Booby Traps Series: What your ‘cankles’ want you to know about breastfeeding

This is the tenth in a series of posts on Booby Traps,™ made possible by the generous support of Motherlove Herbal Company.

There are a lot of things I don’t remember about my first labor and birth, but I do remember one sight quite vividly:  my ankles.

I had a wonderfully bloat-free pregnancy, but a day or so after the birth of my first baby, my ankles looked like little bounce houses at the ends of my legs.  It had been a long labor which ended in a c-section, and in the process I was given bag after bag of IV fluid.

Why would you get lots of fluid in labor?  You might get some if you’re Group B Strep positive.  You might get more fluids if your labor is induced or augmented with pitocin.  You’ll probably get some if you have an epidural, and you might get even more if you have a c-section.  By the time it’s all over you might have gotten some fluids for exhaustion.

I had a number of these interventions, and not surprisingly my body retained a lot of fluid.  That was obvious from the dents I could make in my legs.

What wasn’t as obvious was how having a lot of fluid in labor can affect breastfeeding.  Here are a few of the Booby Traps™ lurking in your IV line:

Breast edema

When you’ve had a lot of IV fluids in labor, the fluid can collect in certain areas, including your breasts.  This fluid retention is called edema, and while it may be mistaken for engorgement, it’s quite different.  It can be very painful, and make it quite difficult for your baby to latch on and remove milk.

I once helped a mother once who had severe edema.  When we tried to use a pump on her breasts (which didn’t work, and was very painful – lesson learned), the flanges literally sunk into her breast, leaving an indented ring.

Linda Smith, in The Impact of Birthing Practices on Breastfeeding, notes that “edema inhibits or prevents the deep attachment at breast that is associated with effective milk transfer and adequate infant intake of colostrum and milk.  Milk stasis [not getting to your baby] is the chief cause of impaired or reduced milk synthesis; therefore, preventing milk stasis by ensuring early and effective milk transfer is the most critical strategy for ensuring normal lactogenesis.”

Got that?  Edema can make it hard for the baby to remove milk, which can cause you to not develop a milk supply adequate for your baby.

She also notes that oxytocin acts as an antidiuretic, and augmentation with it (as pitocin) can cause fluid retention.

One thing that can help if you have breast edema:  Reverse pressure softening.  This gentle manipulation of the waterlogged tissue, which involves making little indentations around the nipple, can help baby latch on and remove more milk.

Excess weight loss in your baby

A new study recently confirmed what some providers have suspected for a long time:  having lots of fluid on board can make a baby look like she’s losing too much weight.

The authors found that “intrapartum fluid administration can cause fetal volume expansion and greater fluid loss after birth, although other mechanisms are possible.”

In other words, some babies are born with extra fluid on board because of all of the fluids their mothers have received.   Their birth weights are inflated by this fluid, and when they shed the fluid it may appear that they are losing too much weight.  And you know how that story often ends.

Milk late coming in

We discussed the many causes for late onset of your mature milk in an earlier post, but it’s worth mentioning again.  Having lots of fluid can cause your milk to come in late, setting off a vicious cycle of sleepiness, (in some cases jaundice), poor milk removal, more sleepiness, supplementation, and eventual low supply. 

And finally, here’s the Booby Trap™ on top of the Booby Trap:™  not a lot of providers know about these problems and how to remedy them.

What to do?  Since the use of fluids is tied to a number of interventions that can occur during your labor – interventions which can sometimes be avoided with the right conditions -  we’d refer you back to my post on planning for a breastfeeding-friendly birth.  And if you run into any of these problems, be sure to seek help from a qualified breastfeeding support person.

Did you have cankles?  How did IV fluids affect your breastfeeding experience?



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31 Comments | Last revised on 06/08/2011


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31 Responses to Booby Traps Series: What your ‘cankles’ want you to know about breastfeeding

  1. Alice Turner says:

    This is a GREAT article. IV fluids are often presented as an intervention that carries no risk. The impact on breastfeeding isn’t considered.

    I have seen some moms avoid an IV during birth, only to get one after the birth because their provider wants to adminster Pitocin (for possible postpartum bleeding). If the provider insists upon Pitocin you can opt for a shot of it instead. That way you can avoid the IV fluids.

    Thanks for another great article BestForBabes!!

    • Haley says:

      You can also turn down the Pitocin after your birth altogether. It’s almost always unnecessary as it’s usually used for “inducing” the delivery of the placenta, which happens on it’s own anyways w/out Pitocin, just not always quite as quckly as OB’s prefer esp. if you’ve already had a long labor that kept your dr. there longer than they’d wanted.

      • Kimberly says:

        I did just that Haley. With my second daughter’s birth, which was completely intervention free, they tried to give me a shot of Pitocin afterwards to help deliver the planceta. It was the easiest in my case, since I delivered my daughter quickly in triage. I declined…it was unnecessary to have a shot of pit after my baby was born for the placenta that would come on its own. For the record, I had zero problems with pp bleeding. My attending OB seemed seriously irritated that I declined though.

  2. Abigail Marcus says:

    The best thing about my lightning-quick second birth is that they didn’t even have time to get an IV in me, so no IV fluids and no IV pit following birth (I got a shot instead). My recovery was SOOOO much easier than birth #1, no abnormal baby weightloss, no weird post-partum swelling, smooth sailing. Was something I didn’t realize until looking back on the 2 experiences. Love this article, I think it’s important to get the word out.

  3. Lynne says:

    I have long believed edema from IV fluids during labor was the main reason why breastfeeding was not possible for me. I was not advised that this was a risk of receiving fluids. I researched this suspicion without success, so I am delighted to see this article and especially the technique of reverse pressure softening.

  4. Angela V says:

    I avoided having an IV with baby #1 until they decided it was time for me to have a cesarean (after a 15 hr labor, 3 hrs of pushing, and baby still at 0 station). Just the IV administered on my way to the OR and, of course, during the operation was enough to give me some serious cankles. I hated them so much after priding myself on not having swollen ankles during pregnancy! I find the birthweight info very interesting. DS wasn’t too interested in breastfeeding (I didn’t even get to try until 3 hours after he was born!) and lost over 10% of his body weight so everyone was getting concerned. Perhaps he was just losing some of that water weight? Luckily, we avoided supplementing and were well on our way to a successful breastfeeding relationship within a few weeks. (Those first couple weeks were pretty rocky!) Thanks for the info!

  5. Thank you for posting about this. So important for moms to be aware of as so often the excessive weight loss after IV fluids leads to unnecessary supplementation which has been shown to shorten the duration of breastfeeding. An IBCLC in my area recently did her PhD thesis on this and found that the fluid given in the 2 hours immediately before delivery had the most impact on weight loss in the baby after birth. Her recommendation is that the 24 hour weight be used for all babies.

  6. karen says:

    This is fascinating! I was giving pitocin and my ankles were huge!!! I was horrified. My breasts were also enormous. My daughter was small and a little pre-term. We were completely harrassed about her weight gain since she lost weight during her first week. She gained well the second week and thereafter but that scare of the first week stuck with me for a long time.

  7. Sara W. says:

    I had this happen to me, and it was the biggest hurdle to breastfeeding I faced. Reverse pressure softening helped, but I didn’t have the luxury of learning about it until I could get home to my computer. I wish SO MUCH that it was better known–I was just told to pump a bit, which didn’t help and tore my nipples up for a week.

  8. eireanne says:

    I had a caesarean & lots of IV fluids. My ankles and feet swelled so bad that I couldn’t even tie my tennis shoes because the laces weren’t long enough to accomodate my gigantic feet. We got off to a rough start with bf’ing, as he was very sleepy & not very interested in nursing most of the time, and my milk took almost a week to come in. I wanted to quit on several occasions in those early weeks, but my amazing husband wouldn’t let me. My baby lost over 10% of his birth weight & I worried we would have to supplement. Fortunately, he gained a couple ounces in between weight checks, which was enough for his doc to say no to supplementing. Six months later, and we are thriving! I wondered if the IV fluids I received had anything to do with his crazy weight loss. Thanks for this article!

  9. Emily says:

    Yes! This!

    While my breastfeeding relationship wasn’t seriously harmed by my IV fluids, the EWL did scare me enough to supplement a total of about 3oz of formula on days 2 & 3 (never more than 1/2 oz at a time), until my milk “came in”. I know my DD was getting colostrum, but it was hard as a new mom to not think she needed “a little extra” since she was less fussy after getting a bit more in her tummy. Plus, it took time for us to get a really good latch, so my nipples were really sore & I felt I needed a break from the constant sucking. (It was either nursing or fussing – really no in between until my milk came in on day 4. Then it was months of OALD and oversupply…)

    This risk was also not discussed with me beforehand, but I’ve been feeling this way for over a year now. Thankfully we recovered from it & are still happily nursing at 17.5 months, and haven’t “needed” any formula since that third day.

  10. Skyfire says:

    This is exactly what happened to me with my first. Pitocin in an IV. On day three my boobs were enormous rocks; I thought it was engorgement. I had little support; “She can’t latch on; just give her formula!” With my second I had a non-medicated birth with no iv, and I was surprised to experience no engorgement at all. I feel that if I hadn’t had the fluids, or if I’d had the support to help me breastfeed despite the edema I would have been successful.

  11. Laura Ling says:

    Wow, I had all of those and just thought it was from pre-eclampsia, stress, and surgery. My only question is do the babies look plumper when they’re born? My daughter was so bony although I was on fluids for 26 hours before she was born. We let them supplement because she dropped a pound and was jaundiced and it took a week (6 days?) for my milk to come in.

    I wish I’d known these things going in… :(

    • Jessi says:

      I had preeclampsia as well with my first, at 41 weeks had to be induced, started me on pitocin and had the IVs which had magnesium sulfate i believe. I gained 70 lbs that pregnancy so i always had terribly large cankles… I do specifically remember them being worse after his birth though. I couldnt wear my own socks they were so huge. and my calves :( Healthy 9lb 6 oz boy though with no other interventions. And he always was way off the growth charts for height and weight. Bf was rocky at first and my body couldnt keep up with his rapid growth. I tried teas and upping my water intake and healthy diet and even opted for a prescription of heartburn meds called reglan to increase my supply. By 2 mo i was pumping and bfing but stopped by 5 mo after i had all of my wisdom teeth pulled and was on pain medicine so i had to pump n dump for days which completely screwed me over. My second child was born at my house in a huge tub of water, no interferances of any kind. For me to describe it i would have to say it was relaxing, easy, comfortable, and waaaay better than my hospital birth. She was 8lb 6 oz. by 4mo was 24 lbs on just breastmilk. shes 9&1/2 mo old and still breastfeeding like theres no tomorrow. And is at about 27lbs.

  12. ania says:

    OMG!!!! Even though I dodn’t have epidural, they gave me fluids just in case. My milk came 5 days after giving birth I thought I will die. I had to feed my child formula for 2 days and then he didn’t know how to latch, but after a week he figured it out. It was the most horrific week of my life. I wanted a natural birth and my dr promised me whatever I wanted, In the end I was put through regular interventions.I can’t get over it and next time I’m doing birthing center or I will deliver home if I have to

  13. Brigitte says:

    After my labor I discovered how very important it is to reasearch, research, research your hospital and doctor’s protocols early in your pregnancy. I filled out my birth plan and then fell victim to a series of protocols b/c my water broke early and my son kept having signs of distress. Lots of IV fluids was the first thing they did. I lost count of how many bags and I was so sad about the sight of my body after I had my son. I was so bloated my clothes and shoes didn’t fit and I’d gained about 15 lbs from fluids. (I only gained 10lbs before that and could still wear pre-preg clothes during pregnancy) My milk never fully came in no matter how hard I tried and since docs tend to not take inability to BF seriously I don’t know if it’s because of possible IGT (what LCs said) or interventions.

    Oh, I don’t know if I can actually suggest treatments here but one of the things I tried for milk was accupuncture (based on research we did) marginal improvement in milk supply but within 24 hours most of the water retention was gone.

  14. Chris Mulford says:

    During the 1980s I attended many hospital births as a newborn nursery nurse, and one of my tasks was to put ID bracelets on the baby’s ankles. Standard operating procedure was to make the bracelet quite tight, with just enough room to slip the tip of your little finger underneath. This was tight enough to keep the bracelet from slipping off. But routinely on the second or third day, the bracelets were loose enough to slide right off over the feet. The bracelets did not change size. It was the babies’ ankles and feet that got smaller. I hypothesized at the time that the moms’ IV fluids–they were given with a generous hand–were pooling in the babies’ ankles, but I had no power to influence the care routines in L&D…a different department. I guess babies can have “cankles” too!

  15. If By Yes says:

    I had fluids for nearly 24 hours leading up to the birth of my child, but I experienced no problems. In fact, since my labour was 52 hours long and I couldn’t keep down any fluids – vomiting them up as quickly as I could drink them – I think the fluids (which were given as part of Group B strep protocols) probably helps me maintain basic hydration. I had cankles during pregnancy but they disappeared within a day of my (vaginal) birth… My son is breastfeeding well and I was grateful for those fluids.

    • Tanya says:

      There’s no question that fluids are sometimes necessary to maintain adequate hydration. In fact, I desperately needed extra fluid in my second labor and birth (hot day, I refused to eat or drink, long labor). It sounds like they were very important in your case, too!

      The problem is that the cumulative effect of a lot of fluid can cause breastfeeding problems, that providers and mothers are often unaware of this, and that providers are often unskilled at handling the problems in a manner that protects breastfeeding when they do arise.

      • Jessi says:

        I literally drank an entire 24 pack of bottled water during my homebirth, with 2 boxed juices. Within 12 hours.

  16. Wouldn’t it be amazing if we could ensure that EVERY pregnant woman read EVERY ONE of these Booby Trap blog posts before giving birth….

  17. rachel says:

    Interesting…something I hadn’t given much thought to before. I had an intervention-free homebirth with my first son and my ankles were actually slimmer in the first days after the birth than they have been in my entire life! Hooray for natural diuresis! Not to brag, but just point out the difference between this and a typical hospital birth. Although my recovery was not so easy due to heavy bleeding from tears and pain from the tears themselves.

  18. Jennifer says:

    Long labors ending in c-sections with both kids, lots of IV fluids both times and “excessive” weight loss both times and perhaps some delay getting milk–maybe 4-5 days. Led to supplementing both times in order to be allowed discharge. Annoying b/c even though after getting out of hospital I exclusively bf both I can’t answer the question that way on surveys because they both got some formula in the hospital.

  19. Melissa H. says:

    Amen! My oldest was born in the hospital, the only intervention being IV fluids and abx. I know my drip was off and I received a flood of fluid. My milk was late coming in, and my son lost over 10% of his body weight. I have since had three homebirths with no interventions. My milk always came in promptly, and my babies did not lose weight as is “normal” after birth.

  20. Angela says:

    My daughter’s birth weight was definitely inflated due to IV fluids. Althought I knew that in my head, I still wavered a few days later when DD was having trouble getting enough milk. It’s good to have this info now, both of my sisters are pregnant and I’ll definitely pass it on!!

  21. Chelsea R. says:

    What a perfectly timed article for me! I just had my second baby this past Sunday…totally different from my first! My first was born only half an hour after getting to the hospital so I never got any fluids. With this second one, I labored for 17 hours, all natural, but they sure did pump me with a lot of fluids! My ankles are HUGE today and it never even occurred to me until this article that it might be from all the fluids I got. I have never retained water in my life until now! I’m not sure how it’s effected my milk supply though. My baby is in the NICU this time around so I’m pumping full time. thanks for the article!

  22. E. says:

    Thank you for mentioning birth weight. This is something no one tells you when you ask about the risks of an IV during labour.

    For me, having an IV resulted in several days of panic (including a nurse cornering me as I sat naked on a toilet, pressuring me to give my baby formula) over whether our baby was gaining enough weight. Once we were at home, a public health nurse looked at my file and said, “Oh, you had an IV? His weight is probably artificially high, there’s likely no need to worry.”

    I’d already been having enormous difficulty with breastfeeding – I really didn’t need to have that anxiety on top of that. Fortunately I struggled through and am still BFing at 1 year. But I blame a lot of complications during my recovery on that IV. My bladder was distended and I had to have a Foley catheter for 24 hours. They don’t warn you about that possibility when they’re putting an IV in. They say, “it’s just water!”. Yeah, right.

  23. Comadrona says:

    Yes, fluid overload and definitely Syntocinon (Pitocin) will do it. Even women who have “only” had the Synto injection for the placenta can be affected. We should be campaigning for a serious reduction in induction rates (get over the stupid “due date” obsession) and implementing physiological third stage – it’s a no brainer!

  24. manda says:

    I was induced, given multiple bags of fluids, eventually had a c section, and on top of all the emotional and physical trauma, my legs and feet swelled up so big, I actually developed stretch marks on my thighs from my crotch to my knees the day AFTER my son was born! I was huge. I was so upset! I was fatter after I had my baby! My son was also swollen. His fingers and toes looked like little sausages. His birthweight was 8lbs 4oz and 3 days later when we were discharged, he was down to 7lbs 6oz, and then down to 6lbs 10oz at 7 days. I figure the 7.6 was probably closer to his true birthweight. Luckily we have a bf friendly dr and she trusted our instincts and sent us off with instructions to bf often and weigh him again a week later.

  25. Kim says:

    This describes my situation to a T. I was group B strep positive, so I was given fluids as soon as I checked in to the hospital. Then because I wasn’t dilating, I was given more fluids and pitocin. The pitocin was so intense that I ended up asking for an epidural. So you guessed it… more fluids. I guess it’s not surprising that I had huge cankles for a week.

    My son was ultimately delivered via C-section and weighed 9 lbs 12 oz at birth (98th percentile). We tried BFing but he had troubles latching, in part because my breasts were so swollen. By the time he was a week old, his weight was down to 8 lbs 2 oz (62nd percentile), so the pediatrician had us start supplementing with formula. Later the lactation consultant I worked with suggested that his birth weight had probably been artificially inflated from all the fluids. I ended up having to pump exclusively because we never could sort out the latch issues, but I’m happy to say that I’m finally producing enough milk to keep up with my son’s needs.

    There are so many things I know now that I wish I knew when I started this journey. Thanks for helping to spread the word about these issues that can complicate breastfeeding.

  26. jj says:

    I had IV fluids in an otherwise uncomplicated vaginal birth because I had been vomiting continuously starting in the earliest parts of my labor and was dehydrated. In cases like mine, it’s a legitimate intervention, and I did not have edema that affected breastfeeding. However, I blew out 3 IVs during active labor and had a lot of resultant swelling in that hand and wrist… within a few months I had De Quervain’s tendonitis in my wrist which DID make nursing extremely painful (for my hand and arm) for several months. Not insurmountable, but really annoying.

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