Active management of third stage of labour and breastfeeding difficulties

Brown, A., & Jordan, S. (2014). Active Management of the Third Stage of Labor May Reduce Breastfeeding Duration Due to Pain and Physical Complications. Breastfeeding Medicine, 9(10), 494-502.

 

13705050_10154248148825406_1695972523_nWhy do the research?

The majority of women receive an injection (called ergometrine, which mimics oxytocin),after they have given birth to help them deliver the placenta more quickly. This injection, known as ‘active management’, reduces the amount of blood loss after birth and may reduce the risk of post partum hemorrhage. However, in very low risk women (e.g. normal birth, no pronged stages of labour, no induction) the risk of hemorrhage is so low that ‘physiological management’ (allowing the placenta to deliver naturally without an injection) is supported.

One reason it might be beneficial to support physiological management is that there is growing evidence that women who receive the injection are more likely to stop breastfeeding in the early days compared to those who do not have it. The reasons for this are unclear. Biological mechanisms are likely at work including stopping the correct hormones expected for breastfeeding being produced in the right amounts. This might lead to breastfeeding difficulties. Alternatively it could be that mothers who choose not to have the injection (when the majority of women do) are more likely to favour ‘natural’ approaches to parenting including breastfeeding.

Therefore this research was undertaken to explore the breastfeeding experiences of mothers who received the injection and those who did not.

 

Who took  part?

Three hundred and ninety mothers with a baby aged 0 – 6 months who had a vaginal birth. A vaginal birth was necessary as if mothers have a caesarean section they should automatically receive the injection

 

What did they do?

Mothers completed a questionnaire examining birth experience, including whether they received the injection or not, breastfeeding duration and if relevant reasons for stopping breastfeeding.

 

What did the results show?

There was no difference in whether mothers breastfed at birth or not based on whether they had the injection. However mothers who had the injection were less likely to be breastfeeding at two and six weeks.

When the reasons why mothers stopped breastfeeding were examined, those who had the injection were more likely to report that they stopped due to difficulties (e.g. poor latch) or pain than those who didn’t have the injection. There were no differences in reason for stopping breastfeeding between the injection or no injection group for reasons such as embarrassment, body image of convenience.

13713353_10210675096940605_1934442076_n What does this mean?

The results suggest that the injection may increase the risk of breastfeeding difficulties and mothers stopping breastfeeding in the early days. The injection did not stop women breastfeeding at birth, which is logical, as it would not stop women attempting to breastfeed but it may damage their experience of doing so.

The artificial hormone in the injection (called ergometrine, which mimics oxytocin), stops the body from releasing prolactin, which is a critical hormone for breast milk production. Research has shown that mothers have lower levels of prolactin at 2 days post birth if they had the injection. It can also interfere with the normal production of oxytocin, which is also needed for successful breastfeeding. When these hormones are lower, babies often don’t feed so well.

The body does ‘catch up’ with making these hormones, but this can take up to two weeks, during which time milk production may be lower and babies might be more reluctant to feed. This can lead to mothers believing their baby is difficult to feed or that they haven’t got enough milk and stopping.

Further research is needed as the injection does shorten the time taken to deliver tha placenta, and reduce blood loss, but there may be no significant benefit for low risk women. Until more research is done, mothers who have received the injection should receive more breastfeeding support, with midwives aware of the potential difficulties and able to suggest strategies to improve milk supply.

 

You can read a copy of the paper here Active management of the third stage of labour