The Association Between Common Labor Drugs and Suckling When Skin‐to‐Skin During the First Hour After Birth

Abstract

Background: Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin, have been previously studied in relation to neonatal outcomes, especially breastfeeding, with conflicting results. We examined the normal neonatal behavior of suckling within the first hour after a vaginal birth while in skin-to-skin contact with mother in relation to these commonly used drugs. Suckling in the first hour after birth has been shown in other studies to increase desirable breastfeeding outcomes. Method: Prospective comparative design. Sixty-three low-risk mothers self-selected to labor with intrapartum analgesia/anesthesia or not. Video recordings of infants during the first hour after birth while being held skin-to-skin with their mother were coded and analyzed to ascertain whether or not they achieved Stage 8 (suckling) of Widstr€ om's 9 Stages of newborn behavior during the first hour after birth. Results: A strong inverse correlation was found between the amount and duration of exposure to epidural fentanyl and the amount of synthetic oxytocin against the likelihood of achieving suckling during the first hour after a vaginal birth. Conclusions: Results suggest that intrapartum exposure to the drugs fentanyl and synthetic oxytocin significantly decreased the likelihood of the baby suckling while skinto-skin with its mother during the first hour after birth. (BIRTH 42:4 December 2015)

An implementation algorithm to improve skin‐to‐skin practice in the first hour after birth

“…If babies do not achieve suckling, the hospital might closely examine practices and review elements that could be interfering with a newborn's instinctive behaviour. For example, synthetic oxytocin as well as epidurals containing fentanyl can change a newborn's behaviour during the first hour, resulting in the newborn not progressing to suckling (Brimdyr et al, ). Robson's criteria applied to the Japanese data set mothers indicates that, of the five mothers in this category, three are primiparas who were not induced and did not have exposure to epidural, one is a multipara who was not induced and did not have exposure to epidural, and one was a multipara who was induced but did not have exposure to epidural.…”

“…Why would they not lick? Why would they not suckle?—needs to lead to further examination of these newborns, perhaps by examining their exposure to labour medications (Brimdyr et al, ), or the infant's physical condition, can give insight into their experience. A review of the Australian data shows that newborns never had the opportunity to consider the achievement of the standard, due to barriers during the first hour.…”

Skin‐to‐skin contact the first hour after birth, underlying implications and clinical practice

“…It expands the understanding of each of these through the lens of the authors' clinical expertise and research experience from direct observation of newborn infant behaviour. Expertise comes from experience as well as analysis of hundreds of hours of videotapes of newborn infants' developing feeding behaviour in skin-to-skin contact (12,17,18,21,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). Additionally, the authors had the opportunity to improve skin-to-skin care after birth, both in vaginal and caesarean delivery at 10 hospitals in Egypt and the United States according to a 5-day video-ethnographic intervention.…”

“…Medicated babies can successfully go through the nine stages and self‐attach. However, there is increasing evidence concerning the negative consequences of certain medications such as fentanyl and oxytocin, on success with breastfeeding . Parents and staff must take into account the consequences when considering amount, timing and choice of specific labour medications.…”

Breastfeeding Outcomes After Oxytocin Use During Childbirth: An Integrative Review

“…Five studies described “baby‐friendly” or early skin‐to‐skin practices following birth . In the report by Bell et al, neonates went to a warmer after birth, per hospital routine.…”