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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