Is there a correlation between PTSD after childbirth and trouble breastfeeding? Absolutely!

I tried breast feeding, but it didn’t work. I tried until my nipples were cracked and bleeding. Due to the trauma I went through, I wasn’t producing enough milk. Plus my baby had colic and was jaundice, so we were forced to switch him to formula. I was devastated. I felt like a failure: I couldn’t give birth vaginally, I didn’t have any maternal bond with this baby that kept crying, and to top it all off, I wasn’t producing any breast milk. Three strikes, I’m out. I must be broken. But there were other things going on in my body that I was not aware of...

Cheryl Beck's recent study, "Impact of Birth Trauma on Breastfeeding," published in Nursing Research in 2008, states that traumatic childbirth can be a "pivotal factor that can impact breastfeeding."

Stressful labor and delivery, emergency cesarean birth, and psychosocial stress or pain due to childbirth are documented risk factors for delayed lactogenesis, which is the initiation of plentiful milk secretion.
One of the cardinal posttraumatic stress symptoms is avoidance of stimuli or triggers related to the original trauma, which can distance mothers from their infants because they are constant reminders of the original trauma the women endured.

She goes on to say that the type of delivery mothers experienced was also a factor in delaying breastfeeding. Women who had experienced longer labors also had elevated adrenaline levels in their blood which resulted in lower milk volume. Compared with women who had vaginal births, mothers who had cesarean deliveries had a lower level of oxytocin, which is a critical hormone needed for successful breastfeeding. (Beck, 229)

According to www.oxytocin.org:

The hormone, oxytocin, which is produced naturally in the hypothalamus in the brain, stimulates uterine contractions, and allows the breasts to "let down" milk in pregnant and lactating women. The hormone is naturally released in response to a variety of environmental stimuli including nipple stimulation in lactating women, and uterine or cervical stimulation during sex, or as the result of a baby moving down the birth canal.

In China, which enjoys a far lower birth-related morbidity rate than the United States, cool showers, which would stimulate the nipples and cause the brain to release its own oxytocin, are advised when labor needs a boost. In the United States, too, midwives have long known the benefits of applying ice to the nipples of women whose labor is stalled.

Childbirth Connection goes on to describe how oxytocin, along with other hormones affect the process of labor and birth:

It can be especially helpful to know about three of the many hormones involved with reproduction: oxytocin, endorphin, and adrenaline. These hormones play a major role in regulating the process of labor and birth.

Learning about these can help a woman understand what will happen during labor and birth. Women and caregivers can take actions that support or disrupt effective action of these hormones. So, understanding how they work and how they are affected is important for making informed decisions.

What is the role of oxytocin during labor and birth?

Oxytocin is often known as the "hormone of love" because it is involved with lovemaking, fertility, contractions during labor and birth, and the release of milk in breastfeeding. It helps us feel good, and it triggers nurturing feelings and behaviors.

Receptor cells allowing a woman's body to respond to oxytocin increase gradually in pregnancy, and then sharply in labor. Oxytocin is a potent stimulator of contractions, which help to dilate the cervix, move the baby down and out of her body, give birth to her placenta, and limit bleeding at the site of the placenta. During labor and birth, the pressure of the baby against the cervix and then against tissues in the pelvic floor stimulates oxytocin and contractions. So does a suckling newborn.

Low levels of oxytocin during labor and birth can cause problems by:

• causing contractions to stop or slow, and lengthening labor
• resulting in excessive bleeding at the placenta site after birth
• leading providers to respond to these problems with interventions.

What is the role of endorphins during labor and birth?

Endorphins are calming and pain-relieving hormones that people produce in response to stress and pain. The level of this natural morphine-like substance may rise toward the end of pregnancy, and then rises steadily and steeply during unmedicated labors. (Most studies have found a sharp drop in endorphin levels with use of epidural or opioid pain medication.) High endorphin levels during labor and birth can produce an altered state of consciousness that helps women flow with the process, even when it is long and arduous. Despite the hard work of labor and birth, a woman with high endorphin levels can feel alert, attentive, and even euphoric as she begins to get to know and care for her baby after birth. Endorphins may play a role in strengthening the mother-infant relationship at this time. A drop in endorphin levels in the days after birth may contribute to the "blues" that many women experience at this time.

Low levels of endorphin can cause problems in labor and birth by:

• causing labor to be excessively painful and to feel intolerable
• leading providers to respond to this problem with interventions.

What is the role of adrenaline during labor and birth?

Adrenaline is the "fight or flight" hormone that humans produce to help ensure survival. Women who feel threatened during labor (for example by fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labor or stop it altogether. Earlier in human evolution, this disruption helped birthing women move to a place of greater safety.

Too much adrenaline can cause problems in labor and birth by:

• causing distress to the unborn baby
• causing contractions to stop, slow, or have an erratic pattern, and lengthening labor
• creating a sense of panic and increasing pain in the mother
• leading providers to respond to this problem with cesareans and other interventions.(www.childbirthconnection.org)

In December 2007, the National Center for Health Statistics released the preliminary U.S. national cesarean rate for 2006: 31.1%. This rate has increased by 50% over the past decade, reaching a record level every year in this century (see chart below).

With the rising number of obstetric interventions, and cesarean deliveries in the United States, the number of mothers who experiencing trauma during birth is going to rise as well.

Cheryl concludes her study with some suggestions to help health care providers respectfully support ALL mothers who want to breastfeed their babies:

• Always ask permission before touching a woman's breast to assist with breastfeeding.
• Be attentive to symptoms that may be indicative of a mother having experienced a traumatic birth, such as...
  1. being withdrawn
  2. having a dazed look
  3. having temporary amnesia
  4. being distracted and detached from her infant while breastfeeding
• Prior to discharge from the hospital, it should be determined whether or not a mother perceives her labor and delivery as being traumatic. If she has experienced trauma, she can be immediately referred to a mental health care provider, and followed more closely once they are at home.
• Let women know that they have the right to choose not to breastfeed without guilt or judgment. Pressure to continue breastfeeding may compound their feelings of shame and inadequacy.(Beck, p. 235)

Also Read: Is Breast Always Best?by Karen Kleiman, MSW

References:

• Barker, Susan E. Cuddle hormone: Research links oxytocin and socio-sexual behaviors. http://www.oxytocin.org/cuddle-hormone/index.html
• Hormones Driving Labor and Birth. http://www.childbirthconnection.org/article.asp?ck=10184
• Beck, Cheryl et al. Impact of Birth Trauma on Breastfeeding. Nursing Research, July/August 2008, vol. 57, no. 4, pp. 228-236.