The connection between your "cankles," IV fluids in labor and your baby's early weigh

November 26, 2012

Did you have IV fluids during your labor and birth?  Did your baby lose a lot of weight in the early days of breastfeeding?  Did your ankles look more like cankles?
A growing body of research is making connections between these things, and it’s important that moms understand these connections for ourselves.
Getting IV fluids during labor is quite common.  Why?  For epidurals, for labor induction or augmentation, for a cesarean section, and for group b strep antibiotics, even for exhaustion.  Many women get fluids for several of these reasons, adding up to a remarkable amount by the time the baby arrives.
What happens next is the subject of a number of recent studies:
  • A 2010 study found“intrapartum fluid administration can cause fetal volume expansion and greater fluid loss after birth.”
  • A 2011 study found that “timing and amounts of maternal IV fluids appear correlated to neonatal output and newborn weight loss.”
  • And a 2012 study found that “maternal average IV ml per hour positively correlated with infant maximum weight loss.”
What these studies have found is something that some providers have suspected for some time:  having lots of fluid on board at birth can make a baby look like she’s losing too much weight.  In other words, some babies are born with extra fluid because of all of the fluids their mothers have received.   Their birth weights are inflated by this fluid, and when they shed it they may appear to be losing too much weight.
When babies’ birth weights are inflated by excess fluid, they are at greater risk of the interventions that come with large weight loss:  supplementation, and in some cases low milk supply and eventual early weaning.  It’s significant enough that one of the above studies concludes that babies’ birth weights should be considered their weights at 24 hours in order to avoid this inflation and resulting breastfeeding problems.

There are other breastfeeding problems which result from large amounts of IV fluids given in labor:  breast edema and delayed milk coming in.

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.  When milk isn’t removed, over time it can result in milk production problems.  Fortunately, there is something you can do to relieve breast edema and make it easier for the baby to latch on:  reverse pressure softening.

Having lots of fluid in labor is also a risk factor for your milk coming in late.  This can lead to other problems, like your baby becoming very sleepy, jaundice, poor feeding, supplementation, and later low supply.  That’s why milk coming in late is associated with early weaning.

What can you do to avoid getting a lot of fluids in labor?  Plan for a breastfeeding-friendly birth, with providers who have a good track record of low-intervention births, good labor support, use of non-pharmacological pain relief methods, ability to move around, and other factors associated with low-intervention births.  And if you run into any of the above problems, be sure to seek help from a qualified breastfeeding support person.

 

Tags: breast edema breastfeeding cankles cesarean section clinical lactation delayed lactogenesis ii epidural fluids in labor group b strep iv fluids breastfeeding labor induction milk coming in late pediatrics pitocin




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