by Anne Eglash MD, IBCLC, FABM
Does administration of oxytocin (Pitocin) effect breastfeeding? Oxytocin plays a central role in the management of labor and delivery in the USA and in many other countries. It is used to induce labor, augment a slow or stalled labor, and given after birth to prevent or control postpartum bleeding.
Oxytocin is a crucial hormone secreted from a breastfeeding mother’s pituitary gland, responsible for milk ejection. All sorts of stimuli initiate an oxytocin surge in breastfeeding women, such as hearing, seeing, feeling, smelling, or thinking about the baby. The question is whether the oxytocin given during labor and delivery messes with the mother’s ability to create her own oxytocin surges in the first few days postpartum, and whether this in turn has an overall effect on the success of lactation.
The authors of a 2017 study compiled the evidence to date on the effect of administrating oxytocin during labor and after delivery on breastfeeding.
What do you think they found? Choose 1 or more:
- Some studies have found that oxytocin during labor and delivery benefits the breastfeeding outcome.
- Studies consistently show that administrating oxytocin is associated with a delay in lactation (taking longer for the milk to ‘come in’).
- Administrating oxytocin intrapartum is strongly associated with a shorter duration of breastfeeding.
- Giving oxytocin during labor causes infants to not nurse as well during the first week postpartum.
- All of the above are true.
- None of the above are true
See the Answer
The correct answer – F
J Midwifery Womens Health. 2017 Jul;62(4):397-417. doi: 10.1111/jmwh.12601.
Breastfeeding Outcomes After Oxytocin Use During Childbirth: An Integrative Review.
Erickson EN, Emeis CL.
INTRODUCTION:
Despite widespread use of exogenous synthetic oxytocin during the birth process, few studies have examined the effect of this drug on breastfeeding. Based on neuroscience research, endogenous oxytocin may be altered or manipulated by exogenous administration or by blocking normal function of the hormone or receptor. Women commonly cite insufficient milk production as their reason for early supplementation, jeopardizing breastfeeding goals. Researchers need to consider the role of birth-related medications and interventions on the production of milk. This article examines the literature on the role of exogenous oxytocin on breastfeeding in humans.
METHODS:
Using the method described by Whittemore and Knafl, this integrative review of literature included broad search criteria within the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, and Scopus databases. Studies published in English associating a breastfeeding outcome in relation to oxytocin use during the birth process were included. Twenty-six studies from 1978 to 2015 met the criteria.
RESULTS:
Studies were analyzed according to the purpose of the research, measures and methods used, results, and confounding variables. The 26 studies reported 34 measures of breastfeeding. Outcomes included initiation and duration of breastfeeding, infant behavior, and physiologic markers of lactation. Timing of administration of oxytocin varied. Some studies reported on low-risk birth, while others included higher-risk experiences. Fifty percent of the results (17 of 34 measures) demonstrated an association between exogenous oxytocin and less optimal breastfeeding outcomes, while 8 of 34 measures (23%) reported no association. The remaining 9 measures (26%) had mixed findings. Breastfeeding intentions, parity, birth setting, obstetric risk, and indications for oxytocin use were inconsistently controlled among the studies.
DISCUSSION:
Research on breastfeeding and lactation following exogenous oxytocin exposure is limited by few studies and heterogeneous methods. Despite the limitations, researchers and clinicians may benefit from awareness of this body of literature. Continued investigation is recommended given the prevalence of oxytocin use in clinical practice.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
The research on the effect of oxytocin during labor and delivery is not strong enough to make any of the above statements above. Overall, the studies on this topic are each designed so differently, that they are hard to compare in order to determine any real conclusions. For example, some studies separate out primiparous women from multiparous women, and others don’t. Some studies made sure to report the mothers’ intent to breastfeeding, while others did not. Even the definition of breastfeeding varied between the studies. Nearly all of the studies were done in high income countries, making any conclusions not valid for lower income countries.
The bottom line is that there are many studies that hint at the possibility that administering oxytocin during labor and delivery may have an impact on breastfeeding outcome. It is important that we not ‘hang our hat’ on one particular study until we have larger, better designed and replicated outcomes on this topic. For now, we can simply shrug our shoulders.
Veronica Annan
All of the above are true
Helen Madukwe
I know that it has an effects on the milk production & I picked B but I did not consider the effect on baby, consistency & delay. This is good to know. Thanks Doc.
Ann Calandro
I was given oxytocin with my first and third baby. None with my second and fourth babies. I experienced significant engorgement with baby 1 and baby 3, but no engorgement with the others. Of course this is an N of one but this was my experience.
annyce
So, I was not expecting this as I chose D. Thinking that an interventionist birth probably had an impact on infant behaviour in the first week. I guess it depends on the variables associated with the administration of oxytocin.
Nora Klein, MD FAAP
One would like to endorse a course that least manipulates Mother Nature. One would hope that oxytocin administration would be considered an option only when and if there is a problem.
Verity Livingstone MD, FABM
There might be a correlation between the maternal exposure to oxytocin in labour and subsequent breastfeeding challenges. The problems lie mainly with the definition of breastfeeding versus lactation. Oxytocin may have a direct positive or negative effect on maternal lactogenesis. It may have an indirect positive or negative effect on the infants ability to breastfeed. Oxytocin augmentation is often used when the baby is stuck and failing to progress. This may prevent an emergency c section or it may contribute to facial moulding and subsequent physical challenges to the infant suckling efficiently. Hence possible breastfeeding challenges. In other words, it is almost impossible to tease correlation versus cause and effect. Never the less, any delivery that involved the use of oxytocin should be considered high risk and the mother and baby need extra close follow up.