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Do labor drugs affect infant suckling after birth?

December 2015

In a newly published study, Brimdyr, Cadwell, Widstrom, Swensson, Neumann, Hart, Harrington, and Phillips present new research to add to the growing body currently available on the negative effects of labor medications on the sucking behaviors of full-term, healthy newborn infants in the first hour following birth.  It has been well-established that positioning the newborn in skin-to-skin care immediately after birth has beneficial effects on the short and long-term health of both mother and infant.

"It is also accepted that maternal medications, including fentanyl, can be transferred from the epidural space to the fetus through placental circulation with a fetal maternal transplacental fentanyl transmission ratio of 0.892" (Brimdyr, et al., 2015). Multiple studies have determined numerous negative effects on the neonate of intrapartum analgesics, including decreased temperature, increased crying, hypotonia, Apgar scores at 1 minute lower than 7, delayed initiation of breastfeeding, higher rates of supplementation, and depressed neonatal spontaneous behaviors.

Rates of labor induction have continued to increase since the early1990s, with synthetic oxytocin (synOT) being the most used inductive agent. The US Food and Drug Administration (FDA) has given synOT the strongest warning, a "Black Box", which states, " Not for Elective Labor Induction: not indicated for elective labor induction since inadequate data to evaluate benefit versus risk; elective induction defined as labor initiation without medical indication", FDA, 2014. Brimdyr et al. report, "...administration of synOT has been found to increase the level of lactate in amniotic fluid during labor, increase the risk of adverse neontal outcomes, and acidemia of the newborn", (2015). Additionally, studies have shown delayed initiation of breastfeeding, dysfunctional suckling, shortened duration of breastfeeding, and decreased neonatal prefeed cues. Maternal effects of synOT include an increase in regional anethesia, instrumental delivery and surgical delivery. Possible links of intrapartum use of synOT have been suggested for childhood Attention Deficit Hyperactivity Disorder (ADHD), and Autism Spectrum Disorders.

The study results "...suggest that intrapartum exposure to the drugs fentanyl and synthetic oxytocin significantly decreased the likelihood of the baby suckling while skin-to-skin with its mother during the first hour after birth", (Brimdyr et al., 2015).

Those of you who subscribe to Birth: Issues in Perinatal Care can download the full article from the Wiley Periodicals website. You can also check with your institution to see if they have access to the article. It is WELL worth the read.

Kathy



Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA
Course Tutor, Step2 Education

 

References:

Brimdyr, K., Cadwell, K., Widstrom, A., Svensson, K., Neumann, M., Hart, E. A., Harrington, S., and Phillips, R. (2015). The association between common labor drugs and suckling when skin-to-skin during the first hour after birth. Birth Online, 10 October. doi: 10.1111/birt.12186

 

 

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