Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding: Elucidating Physiologic Pathways

The importance of breastfeeding as a public health priority has increased as new research reinforces the health benefits to both mother and nursling, even continuing years after weaning. However, many women do not nurse as long as they intend. Birth practices such as labor medications and the routine separation of mother and baby are two of the several intrapartum influences on breastfeeding outcomes. This paper seeks to elucidate the physiologic mechanisms affecting breastfeeding outcomes of the commonly administered intrapartum drug, synthetic oxytocin. A modified ascending, link tracing methodology was used to identify studies about breastfeeding and human lactation which describe possible physiologic pathways related to the intrapartum use of synthetic oxytocin on breastfeeding outcomes. A cascade model was constructed with the findings of three physiologic pathways: dysregulation of the maternal OT system, crossing of the fetal blood brain barrier, and uterine hyper stimulation. Downstream negative effects related to breastfeeding include decreased maternal endogenous oxytocin, increased risk of negative neonatal outcomes, decreased neonatal rest during the first hour with the potential of decreasing the consolidation of memory, decreased neonatal pre-feeding cues, decreased neonatal reflexes associated with breastfeeding, maternal depression, somatic symptoms and anxiety disorders. No positive relationships between the administration of synthetic oxytocin and breastfeeding were found. Practices that could diminish the nearly ubiquitous practice of inducing and accelerating labor with the use synthetic oxytocin should be considered when evaluating interventions that affect breastfeeding outcomes.