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.