Is medical intervention and the “system” the reason why our breastfeeding rates are so low in the UK?
In a nutshell, I believe so.
In this blog, I’ll be exploring the hormone oxytocin that is key to labour and breastfeeding and why I think the times we live in where medical intervention is on the rise, is the reason why our breastfeeding rates are low.
Please note, this is not evidence based is purely my opinion based on my experience and knowledge as a midwife who has worked in the clinical setting.
As mentioned, oxytocin is such an important hormone in labour and breastfeeding. We need to understand what oxytocin is and how it works to recognise the impact it can have on our breastfeeding experience.
Oxytocin is known as the love hormone or feel-good hormone; the two main physical functions of oxytocin are to stimulate uterine contractions in labour and childbirth and to stimulate contractions of the breast tissue to expel breast milk for the baby.
Oxytocin also acts as a chemical messenger in your brain and has an important role in many human behaviours and social interactions, including sexual arousal, parent-infant bonding, romantic gestures. Hugs, kisses, feeling happy in the company of loved ones, sex are examples where oxytocin is released.
Cortisol is the hormone released when we feel stressed; it helps your body deal with stressful situations, as your brain triggers its release through the sympathetic nervous system and triggers the “fight or flight” system which is in response to many different kinds of stress. The short-term release of cortisol can help you run quickly from danger, however, when cortisol levels are too high for too long, this hormone can have a more negative impact.
Oxytocin and cortisol cancel out each other. So, when oxytocin levels are high, cortisol levels are low and when cortisol levels are high, oxytocin levels are low. So, if oxytocin (a hormone that works best when we are cool, calm and collected!) is key in labour and let down of breast milk, it makes sense that stress can have a huge detrimental effect on both right???
I want you to cast your minds back to the 1950s and 1960s where home births were the norm and medical intervention was probably non-existent or beginning to be introduced through the NHS and hospital births. In this era, midwives were called out predominantly to home births and managed labour in a home setting of low risk births; transfers to the hospital were low or only required for higher risk patients with known medical histories. They slowly started to increase when epidurals were introduced as a pain relief option. The women who stayed at home, progressed well and went on to have vaginal births and also breastfeed. Nowadays, low risk mums are having their babies in hospital- whether its birth centre or labour ward. Naturally, oxytocin levels can be knocked down in a hospital setting due to the clinical environment, the noise, the lighting which can all have an effect on how we birth. If we know that oxytocin is the driving hormone in labour, we should do everything to keep our levels high and keep the stress hormone of cortisol low. Unfortunately, in a hospital setting, this can be forgotten about or not possible to do.
Now, with only around 2% of UK births being conducted at home, can we really be surprised with our breastfeeding rates being so low? If 98% of births are being conducted in the hospital, this means more intervention, which will naturally impact our oxytocin levels and can affect our feeding experiences after our babies are born. If your baby is born via forceps, ventouse or caesarean, this increases your risk of other problems post birth which in turn can delay in skin-to-skin contact post birth, delay in “the golden hour” and cause cortisol levels being high and oxytocin levels to be low. We know that, through studies, babies who are immediately placed on their mother’s skin post birth and left interrupted are more likely to succeed in breastfeeding due to the hormonal release and response to this and also giving baby the opportunity to learn using their natural instinct and senses. I also think of my relatives in Bangladesh who live in a rural village and predominantly have home births and go on to breastfeed. They do not attend antenatal classes or have lactation consultants teaching them how to breastfeed but they go on to have vaginal births at home and breastfeed for at least 2 years. I believe the reason for this is because of the natural oxytocin that is oozed during their labour while at home which allows them to progress well and are able to breastfeed due to the reduced medical intervention and being left in an oxytocin bubble with their newborns, with little to no interference, allowing babies to breastfeed due to the less stressful environment.
As well as medical intervention being a cause in our low breastfeeding rates and affecting the natural behaviours of the newborn to facilitate breastfeeding, we are working in a system that is working against how breastfeeding should happen. Again, through studies, we know that an unrushed approach is the best way to get baby to learn how to breastfeed. In my clinical practice I have seen the golden hour be interrupted by unnecessary checks that can be delayed such as weighing the baby, or midwives having a hands-on approach to help babies to breastfeed which can cause stress to mums and babies and affect their ability to learn. Also, this rush to feed the baby paired with the lack of time and resources midwives are given to support mothers to breastfeed, leads to this urgency that if they don’t feed by a certain time, they need formula, which then leads to a lot of unnecessary supplementations of formula being given to babies.
This is why things like hypnobirthing and antenatal education around birth and breastfeeding is so important. While the system has increased our intervention rates in birth and impacted our breastfeeding rates, we must take responsibility in empowering ourselves with knowledge and educating ourselves to ensure we have an optimal birth where we feel in control and happy with the outcome and go on to have a positive feeding experience.
I use my platform to advocate women to ensure they have the golden hour post birth regardless of how they birth and if it is possible, that they harvest colostrum if they are able to, to reduce the likelihood of giving formula and to have an unrushed approach in getting baby to feed by letting them explore the breasts and use their natural instincts and senses to get familiar with breastfeeding.
We must remember babies do not know how to breastfeed as they have had the placenta provide everything for them in utero, so although it is a natural thing for them to do, they need to be given the chance to learn and we must not interrupt that process. Also, be proactive in creating a calm environment in the hospital, even if you do end up with intervention. Sometimes intervention is necessary but it doesn’t have to impact your experience- think about the lighting, the sounds, the people involved.
It’s your birth, your experience, you are in control so do not let anyone else be in control of this, apart from YOU.
