Pitocin and Breastfeeding

Synthetic Oxytocin and Depressed Newborn Feeding Behaviors; Could There be a Link? Posted on May 1, 2012by Robin Kaplan 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. Share this: Facebook849 Twitter31 Pinterest Google +1 Email More Like this: ★Like One blogger likes this. This entry was posted in Research and tagged Jennie Bever Babendure, oxytocin. Bookmark the permalink. ← High Levels of TRAIL Protein in Breast Milk Might Contribute to Anticancer Activity Meet Our ILCA Staff – Ashley Lehman → 19 Responses to Synthetic Oxytocin and Depressed Newborn Feeding Behaviors; Could There be a Link? DAWN says: May 1, 2012 at 3:02 pm 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. Reply Petra Hoehfurtner says: May 2, 2012 at 7:58 am 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? Reply Amber says: May 2, 2012 at 4:36 pm 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. Reply Lisa Piazza says: September 8, 2012 at 8:57 am 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. Reply Lisa Piazza says: September 8, 2012 at 8:59 am Does anyone have a reference regarding SELECTIVE crossing of natural oxytocin vs synthetic? speaking4baby says: May 5, 2012 at 4:26 am 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. Reply lactationmatters says: May 5, 2012 at 11:11 am Thanks Claire for your input and sharing your doctural research findings. Reply breastfeedingscience says: May 9, 2012 at 9:48 pm 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! Reply Gina says: May 18, 2012 at 4:05 am 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 Reply Karen says: May 18, 2012 at 11:50 am 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. Reply breastfeedingscience says: May 21, 2012 at 5:33 pm @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! Reply gina pemberton says: May 22, 2012 at 3:03 am 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 Reply christianlady says: May 23, 2012 at 7:14 am 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? Reply breastfeedingscience says: May 24, 2012 at 4:58 am @Gina–sorry about the link, check your email! Reply breastfeedingscience says: May 24, 2012 at 5:00 am @christianlady–I don’t think we really know yet. Lots of great ideas for research! Reply Pingback: Study links Synthetic Oxytocin and Depressed Newborn Feeding Behaviors | Louise Powers – Qi Healer and Doula Pingback: Let’s Celebrate: World Breastfeeding Week and Happy Birthday, Lactation Matters! | Pingback: Study links Synthetic Oxytocin and Depressed Newborn Feeding Behaviors | Qi Healer, Birth and Postpartum Doula – Assisting mothers and families in Princeton, Flemington and surrounding areas in NJ & PA. K. Jean Cotterman says: October 8, 2012 at 7:37 pm 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.” Reply Leave a Reply Enter your comment here...

The human milk microbiota plays a role in health of the infant | InfantRisk Center

The human milk microbiota plays a role in health of the infant | InfantRisk Center

Biological Nursing

Biological Nursing: a relaxing approach to latch by Martha Peelor, RN, IBCLC. by Breastfeeding Center of Pittsburgh on Thursday, November 15, 2012 at 8:21am · . Over the last 40 years, first as an LLL leader (1971) and then as an IBCLC (1985), I have been privileged to observe, assist and encourage countless mothers and babies as they begin the dance of breastfeeding. I taught pre-natal breastfeeding classes and I have been able to see new mothers with their babies in their homes, at meetings, in the hospital and now, in the pediatrician’s office for their first one or two visits. In all of these settings, both before and after the baby was born, I have found that most mothers, fathers and other family members have a mental picture of the new breastfeeding couple. Usually, mom is in a rocking chair, in a beautiful new nursing gown. She is holding the baby in the cradle hold, leaning over the baby and gazing adoringly into the baby’s eyes. There is usually no sign of pillows supporting the baby or the mom’s arms. What we don’t see in this picture is the pain in mom’s eyes and face as she sits on her sore perineum or holds the baby tight against her cesarean incision; the tension in her body as she struggles to hold the baby’s weight; the ache in her back, neck and shoulders from leaning over the baby; and, the pressure she is exerting on the baby’s back or head to keep the baby from rolling too far into or away from the breast. While the football and side-lying positions change the above dynamics, many new moms find these positions problematic as well. These are the ones I knew, however, and these were the positions I taught new mothers. A few years ago, at an International Lactation Consultant Association conference, I had the opportunity to hear Suzanne Colson, PhD, MSc, BA, RGN, RM and Honorary Senior Midwifery Lecturer at Canterbury Christ Church University, speak about Biological Nurturing. Her research, video and discussion of the value of “laid back breastfeeding” totally amazed me. If you are not familiar with her work, please do yourself the favor of going to her website, biologicalnurturing.com and checking it out. I returned from that conference as a fervent convert to the concepts involved in BN. These include the release of neonatal reflexes which help baby to latch and the importance of gravity with the baby in a full frontal position in optimizing the baby’s ability to find the breast and nipple and achieve a deep, asymmetric latch. There is a lot more to BN than these two concepts but they were the main ones I brought home. In my office/lactation room at work, there is a small, cushioned recliner for the new mom to use while we do a consult. Mom and I talk about the positions she has been taught and I ask her if she would like to learn a new one that will be very comfortable for both her and baby. Most moms were glad to do that but not all were thrilled about the idea of nursing in that position. (Remember the mental picture above?) However, when I tell them that their babies might do an amazing thing (self latch) it makes them more willing to try. The moms who have latch problems or sore nipples or problems keeping the baby awake are very happy to try this “radical” way of breastfeeding. So mom takes her shirt off and we fix the recliner so that she is lying at about a 45 degree angle. Then we put the undressed baby face down between the breasts and watch what happens. Most of you have probably watched one of the “self-attachment” videos showing the newly-born baby crawl up the mom’s belly to her breast and start nursing. During a consult there is a lot to do and a limited time so mom helps the baby to the breast and puts her by the nipple. The baby then bobs around, lifts his head, does some pushing with her feet and legs and brings his head around in alignment with the nipple. There is usually a quick, deep latch, face down and then the baby turns her head to the side as he starts to feed. A pillow is put under the mom’s arm on the side where she is stabilizing the baby. The look on the mom’s face is priceless. Two wonderful things have happened. The first is that she is not sitting on her perineum; she is sitting on her sacrum. So that pain is gone. Her body is relaxed and completely supported. There is no tension in her neck, shoulders or back. Since the baby can feed this way in a vertical, horizontal or oblique lie, mom does not need to have the baby’s weight on an incision. Unless she is supporting a very large or pendulous breast, her opposite hand is free. The second wonderful thing is that the baby, who may have been really struggling with latch, generally gets on with very little trouble. This is wonderful for both mom and baby. Most babies nursing this way have very effective feedings; they are less likely to fall asleep because of poor milk flow. Moms often say that this was the best feeding the baby had ever had! The laid-back position (someone needs to find a name for it) has worked really well for the moms who have tried it. Every mom has loved nursing this way and if the babies could talk, I know they would agree. This position can be used even if the baby is using a nipple shield to latch. I primarily see moms and babies in the first week post-partum so I haven’t used this position with older babies. However, on the Biological Nursing website, there is a wealth of information and pictures which involve new babies and older babies as well. . Unlike · · Share

Breastmilk and stem cells

Human milk contains PLURIPOTENT stem cells Stem cells are present in human breast milk. These cells can become many different kinds of cells. The cells can be non-invasively collected and studied in vitro. These findings have implications for infant development and regenerative medicine. Last month during the Bi-Annual Meeting of the International Society for Research in Human Milk and Lactation in gorgeous Trieste, Italy, one could hear a pin drop when Dr. Foteini Hassiotou presented her and colleagues’ ground-breaking work on human stem cells in breast milk. Most of us are familiar with embryonic stem cell research as potentially revolutionary for medical science and human health. This is because during embryonic development, all of our adult tissues derive from three initial germ layers - the endoderm, the mesoderm, and the ectoderm. In this way, embryonic stem cells are pluripotent, which means that the cells have the capability to develop into any of the 200 cell types in our body. However, significant controversy surrounds embryonic stem cell research, constraining research efforts on this topic. Adult stem cells exist, but they are generally more limited in terms of the types of cells they can become- known as multipotent. Although the presence of adult stem cells had been known to occur in mammary tissue, the presence of stems cells in breast milk was established by Cregan and collegues in 2007. Their initial research suggested that these cells were multipotent and could develop into a limited number of subsequent cell types. In 2010, the multipotent features of stem cells in breast milk was confirmed by researchers in India (Patki et al., in 2010). Dr. Hassiotou and colleagues have now established that pluripotent stem cells are active in the lactating breast and can be non-invasively collected from breast milk (2012). Embryonic stem cells have a “core-circuitry of self-renewal” through the transcription of particular genes (OCT4, SOX2, NANOG, SSEA4, & three transcription factors (TFs)) (Hassiotou et al., 2012). hBSC show similar patterns of gene activity that allow for the stem cells to replicate. hBSC were not found in nonactive mammary tissue. Rather, hormonal cues during pregnancy and lactation seemingly activate the stem cells within the mammary gland. Moreover, hBSC are localized within particular areas of the lactating breast. For example, cells expressing TFs were more prevalent in the myoepithelial layer, but much less prevalent in the lumen, ducts, or alveoli. Most excitingly, in vitro investigation of hBSC revealed that cells differentiated into cell types of all three germ layers, suggesting pluripotency. For example, hBSC can become neural cells and cells that express insulin, including many others! In general, discussion of stem cells usually turns to regenerative medicine. Proponents for developing stem cell therapies hypothesize that stem cells could be used to treat patients with spinal injuries, neurodegenerative disorders such as Parkinson’s, or Type I diabetics, whose islet cells in the pancreas no longer produce insulin. However, from an developmental biological perspective, I am most intrigued about what these hBSC may do when ingested by the infant. Hassiotou and colleagues suggest that hBSC may behave similarly to immunofactors in the infant, crossing into the infant’s bloodstream and playing a role in tissue repair and development. The discovery of pluripotent stem cells in human milk is a game changer, whether your perspective is regenerative medicine or developmental biology. Research on pluripotent stem cells can now potentially rely on hBSC collected non-invasively, reducing reliance on human embryonic stem cell research. Within the neonate, these stem cells ingested via breast milk may contribute to developmental programming for health and metabolism later in life. We can further hypothesize that stem cells in breast milk may be critically important for tissue development and repair in pre-term and NICU infants. Although there are only a handful of studies on this topic, the implications of this discovery cannot be overstated. I know I am not alone among my colleagues in eagerly anticipating the next discoveries in human breast milk stem cells. Cregan MD, Fan Y, Appelbee A, Brown ML, Klopcic B, Koppen J, Mitoulas LR, Piper KM, Choolani MA, Chong YS, Hartmann PE. (2007) Identification of nestin-positive putative mammary stem cells in human breastmilk. Cell Tissue Res. 329:129-36. Hassiotou F, Beltran A, Chetwynd E, Stuebe AM, Twigger AJ, Metzger P, Trengove N, Lai CT, Filgueira L, Blancafort P, Hartmann PE. (2012) Breastmilk is a novel source of stem cells with multilineage differentiation potential. Stem Cells. 30:2164-74. Patki S, Kadam S, Chandra V, Bhonde R. (2010) Human breast milk is a rich source of multipotent mesenchymal stem cells. Hum Cell. 23:35-40. Contributed by Prof. Katie HInde Human Evolutionary Biology Harvard University Return to SPLASH! front page Are you subscribed to our email newsletter? Sign up for our email newsletter Document Actions Send this Print this Our Sponsors Our sponsors are passionate about milk science and are great supporters of the milk science community.

Breast Milk During the Storm

Breast Milk During the Storm: With Power Gone, Moms Safeguard their Stash By Bonnie RochmanNov. 01, 20122 Share inShare0 Image Source / Getty Images Related 20 Ways to Make Breast-Feeding Easier Bloomberg’s Breast-Feeding Plan: Will Locking Up Formula Help New Moms? Boob Tube: A New Reality Show About Extended Breast-Feeding? Who Cares Email Print Share Facebook Twitter Tumblr LinkedIn StumbleUpon Reddit Digg Mixx Delicious Google+ Comment Follow @TIMEHealthland Eliza Stein hardly remembers what clothing and baby gear she grabbed on her way out of her New York City apartment when her family lost power, but she did make sure to bring along one vital item: her breast milk. She descended 35 floors in the pitch-black stairwell of her Chelsea high-rise, her 11-week-old son in one arm and 50 bags of frozen milk in the other. Stein deposited her stash in a freezer belonging to the parents of a friend. “It’s kind of like liquid gold,” she says. “I can’t just let it go to waste.” With power out in much of New Jersey and swaths of New York in the aftermath of Hurricane Sandy, breast-feeding moms have been frantically making arrangements and matches, scouting out available freezers and using Facebook to link up those with thawing breast milk with those lucky enough to have electricity and freezer space to spare. Pumping breast milk is a time-consuming proposition, and many mothers have spent dozens of hours stockpiling milk they rely upon to nourish their infants when they return to work after maternity leave. That’s the case with Frances Ames, who was supposed to return to her job as an attorney this week now that her infant daughter is 3 months old. Ames, from Maplewood, N.J., has spent the past month collecting and freezing milk for her baby. With power gone, she’s added ice and dry ice and has been running a generator intermittently to keep the milk cold. All the food in her combination refrigerator/freezer could potentially spoil, but, says Ames, “I don’t care about anything else except for the breast milk.” (MORE: Storm Sandy Closed Schools, But Were Officials Too Eager to Cancel Class?) Breast milk, bursting with antibodies, is actually a pretty hearty substance, says lactation consultant Katy Linda, who created tips on preserving breast milk to help moms prepare for the storm. Breast milk placed in a full freezer should remain frozen for 48 hours. And breast milk that’s gone slushy is still considered frozen, according to the Human Milk Banking Association of North America. And research in the journal Breastfeeding Medicine suggests that even thawed breast milk that’s been unrefrigerated for up to eight hours can be safely refrozen. If in doubt, says Linda, use common sense, and take a whiff before feeding thawed milk to baby or refreezing it. “If it’s gone bad, it will smell bad,” she says. “You will know.” For moms who produce too much milk and typically freeze the surplus, being faced with having to “pump and dump” borders on lactation sacrilege. Moms without electricity in Sandy’s aftermath can use manual pumps — rudimentary gadgets they’ve rarely, if ever, used — instead of electric ones to maintain their milk supply. But they’ve got nowhere to store the milk they extract. That’s why some are donating their milk to babies who need it, via a Facebook page maintained by the New Jersey chapter of Human Milk for Human Babies, a group that fosters milk sharing. Many experts caution against mom-to-mom donation, since private donations aren’t screened for disease or pasteurized as are donations to official human milk banks. But many mothers are at ease with the concept, rationalizing that if a donor mom feeds her breast milk to her own baby, it’s probably safe. (MORE: Milk Banks vs. Milk Swaps: Breast Milk’s Latest Controversy) In Montclair, N.J., which has been without power since the storm hit, Chelle Hayes has been serving Read more: http://healthland.time.com/2012/11/01/breast-milk-during-the-storm-with-power-gone-moms-safeguard-their-stash/#ixzz2AygaFwAF