Transcript: How Routine Labor Interventions Can Lead to Breastfeeding Problems

This is a text transcript from The First Time Mum’s Chat podcast. The episode is called How Routine Labor Interventions Can Lead to Breastfeeding Problems and you can click on the link to view the full episode page, listen to the episode and view the show notes.

Helen Thompson: Recently, I was surprised to learn that in the USA and Australia, that the cesarean rate is in excess of 30%. So more than one third of moms will experience a cesarean. Of course when you add the other routine labor interventions this percentage goes up.

I’ve wanted to talk with someone about how these routine labor interventions can cause problems for breastfeeding for some time and in this week’s episode of First Time Mum’s Chat I’m delighted to be chatting with mother of 2, lactation consultant, childbirth educator, author, and volunteer breastfeeding counselor, Kelly Durbin about this very topic!

During our chat you’ll hear Kelly talk about:-what happens when more than one Intervention is used during a single birth experience for the same mother. Lactation and breastfeeding don’t seem to be related to the process of births. How do labour interventions cause breastfeeding problems?

And so, so much more.

Hi Kelly and welcome to First Time Mum’s Chat. I’m really looking forward to chatting with you about how routine labor interventions can impact breastfeeding. This is such an important topic which I know you’re very passionate about and it’s often overlooked. So can you please start by telling us about yourself and your background?

Kelly Durbin: Yeah, my name is Kelly Durbin. I’m an international board certified lactation consultant. I’m also a childbirth educator and I got interested in lactation very naturally years ago when I had my first daughter. At the time I was teaching 6th, 7th and 8th graders, and I wasn’t really thrilled about teaching middle school.

I went through the childbirth class, it took many weeks. I took an independent class, not at the hospital, and I learned all I could about birth, labor and then, of course, breastfeeding because I started breastfeeding on day 1 and I really became hooked on this information. It consumed me, I was fascinated by the whole process and I really realized at that moment that although I was actually a trained teacher, I was teaching the wrong material and the wrong students. Then I immediately shifted my focus to childbirth and breastfeeding and I became certified in both. It took me a few years in lactation. I started out as a volunteer and I have been a volunteer providing volunteer breastfeeding support for 16 years and then later on I became certified and an international board certified lactation consultant.

I still do volunteer work because I feel so strongly about it that people do need support and oftentimes it’s not high level support. It is things that we can talk about on the phone or you could email me about things that people have general questions. Of course we come usually to breastfeeding as adults and we’ve never had experience in this and it really helps to have somebody who’s there to help you answer simple questions or give reassurance or even some medium level guidance.

I certainly don’t do clinical work or high level guidance through volunteer work, because that generally involves referring people to someone who can meet their needs in a better way. I feel very, very passionate about the work that I do as a volunteer at this stage, even though I have also incorporated other lactation services and childbirth teaching into my professional repertoire.

Helen Thompson: Wow, you’ve had a lot of experience there. So you’ve certainly got a lot to give to any mom who’s expecting a baby and you’re obviously very passionate about what you do.

Kelly Durbin: I am, I feel really strongly about it and I felt this way mostly because Helen, I encountered some wonderful people who supported me through volunteer breastfeeding when I had my first and my second and I thought, you know, this is such an incredible, valuable service. So, despite the fact that I now have other roles, I work for a company that trains childbirth educators, doulas and lactation consultants, but I still volunteer several hours a month because I feel so strongly about it.

Helen Thompson: So what routine labor interventions can cause problems for lactation?

Kelly Durbin: Well, this is surprising to many people, but routine labor interventions can cause problems for breastfeeding and generally, we see things, high level problems resulting from cesarean delivery or forceps delivery, vacuum, which is also called Ventouse, epidural, IV fluids even and synthetic Oxytocin and induction of labor even. So all of these are seen or kind of advertised as routine labor interventions. They’re quite common in fact, I know that our labor interventions rate here in the U. S. overall is generally high. The cesarean rate here is over 30%. I believe in Australia that it is similarly high, one third of people! 1 3rd results many times in lactation issues and these problems can come up, even though everybody is told these interventions are routine, they’re very safe, you’re likely to have zero or very few problems that result from this.

A lot of times what people focus on when they’re in labor or they’re preparing for labor in a childbirth class, they’re focusing on the maternal and infant outcomes that are related to these labor interventions, but they aren’t told this could cause problems for breastfeeding. This could cause problems for your milk coming in, something like that. So a lot of people go into this not knowing, not being fully informed that there are downstream consequences.

Helen Thompson: Yeah, I think that’s true. When I was growing up, we didn’t have any of that and we didn’t even have anybody to help us with any of those. Nobody tells you that you can have problems and I would have thought with the forceps that can have a huge impact on a baby when they come out. I don’t know very much about it, but I would have thought it squishes the baby a little bit and when they actually come out, it can be a little bit awkward for the baby because they’ve had all these things stuck to them to pull them out.

Kelly Durbin: Yes, it can. In fact, forceps is an interesting one. I like that you bring that up. It’s quite simple in the way that it does interfere with breastfeeding. So, infants require the full use of all of their facial nerves, and they use the nerves to sense things at the breast. In fact, they use the nerves in their cheeks and their lips. They have to have full use of their tongue, obviously, to accomplish successful breastfeeding. Sometimes forceps delivery can disrupt facial nerves, especially the one that is useful for full tongue movement. Some babies really do suffer when they have nerve damage. It may not be immediately obvious that they have nerve damage, but it can affect their ability to latch and to suck effectively at the breast.

I’ve read that it doesn’t take too long, but it can take some babies up to 30 days to recover from forceps nerve damage, and that can really get a baby off to the wrong foot when we’re talking about learning to latch and, and sustaining a good latch for that learning period in the first few days and weeks. So that can cause some suboptimal breastfeeding in the very beginning and then once the nerves heal, people feel like, okay, now I have to relearn, this baby has to relearn breastfeeding techniques, so it can cause feeding problems for the infant.

Helen Thompson: Does that include, does that relate to the rooting reflex when the baby’s learning to breastfeed, that you rub the cheek and it encourages the child to go towards the breast?

Kelly Durbin: Yes, the rooting reflex is in fact triggered by the baby either being touched on the corner of the mouth or sometimes just on the cheek and they will open their mouth and sometimes look right to left and they’re looking for the breast or for the nipple. That reflex is in fact triggered by touch of something on the face near the mouth and cheeks. So, yes, you are correct.

Helen Thompson: Yeah, I was thinking about that when you were talking about the nerve damage through the forceps. I was wondering whether that rooting reflex would have an issue with that?

Kelly Durbin: I can’t speak about any particular incidents where the rooting reflex is ineffectual at that point but I’m guessing that any kind of nerve damage that does interact with the lips, the tongue and the cheeks would interfere with innate reflexes. Frankly, what babies are using when they come to the breast are intact, innate reflexes, and that is something that we do not want to disturb but some of these labor interventions, including forceps delivery can disturb those reflexes and then infants will struggle a little bit because they have to compensate in some other way in order to accomplish feeding.

Helen Thompson: Yeah, I can definitely relate to that because I’ve heard so many mums saying to me that they find it really difficult to latch and there could be umpteen reasons for that. The ones that you’ve mentioned are things that people just don’t think about. What comes up when I’m talking to people about it is tongue tie, is one of them. They don’t think about all the interventions of when we don’t have a natural childbirth.

Of course, I’m not saying that every mother has to have that and I’m not saying to a mom that if they don’t have a natural childbirth, there’s anything wrong. I’m not putting that out there. I’m just saying that I think a lot of people don’t realize that these things can cause problems in breastfeeding.

Kelly Durbin: Yes, yes, a lot of people don’t realize. In fact, generally, when I talk to people and they’re experiencing problems that they feel what is the root cause of this, how is something going wrong here, I don’t see any actual problem. I always ask them, especially if the baby is under six weeks old, how did your birth go, what kind of birth did you have, was the baby born by a cesarean, was there intervention involved? A lot of times people reveal to me that they did have multiple routines or at least one routine interventions that is and I often think, even though there isn’t any way for me, as a lactation consultant to say, well, then this is exactly what caused your problem, in the case of forceps and nerve damage, we can often say, this is very likely what’s causing your problem.

Some other interventions, it’s hard to pin it down to one specific thing. However, if someone comes to me and they say, well, I had an epidural, an induction, IV fluids that lasted 8 hours and a very difficult pushing stage, I can infer that they likely have some stress related to an outcome related to one of these interventions. Generally, like I said, it’s hard to pin down exactly what happened, but we can use some more robust lactation care to help somebody restart or reboot the process then.

Helen Thompson: It’s also the baby. If you think about all of that, the baby’s going through stress as well. Of course the mother is, but so is the baby going through stress when they’re coming out. So, you can understand that the baby’s feeling a bit stressed, the mother’s feeling stressed, so if you add all those into the conundrum, well then, you’ve got two very stressed people. So you can understand why breastfeeding can have a problem at first.

Kelly Durbin: Yes, absolutely.

Helen Thompson: So, is there any negative routines that you feel are worth mentioning here that we haven’t added?

Kelly Durbin: I will suggest that separation right after birth, even though this doesn’t seem like a labor intervention that happens during labor, it’s something that happens often in the hospital stay. A lot of times people are recognizing in many locations, it doesn’t happen in all hospitals or care facilities, but people do recognize now that separating the mother and the infant in the hours after birth is not a great idea and it certainly doesn’t support breastfeeding behaviors. Obviously, if the baby is not in the same space with the mother, breastfeeding can’t happen, but certainly routine separation still takes place in some cases. A lot of times, and this goes back to what we talked about at the beginning, a lot of times people don’t realize that even minor or small amounts of separate time after the birth can impact breastfeeding because the infant is primed within the first 60 to 90 minutes to accomplish their first feeding. When we take that opportunity away, if, for instance, the baby is having a bath or being checked out, like routine medical checks for just the visual Apgar scores or something that the nursing staff will perform, those tasks can normally be done while the mother and the baby are together. In fact, while she is holding the infant, and that is something that is far more supportive of breastfeeding than people realized in the past. Routine separation, kind of used to be a no brainer. People would take the baby immediately after the birth and do the weight check, do a bath, get the baby dressed in something, a diaper, a hat, some clothing, but all of those things are unnecessary and we now know, based on years of research that routine separation, if it’s not medically necessary, is something that is not supportive of breastfeeding.

In fact, it is disruptive and it interferes with breastfeeding. So what I think is still happening is that people don’t necessarily realize, and this is something that I feel is important to teach in childbirth classes because it is so important for getting things off to a good start for breastfeeding, is that directly after the baby is born, if the baby stays with the mother, and optimally it would be skin to skin right on the chest, even if the infant doesn’t latch within a certain amount of time, say 60 minutes, there are still things happening.

The mother is experiencing a dramatic hormonal shift that happens right after the placenta is born. The infant is experiencing, the new environment has changed, they’re obviously breathing on their own. All of these things are happening but there’s also a connection that’s being established for breastfeeding and the baby in that position with the parent on the skin is getting the input to begin the innate breastfeeding behaviors, the ones that the baby already has programmed inside. So when that separation occurs, even though we can go back to it, you can maybe 3 hours later, put the baby there, the optimal time happens and the infant is primed for it directly out of the birth canal. So the separation, even though I would say it’s not a labor intervention, is definitely one that is something that can interfere if we separate mother and baby immediately after birth.

Helen Thompson: I love how you talk about skin to skin because as you probably are aware, I teach baby massage and I’m very, very passionate about the mother being able to give their baby that skin to skin contact and when they’re first born, having that skin to skin. I know this is not your expertise, but even waiting for the placenta to come out and let them have skin to skin before that, before you cut the cord, I think it’s all part of what you’re talking about. The baby is primed, as you say, for getting used to the mom and getting used to the breast and used to the skin to skin and waiting for that time before you actually cut the cord is really important.

I actually had a really interesting chat to a midwife here in Australia, who talked to me about that. It was really interesting what she said about that. Waiting for that time and allowing the time for the baby to get used to the mom and the mom getting used to the baby before you cut that cord, because it’s exactly what you’re saying about a good latch, because you’re giving both baby and mother the time to reflect and feel each other if that makes sense.

Kelly Durbin: Yeah, absolutely and there are many things, even though it doesn’t appear that the baby is doing anything, there are all sorts of things that are happening. The hormonal exchange is happening. That is a period of time for the mother when the oxytocin response in her body is highest, I think in her whole life, right after giving birth. That is something that facilitates breast milk release. So when the baby is there, they are also stimulating that oxytocin response in the mother, which facilitates breastfeeding.

Helen Thompson: Yeah, I can definitely relate to that and I think if more and more people do that, it’s much more supportive to both mother and baby.

Kelly Durbin: Yes, it is. I was going to mention a really interesting case, a study from Victoria, Australia. It was released in 2022 about labor interventions, and I found this to be fascinating. They studied several interventions, and this study concluded that when birth for one single person, one mother includes multiple interventions, the degree of interference or harm to breastfeeding is actually higher.

So what we’ve learned is, when you have more than one intervention. So, let’s say somebody had induction of labor, they also had IV fluid, epidural. All of those things compound the effects that could cause negative or downstream consequences for breastfeeding and that I find to be fascinating. The study more specifically had the outcomes at 3 months and they said that exclusive breastfeeding rates at 3 months were lower for people who experienced more labor interventions during a single birth episode. It’s fascinating.

Helen Thompson: I think that’s really amazing to hear because I never realised the effect interventions can have, especially if a mum’s had three, can you imagine! As we mentioned before, the stress that can cause for both the baby and the mother.

Kelly Durbin: Well, and one other thing that people do often talk about in childbirth classes is that one intervention often leads to another. So it can be wise to try to plan for the lowest intervention. You might find that you need to do something. You need to do one or maybe two, but once you start racking up the number of interventions, the degree of breastfeeding interference will also increase.

Helen Thompson: Yes, I can understand why and congratulations on the launch of your book earlier this year. Can you tell my listeners a bit about your book?

Kelly Durbin: I recently wrote a book called ‘Protecting Your Potential for Breastfeeding’. After 15 years of supporting nursing mothers, I realized that people are not reaching their breastfeeding goals And it’s not because they intend to give up, but it’s because of a multitude of obstacles that come together to derail their breastfeeding journey.

In part one, I write about how to get started breastfeeding, how milk production works and many ways to maximize your breastfeeding potential. In part two, I explain over 70 factors that people often encounter that interfere with breastfeeding. This book is available in paperback and e book formats.

Helen Thompson: Thank you, Kelly, for that information. So how can my listeners find you or get in contact with you?

Kelly Durbin: Looking at my web page would be one easy way to find out about the book. My web page is called ProtectingYourPotential.Com, which is similar to the name of the book, protecting your potential for breastfeeding and I’m also on LinkedIn as a professional. If people are very zealous and they want to communicate with me, interested in connecting as a professional, feel free, I’m on LinkedIn and I think that’s it on my web page. I do have an Instagram, but I’m in the process of, getting it a little more active, it hasn’t been too active yet. Soon I will be on Instagram a little more actively.

Helen Thompson: Well, thank you, Kelly, for being on the podcast. I’ve really enjoyed talking with you, and it’s been a pleasure to have you.

Kelly Durbin: Thank you so much for having me today.

Helen Thompson: Kelly shared some great information and I found her passion for helping mums during their breastfeeding and lactation journey very moving. I highly recommend checking out her recently published book and I’ve included a link to where you can get it on Amazon, as well as Kelly’s website and social media in the show notes which can be found at MyBabyMassage.net/podcast/149.

I’ve also included a link to the earlier episode with Midwife Beau Wilson, which I mentioned during the episode, which will assist you further. I share each episode on a first time Mom’s chat Instagram page. Please support me by following me. Next week will be the 150th episode of First Time Mom’s Chat, so please listen and support me when I celebrate this amazing milestone.

I can’t believe it’s been almost three years since I commenced this podcast. Be sure to listen to this episode when it comes out next week and please subscribe to First Time Mum’s Chat via your favourite platform so that you can get quick and easy access to all our episodes when they are live.