Written by Jennie Bever Babendure, PhD, IBCLC
The ever increasing rates of labor induction and augmentation have caused many to begin to ask if the use of synthetic oxytocin to start or augment labor may impact mothers and babies after birth. In an Acta Paediatrica article published online ahead of print, Ibone Olza-Fernandez and her colleagues asked this question by looking at neonatal feeding reflexes in relation to oxytocin dosage during labor1. In this small pilot study, researchers documented the total dose of oxytocin given during labor to induce or augment contractions in 20 first time mothers. On day 2 of life, and at least 1 hour after breastfeeding, they placed babies skin to skin with their mothers in biological nurturing positions to elicit Primitive Neonatal Reflexes, including those involved in breastfeeding. When 3 observers blind to the oxytocin dose coded videotapes of these 20 minute sessions, they found a significant correlation between higher doses of synthetic oxytocin during labor and the absence of sucking behavior in infants. In fact, many of the newborns whose mothers received higher doses of oxytocin spent a large part of the 20 minutes skin to skin crying.
When the authors later followed up with the mothers about breastfeeding status at 3 months, they found another surprising correlation: mothers who were exclusively breastfeeding at 3 months had received a lower average dose of oxytocin during labor than mothers who were not breastfeeding exclusively.
Findings of this study are limited in that this was a very small pilot of only 20 women, and all received oxytocin either to augment or induce labor, thus the study lacks an important control group of mothers who did not receive oxytocin. As such, the authors are careful to point out that the results should be interpreted with caution. The relationship found between oxytocin dose and infant suck in this study is a correlation only, and provides no evidence that higher doses of oxytocin caused the depression in sucking behavior. (Click this link for a great discussion of why we can’t say a correlation indicates cause.)
In addition, all study mothers received epidural anesthesia, thus the depressed sucking behavior could be related to maternal dose of anesthesia (which was not recorded), precipitating increased need for labor augmentation. However, as studies in rodents have shown reduced food intake in response to oxytocin injection, and previous clinical research has demonstrated an association between intrapartum oxytocin administration and risk of artificial feeding independent of epidural anesthesia, the idea that synthetic oxytocin might have an impact on breastfeeding behavior is an intriguing hypothesis that deserves further study2-8.
I joke that the picture below shows me ‘under the influence’ of oxytocin. If you look closely, I look just the tiniest bit love-crazed. Could oxytocin, a hormone that can inspire such intense bonding actually have a negative effect at high doses? I’ll keep a close watch as further research unfolds!
For more research commentary, check out Jennie’s new blog: www.breastfeedingscience.com
1. Olza Fernández I, Marín Gabriel M, Malalana Martínez A, Fernández-Cañadas Morillo A, López Sánchez F, Costarelli V. Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study. Acta Paediatrica 2012.
2. Arletti R, Benelli A, Bertolini A. OXYTOCIN INHIBITS FOOD AND FLUID INTAKE IN RATS. Physiology & Behavior 1990;48(6):825-830.
3. Jordan S, Emery S, Watkins A, Evans JD, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG: An International Journal of Obstetrics & Gynaecology 2009;116(12):1622-1632.
4. Benelli A, Bertolini A, Arletti R. OXYTOCIN-INDUCED INHIBITION OF FEEDING AND DRINKING – NO SEXUAL DIMORPHISM IN RATS. Neuropeptides 1991;20(1):57-62.
5. Olson BR, Drutarosky MD, Chow MS, Hruby VJ, Stricker EM, Verbalis JG. OXYTOCIN AND AN OXYTOCIN AGONIST ADMINISTERED CENTRALLY DECREASE FOOD-INTAKE IN RATS. Peptides 1991;12(1):113-118.
6. Ounsted MK, Boyd PA, Hendrick AM, Mutch LMM, Simons CD, Good FJ. INDUCTION OF LABOR BY DIFFERENT METHODS IN PRIMIPAROUS WOMEN .2. NEURO-BEHAVIORAL STATUS OF INFANTS. Early Human Development 1978;2(3):241-253.
7. Ounsted MK, Hendrick AM, Mutch LMM, Calder AA, Good FJ. INDUCTION OF LABOR BY DIFFERENT METHODS IN PRIMIPAROUS WOMEN .1. SOME PERINATAL AND POSTNATAL PROBLEMS. Early Human Development 1978;2(3):227-239.
8. Wiklund I, Norman M, Uvnas-Moberg K, Ransjo-Arvidson AB, Andolf E. Epidural analgesia: Breast-feeding success and related factors. Midwifery 2009;25(2):E31-E38.
Jennie Bever Babendure, PhD, IBCLC
I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.
Sounds very vague and too many variables to really make a comparison or any real conclusion. While I k ow all labors, deliveries, babies and moms are different, my experience is as follows, My first four babies were born with no epidural or pain medicine but induced with medication, had no nursing-sucking problemsand successfully nursed for 12-20a months. My fifth child has not induced, had no pain medication and we struggles for two days to get him to latch, suck and nurse.
Thank you for the information 🙂 In my opinion it is not the Oxytocin that is the problem, it is the fact that it is synthetic Oxytocin. I heard years ago (I wish I had the research) a woman talking about taking synthetic O as she had fertility problems, she had a daughter who 20 years on couldn’t get pregnant and was told that this was down to the synthetic Oxytocin her mother had received.
If that is true – why shouldn’t it impact negatively on the baby afterwards? Do you know anything about this?
It should be noted that the synthetic oxytocin used (pitocin) does not cause the psychological changes that natural oxytocin does because it cannot cross into the brain. High levels of natural oxytocin are beneficial to both and encourage bonding. Synthetic oxytocin does not have that effect.
I thought peripheral Oxytocin (OT, natural or pharmacologic) does not in general cross the blood brain barrier. Although I have also read that maternal OT does cross the placenta, and suppresses infant brain excitatory neuron firing, to decrease oxygen demand and therefore the risk of hypoxic damage during labor and delivery (Tyzio, 2006). Must be a porosity significant mainly to that developmental stage.
Does anyone have a reference regarding SELECTIVE crossing of natural oxytocin vs synthetic?
I believe the findings of this study to be credible because oxytocin is involved in the digestive system via the vagus nerve. It creates a positive feedback loop that stimulates the digestive juices when we anticipate a good meal, then we feel pleasure as we eat, which stimulates more oxytocin production, which facilitates digestion. While synthetic oxytocin is chemically identical to the real thing, its actions are different. Animal research has suggested that when a substance binds for the first time to its receptors, it sets a pattern for the life of the organism. So if what binds to oxytocin receptors in a newborn is Pitocin/Syntocinon, that would have to have subtle effects that are different from those of oxytocin. My doctoral research on the relationship of oxytocin use at birth and psychosocial functioning in three-year-olds found a number of colicky babies who became picky eaters. I also found statistically significantly fewer mothers who received Pitocin to be exclusively breastfeeding at 6 months than mothers who did not get Pitocin. I’d say this is a line of research very well worth pursuing further.
Thanks Claire for your input and sharing your doctural research findings.
Thanks to all for your thoughtful comments. Although the research is in its infancy at this point, I find it interesting primarily because it continues the questions and conversation about how birth practices might impact lactation outcomes. I hope we will see further studies from this research group in the future!
This is great!
Any chance you have any information effects of breastfeeding for babies going through opiate withdraw? Or maybe u can do the first study 🙂
It is important to remember synthetic oxytocin (pitocin) does not cross the blood brain barrier in the same manner/doses as natural oxytocin.
The baby is over saturated with an artificial mimicking substance. Where mom has far less oxytocin influence than in a natural labor.
It is not surprising at all that they are out of sync.
@Gina–I found a few articles on methadone and breastfeeding. Here’s one that might be helpful. http://www-ncbi-nlm-nih-gov.ezproxy1.lib.asu.edu/pmc/articles/PMC2689552/?tool=pubmed Best of Luck!
Thank you for sending me that article, the only problem is that you need an ASU username and password. Any chance you could copy and paste it onto an email for me? gina.pemberton@gmail.com
Does the use of synthetic oxytocin postpartum have any affect on mom’s body that could change the outcome of attempts to breastfeed? What about postpartum depression, when milk comes in, afterpains, and bonding?
@Gina–sorry about the link, check your email!
@christianlady–I don’t think we really know yet. Lots of great ideas for research!
Natural oxytocin and ADH (antidiuretic hormone) are both stored in the posterior pituitary. Partial similarity in the molecules of the two hormones permits each to attach to binding sites of the other(at least, in certain situations). Nature is a smart old gal. When an MER is stimulated by Oxytocin, the myoepithelial cells surrounding the alveoli contract and expel milk into the ducts (presumably to be soon removed by the baby.) Nature will need H2O stored close to the lactocytes lining the alveoli to help make the next “batch” of milk. So to help this be “automatic”, the oxytocin molecule can also function in the kidneys to cause them to reabsorb and retain some of the fluid they would otherwise eliminate. The synthetic pitocin molecule is also capable of attaching to ADH binding sites in the kidney. So my long-time clinical observations are that Pitocin used for induction, augmentation and/or 3rd stage management seems to contribute proportionately to postpartum edema. (In the breasts, this edema often interferes with efficient latching and effective milk removal in the first 7-14 postpartum days, and by contributing to overhydration, may even cause delay in Lactogenesis-2.) This specific effect of pitocin on early initiation, in itself, would seem to have some possible relation to breastfeeding rates in the subsequent months. For this reason, I have stated that “Breast Edema is an elephant in the postpartum living room.”
for Mom who delivered after 3 hrs labor, bled a 4-5 pads the 2-6 hrs after delivery, started IV Oxytocin 1 hr after delivery, then baby nursed 1 hour good latch, then baby 95% slept the next 15 +hrs not wanting to nurse. Could oxytocin suppressed baby nursing reflex? Baby at 24 hours now.
Thank you for pointing out this extremely important fact: “The relationship found between oxytocin dose and infant suck in this study is a correlation only, and provides no evidence that higher doses of oxytocin caused the depression in sucking behavior.”
In fact, as a layman, I find the most probable explanation to be that some women have naturally low oxytocin levels, which leads to administration during labor and also is correlated with lower rates of breastfeeding. Why do so many people love to make quick causalities instead of searching for latent variables?