Jan comments on previous posts:
<A wonderfully interesting thread has emerged....
<< If a woman is given an epidural, no oxytocin is released in the brain
and
no
maternal behavior results. A c-section mom may have a harder time
breastfeeding
because of lack of oxytocin in the early days. "The absence of the
second
phase
of labor [where there is a great release of oxytocin] and delayed
skin-to-skin
contact contribute to this immature oxytocin pattern. Women having had
a
Cesarean section are less calm and interactive than those having had a
vaginal
delivery. This may be related to these different oxytocin patterns."
and then this response:
<<This is very interesting. Could this be a contributing factor for the
seemingly
rising amount of children with breastfeeding difficulties in the early
pp
days?
Not only that the baby may be under the influence of maternal delivery
medications, but also that mom's milk will come less prompt and less
abundant?
That would be another strong advice against medicalized birthing
practices
for
otherwise healthy labouring women. >>
This brings up a thought. I've been noticing that when our moms are
having
to pump -- baby in the NICU; not latching, or whatever.... -- it is
taking
several pumpings in most cases for the mothers to produce *anything* of
substance -- sometimes up to pumping 6 or 7 times! Now, the vast
majority of
mothers get an epidural during labor. I wonder if, instead of blaming
the
pump which I've been doing, the lack of ability to pump the colostrum is
more
directly related to the suppression of the oxytocin related to the
epidurals.>
As I read the original post, I thought Michael Odent was quoted as saying
that it was administration of pitocin (artificial, purified
pharmaceutical oxytocin) that interfered with the feedback stimulus to
the release of natural oxytocin.
Pitocin induction and/or augmentation often precedes epidural
administration by many hours. Its continuance during an epidural is
necessary to keep the contractions going because of the epidural's
interference with strength and frequency of contractions. And pitocin
administration is continued for a while after delivery to guard against
uterine relaxation and hemorrhage.
So that sounds to me as if it is not the epidural per se that reduces
natural oxytocin secretion, but the prolonged administration of the
pharmaceutical equivalent..
I suspect pitocin also upsets the feedback relationships that affect ADH
(antidiuretic hormone) as well. That is a whole other thread in relation
to competition for binding sites, overhydration, engorgement, areolar
firmness causing difficulty latching etc.that is really sort of separate
from the present thread.
I am not certain about the half life of either pitocin or oxytocin, but
I think it is relatively short. So I do not see how pitocin
administration during labor and in the recovery room for the prevention
of hemorrhage could be said to automatically reduce the subsequent amount
of oxytocin secreted in the first few days, especially in the case of
C.Section mothers. That seems too simplistic.These mothers often have
many other factors that might make their course of lactation different
from a mother with an unmedicated, vaginal birth.
As to the lack of yield from a pump in the beginning, it has been my
experience that it is more likely due to at least 2 factors.
1) The MER is as yet, unconditioned, at least in first time nursing
mothers. Though it is well recognized in the dairy industry, we in human
health care often fail to realize that the MER is the single most
powerful force in moving milk from the back of the breast forward.
Mothers need to know this. I think we need to begin by explaining this
simply and impress on the mothers that they will always get better
results if they consistently try to trigger it by massage and digital
expression prior to trying to use the pump.
2) In the first 24 hours or so, digital compression yields more than
the pump because it allows for more direct targeting of the milk sinuses
and involves direct positive pressure on the small amount of milk present
in them.
Accurate targeting of pressure makes it possible to express droplets of
colostrum from most mothers even prenatally. The Marmet method addresses
both the stimulation of the MER and the accurate targeting of positive
pressure and alternating the sites. This will usually yield droplets or
even more from the very first attempt. IME, the sooner colostrum is
removed, the quicker the volume builds up.
I think it is a mistake to jump to the conclusion that the pump or the
epidural or the pitocin must be at fault. Only when the sinuses become
somewhat overdistended and accompanied by very full ducts behind them is
there better potential for the pump to yield any appreciable volume.
The application of negative pressure does not pull on the milk. It pulls
first on the flesh, to "drag" the nipple far enough into the flange to
target the general subareolar area likely to contain sinuses. If the
flange is close to the right size, the sinuses are then compressed by
positive pressure against the bend in the flange. If there is a
sufficient backup of milk in the ducts and an effective MER, the pump
witll then begin to yield the milk.
Just my $.02 ( $.10?) worth.
Jean
******************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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