be born into, and rightly so. From pain to endorphin to oxytocin to prolactin, it's all interconnected. How can we possibly think that interfering with even one of these could NOT have an impact on everything else that follows?

I again quote my favorite onscreen heroine of all time:


"Does the word 'duh' mean anything to you?"