What is it about?

This study examines the correlation between two commonly used labor medications (pitoin and fentanyl based epidurals) and a newborn’s ability to breastfeed in the first hour after birth. The first hour after birth is a crucial window to the success of establishing breastfeeding. A strong negative correlation was found between the amount and duration of exposure to epidural fentanyl and the amount of pitocin (synthetic oxytocin) against the likelihood of suckling during the first hour after birth, suggesting that exposure to these widely ­used medications has an adverse impact on newborn behavior. Significantly, suckling in the first hour after birth has been shown in other studies to increase desirable breastfeeding outcomes. The CDC goal of improving breastfeeding rates in the US could save more than $13 billion annually in pediatric healthcare costs, as there are numerous correlations between breastfeeding and the health of both mother and baby.

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Why is it important?

A substantial body of research, including a recent Cochrane review, demonstrates that positioning a newborn skin-to-skin during the first hour after birth has beneficial effects on the health of the baby and the mother. The instinctive behavior pattern of normal, unmedicated neonatal infants during the first hour after birth while in continuous skin-to-skin contact with their mothers results in the progression of nine instinctive neonatal behaviors. Breastfeeding within the first hour has been shown to have an inverse relationship with breastfeeding difficulties and neonatal mortality. Several studies have sought to evaluate effects of exposure to epidural medications on infant behaviors and breastfeeding rates in the hours, days, and weeks after birth with conflicting findings. Rates of induction of labor in the United States have been increasing since the early 1990s to 22.8 percent, with synthetic oxytocin (synOT) alone trending toward being the most commonly used induction agent in 2012. This study offers an opportunity to examine the instinctive behavior of the newborn, immediately after birth, as impacted by the common labor medications of the mother.

Perspectives

It is crucial for new parents to be aware of the risks of intrapartum drugs, and medical professionals have an ethical obligation to inform parents of such risks, especially when these drugs are so prevalent in Labor & Delivery. In the United States, more than 80% of women intend to breastfeed, but only 22% are exclusively breastfeeding at 6 months, as recommended by the American Academy of Pediatrics (AAP), the World Health Organization, and others. Pitocin remains the most widely ­used drug for inducing labor and 61% of first-­time moms receive an epidural. This study may offer insight into why our intentions don’t match our outcomes.

Dr Kajsa Brimdyr
Healthy Children Projects Center for Breastfeeding

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This page is a summary of: The Association Between Common Labor Drugs and Suckling When Skin‐to‐Skin During the First Hour After Birth, Birth, October 2015, Wiley,
DOI: 10.1111/birt.12186.
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