In my recent podcast, Dawn Thompson addressed traumatic birth. One issue she mentioned was the commonly-performed episiotomy. For sure, the lack of evidence for such a barbaric procedure is a problem.
But for breastfeeding mothers, two central questions arise. First, how does an episiotomy affect the breastfeeding experience?
- Tissue trauma results in substantial perineal pain. Such pain is likely to be exacerbated by sitting positions. (Using a cradle hold, or a football hold.)
- Maternal pain can and usually does interfere with let-down.
- An episiotomy may be needed for an assisted delivery. That may be associated with head trauma for the newborn.
Second, what can be done to overcome those problems? Here are 7 suggestions.
Find different positions to nurse
Here’s one that’s obvious: Nurse in a side-lying position. Getting the pressure off from the perineum just makes sense.
Sometimes, after a traumatic birth, newborns have head trauma and a headache. They might nurse better when their head is unencumbered. The side-lying position doesn’t confine their head in any way.
And, here’s a little hidden secret: How about a standing position? Placing the baby on a sturdy, safe surface (e.g., a countertop) might work, depending on the nursing mother’s height. Or, an ironing board, backed up to a wall, or a changing table might work, too.
Consider pain relief medications
Unquestionably, episiotomies are painful. Some more so than others. Of course, I’ll offer the obligatory caution to check with your doctor before taking a pill. But I’ve administered mild analgesics (“pain pills”) to tons of postpartum women. And they’ve reported substantial relief from them.
Pain relief is critical. Pain makes it very difficult to relax and have a happy breastfeeding experience. Research clearly shows that pain inhibits the let-down reflex.
Consider non-pill treatments to help episiotomy
Having been the nurse for hundreds if not thousands of mothers on postpartum floors, I’m pretty sure I’ve offered every episiotomy treatment known in America. Overall, I’d summarize those as:
- hot/cold treatments
- topical treatments (sprays, squirts, creams, salves etc.)
- special exercises
- stool softeners
- special cushy devices to sit on.
There’s a fairly good list here, although the photos are misleading at best (and sometimes just flat-out inaccurate.)
Talk it all out—or listen while someone else does so
On the podcast, Dawn explained that a traumatic birth is more than the physical pain. It’s about the loss of a hoped-for experience. So it’s normal to feel disappointed, disempowered, disheartened, and other “disses.” Talk it all out, or else be the person who listens while someone else talks it out.
Furthermore, multiple studies have shown that women are more likely to have a diminished sense of self following childbirth interventions. Does this diminished sense of self impact the mother’s ability to confidently initiate and continue breastfeeding? In my estimation, yes!
Know your rights
Speak up! All clients have the right to refuse a procedure. However, don’t say yes or no to a procedure until you understand the implications that may follow. Sometimes, an episiotomy is justified. But “routine” episiotomies are not.
As a seasoned labor/delivery nurse, I could shout from the rooftops about the lack of evidence for a routine episiotomy. I’ve seen hundreds performed. But I was horrified, and I mean horrified when I saw the video that Dawn mentioned on our podcast. I’ve never seen anything like that. I expect I never will. (The client sued the obstetrician.)
Find helpful resources
During the prenatal period, talk with your obstetrician about the practice bulletin issued by the American College of Obstetricians and Gynecologists that discourages episiotomies. (Non-members can view the abstract of Practice Bulletin 165 for free; pertinent points, are listed here.)
Both before and after birth, every mother should look for general resources. Dawn’s US-based organization, Improving Birth has several general resources related to traumatic birth (although I was unable to find anything specific to episiotomy.) Another place for good reading is the Birth Trauma Association in the UK.
Breastfeeding is not “just breastfeeding.” These events are all inextricably linked: conception, gestation, partuition, lactation. I’ve said it before and I’ll say it plenty more times. Birthing practices, hospital practices, and more affect the overall experience.
I’ve picked on just one topic here today. Traumatic birth is a wider topic. What are your thoughts about how a traumatic birth affects breastfeeding?