 |
|
|
|
|
|
Question: I am going to deliver my first baby in the next few weeks and would like to use natural childbirth, but would like to know of the side effects of pain medications on my baby, should I choose to use them.
Answer: Research suggests that infants born without maternal intrapartum medications are the most alert and likely to latch-on and breastfeed well in the immediate post-partum period. Maternal analgesia, both IV and epidural, have been shown in some studies to disturb newborn behavior by making the infant slow to arouse, slow to show early hunger cues, and delay the time to effective breastfeeding.
Some medications and methods of analgesia may be better than others. By far the most sedating and disruptive of maternal-infant interaction is meperidine (Demerol). It is rarely used in obstetrics any longer as it a poor analgesic and can cause neonatal respiratory depression. For postpartum use, morphine is much safer and more effective, as most of it is taken up by the mother's liver, and little remains to enter the milk. In addition, as the infant is taking only small amounts of colostrum for the first 2-3 days, little medication is transferred.
General anesthesia can certainly disrupt early breastfeeding, but is usually only used for emergencies. Once the mother is alert enough to hold her infant, she may breastfeed, but the infant may be too sleepy to latch well initially. Epidural anesthesia is the most commonly chosen method of analgesia for labor and delivery as small amounts of anesthetics are used and little is transferred to the infant.
|
|
Even with this method, however, there are some studies that suggest that early suckling may be diminished. No adverse long-term effect on successful breastfeeding has been demonstrated, however.
Although "natural" labor and delivery are desirable, pain itself can cause problems for mother and baby with elevated maternal blood pressure and reduced blood flow to the uterus. With appropriate preparation and non-medication techniques such as positioning, deep breathing, massage and focused attention, many mothers can do well with natural childbirth. A woman should not be afraid to ask for pain relief when needed. Any medication effects will wear off, and continued close skin-to-skin contact can facilitate successful breastfeeding.
Neonatologist, Children's Hospital and Sharp Mary Birch Hospital for Women |
|
Nancy E. Wight MD, IBCLC, FABM, FAAP
|
|
|
|
|
|
Nancy E. Wight MD, IBCLC, FABM, FAAP Just as perinatal care itself involves many different medical disciplines and specialties, breastfeeding is also a team sport involving many members of the health care team in addition to the mother, infant and family. Nurses have traditionally assisted new mothers in establishing breastfeeding and teaching basic newborn care skills. Until recently, however, medical and nursing schools might have covered (briefly!) the physiology of lactation, but did not address the clinical management of breastfeeding. As the risks of not breastfeeding became known and breastfeeding initiation rates rose, a new discipline, the lactation consultant, was created to fill the gaps in knowledge and care of the breastfeeding family. Lactation consultants were to provide expert clinical service, but also to educate their fellow caregivers, conduct research, and advocate for breastfeeding in the hospital and the community. Lactation specialist, educator and consultant programs were developed, and basic qualifications, standards of practice and a code of ethics were established for International Board Certified Lactation Consultant (IBCLC) certification. As the numbers of lactation consultants grew, hospitals took advantage of this expertise to support their breastfeeding mothers. Two basic models for utilizing lactation consultants evolved: the "see everyone" model and the "consultation" model. In low volume, smaller birthing settings, a single lactation consultant was able to "touch base" with almost every mother. As the volume of deliveries grew, more lactation consultants were added. Although an integral part of the care of mother and baby, nurses in this setting tended to abdicate breastfeeding education and support to the experts - the lactation consultant. This was not an attempt to shirk work, but a true attempt to provide "the best" to mothers and babies. The mothers also, were led to assume that each one of them would see a lactation consultant. The other model to evolve was the lactation consultant as a true "consultant" being called in after the responsible nurse had assessed the situation and made basic interventions |
|
to correct any common problem such as sore nipples or a sleepy baby. In this model the nurse must have, and maintain, a basic level of lactation knowledge and skill. The consultant is brought in on difficult or complex cases, such as special maternal medications or illnesses. In this setting, even initiating pumping for a premature infant could be handled by the mother's post-partum nurse or the infant's NICU nurse, with the lactation consultant providing oversight and long-term follow-up. Specific policies should be available to delineate to role of the nurse and the lactation consultant, and to guide referrals.
These two models are simply opposite ends of a continuum of possible situations. Problems arise when one part of the perinatal system is functioning with one set of expectations and another part is using a different paradigm, as in prenatal educators suggesting all mothers will be seen by a lactation consultant, but there are not enough lactation consultants to fulfill that expectation, or they are being used in the consultant mode. As feeding an infant is a very large part of caring for an infant, we believe that breastfeeding knowledge and skills are an essential part of every perinatal care provider's competencies. Nurses are on the "front line" and must be able to assist with that first feeding in the delivery room, help a mother to position and latch on a newborn on the post-partum floor, and know where to look for information on medications that might be a problem for the breastfeeding mother or her infant. Physicians also, must be held accountable for up to date knowledge regarding breastfeeding. Resources that may be helpful are the nursing competencies found in the California Perinatal Quality Care Collaborative Toolkit at: http://www.cpqcc.org, and the Wellstart Lactation Management Self-Study Manuals at: http://www.wellstart.org/. Association of Women's Health, Obstetric & Neonatal Nurses (AWHONN) evidence-based clinical guidelines are also available to assist in developing appropriate competencies for each phase of perinatal care. http://www.awhonn.org |
|
