Effects of some ward routines on behavioural and physiological adaptation to breast-feeding

Abstract: The overall aim of this thesis was to study how early breast-feeding would be influenced by pethidine given during labour and by an emergency Caesarean section. Eighteen mother-infant pairs which were exposed and 26 which were not exposed to pethidine during labour were observed the first two hours after birth. The infants were put skin-to-skin on their mothers' chest. The developing breast-feeding behaviour was observed. It was found that the pethidine exposed infants had a delayed and depressed sucking and rooting behaviour. Infants with a short dose-to-delivery interval had the most depressed sucking behaviour and infants with high concentration of pethidine in the umbilical cord did not suck the breast at all during the observation. Seventeen primiparous women who had had an emergency Caesarean section and 20 women who had had a vaginal delivery were blood sampled during a breast-feeding two days after childbirth and oxytocin, prolactin and cortisol levels were measured with RIA. Women who had had vaginal delivery had a pulsatile oxytocin the first ten minutes of breast-feeding (ranging from 1-5 pulses) pattern and elevated levels of prolactin 20-30 mimltes after the onset of breast-feeding. The number of pulses was related to the amount of milk the infant ingested during the studied breast-feed and the duration of exclusive breast-feeding. Women who had had a Caesarean section had significantly fewer pulses of oxytocin (ranging from 0-3) and no elevation of prolactin. The number of pulses was related to the amount of milk the infant ingested during the studied breast-feeding in both groups. Regression analysis showed two factors to be of importance for for the differences in oxytocin patterns between the groups and that was the absence of a second stage of labour and a delayed first suckling occasion. Cortisol decreased significantly in both groups. The personality inventory, the Karolinska Scales of personality, were filled in on the second day by the mothers described above and on the day of partus by 13 primiparae and 16 multiparae and were compared with a normative group of women. The results showed that women who had had a vaginal delivery scored lower in anxiety variables and higher in socialisation than the normative group. In addition the multiparous women but not the primiparous women showed similar differences on the day of partus. The women who had had a Caesarean section did not show these differences. Basal levels of oxytocin were inversely correlated with anxiety scores in mothers with a Caesarean section and the number of pulses of oxytocin were correlated with social desirability in the women who had had a vaginal delivery. The data give further support for the importance of early breast-feeding for some maternal adaptations, such as milk production and behaviour. Furthermore, early interaction may together with labour influence maternal oxytocin secretion which may underlie some maternal adaptations. Two routines were found to disturb early suckling -pethidine given during labour and Caesarean section. Some suggestions as how to compensate for this are given. Key words: Breast-feeding, oxytocin, prolactin, cortisol, Caesarean section, newborn infant behaviour, pethidine. Stockholm, December 1996 ISBN 91-628-2269-1