The hormone oxytocin is essential in a woman’s transition into a new life stage – the period of “being a mother” (Gu et al., 2015). Oxytocin concentration during pregnancy itself is thought to influence maternal behavior and the formation of the emotional bond between her and the child. It helps reduce anxiety and improves the mother’s physiological response to stress (Johnson, 2013). As stated by various authors (Gu et al., 2015; Love, 2013; Olff et al., 2013; Scantamburlo et al., 2009), oxytocin influences maternal behavior, well-being, bonding with the child, sexual life, stress regulation, memory, eating habits, and social belonging.
Oxytocin, along with vasopressin, plays an important role in regulating the HPA axis and thus influences emotional and social behavior. This influence can be direct or indirect. Oxytocin found in the brain inhibits the stress-activated HPA axis and amygdala activity while regulating autonomous fear. It also helps in forming social judgment, behavior, and promotes a sense of social belonging (Scantamburlo et al., 2009). In interaction with dopamine, it influences the maintenance and preservation of maternal and social behavior (Cox et al., 2015). Gu and colleagues (2015) emphasize that any disruption in oxytocin levels makes the transition to motherhood more difficult. By this, they primarily mean the use of synthetic oxytocin during labor. Oxytocin has a key role in female behavior in three situations where a bond is established. These three situations are: sexual intercourse, birth, and breastfeeding. For this reason, it is assumed that oxytocin influences the establishment of social bonds (Scantamburlo et al., 2009).
During pregnancy, labor, and breastfeeding, oxytocinergic neurons undergo morphological changes due to all the stimulation they are exposed to. Various sensory stimuli contribute to adaptive changes in maternal-infant bonding. Oxytocin also influences bonding with the unborn child during pregnancy. Its levels in early pregnancy and after birth clearly indicate the beginning of bond creation between the unborn child, later the newborn, and the mother. Maternal bonding is strengthened by gazing at the child, loving touches, talking to the child, and cuddling. At the same time, successful bonding is shown through careful, regular monitoring/checking of the child (Scantamburlo et al., 2009). As stated by Olff and colleagues (2013), elevated levels of endogenous oxytocin before birth are associated with greater and more successful bonding between mother and child. HPA activity is reduced during breastfeeding, which lowers stress hormone levels, allowing the mother to focus more easily on caring for the newborn (Love, 2014). The lactation period leads to reduced HPA responsiveness and is maintained by the newborn’s sucking (Scantamburlo et al., 2009; Brunton et al., 2008). Love (2014) states that activity within the hypothalamus was observed in mothers when seeing their own child, while no activity was detected when looking at someone else’s child. This factor significantly influenced plasma oxytocin levels. The value of oxytocin is linked to the display of attention and affection by the mother, as well as by fathers toward the child.
Since oxytocin is also released into the brain in breastfeeding mothers, researchers (Jonas et al., 2008) assume that changes in behavior patterns occur precisely because of it. Today, the use of synthetic oxytocin is increasing. It is primarily used for the induction or stimulation of labor, to prevent postpartum hemorrhage, and sometimes to trigger lactation. When used thoughtfully, it can have immediate positive effects: it can mimic the action of the body’s own oxytocin, stimulate contractions, and prevent postpartum bleeding. The use of synthetic oxytocin is currently too subjective for healthcare professionals. Its incorrect use can lead to adverse effects. It can lead to uterine hyperstimulation, fetal distress, poor fetal oxygenation, lower fetal heart rate, and even uterine rupture. The impact of synthetic oxytocin on the mother’s well-veing is quite unclear, which is why researchers emphasize the importance of further research in this area (Gu et al., 2015). The link between oxytocin and mental health during pregnancy, as well as the link between postpartum depression and oxytocin, was investigated by Gu and colleagues (2015) in two longitudinal studies. In the first study, women over 18 years old, in their 12th–14th week of pregnancy and expecting a single child, were eligible to participate. 341 women decided to participate; 29 were excluded from the study due to miscarriage or premature birth, and 287 women were followed for 2 months after birth. The clinical sample consisted of 75 women, who were also followed for 2 months after birth. To check the link between oxytocin and postpartum depression, 316 women from a hospital in Montreal volunteered. The conditions were being over 18 years old and living an hour away from the hospital. Two months after birth, the participants were visited at home, where blood samples were also taken to determine oxytocin concentration. A positive correlation was discovered between the use of synthetic oxytocin and oxytocin concentration after birth. From this, it was predicted that the use of synthetic oxytocin has a long-term impact on the woman. Lower doses of synthetic oxytocin were observed in women who were exclusively breastfeeding compared to those who were bottle-feeding. In those with higher levels of synthetic oxytocin, symptoms of depression and anxiety were more pronounced (Gu et al., 2015). Jonas and colleagues (2008) reached similar findings regarding the impact of synthetic oxytocin on the mother’s personality. Stuebe and colleagues (2013) also found that lower oxytocin concentrations after birth are associated with a higher occurrence of signs of anxiety and depression. It should be emphasized that breastfeeding mothers show fewer signs of anxiety and are more resistant to stress than women who do not breastfeed. Mothers who experience negative feelings after birth show less positive inclination toward the child and are less sensitive to the child’s needs (Bell et al., 2014).
Jordan and colleagues (2009) investigated the impact of medications routinely received by women during labor on breastfeeding within 48 hours. This was a retrospective cohort study analyzing the documentation of 48,366 women who gave birth on their due date to a single healthy child. Data on births at Cardiff Maternity Hospital were collected prospectively and analyzed using the SPSS program. They found that breastfeeding success rates are influenced by certain demographic data. The rate increases with the mother’s age, parity, and socioeconomic status. The results show that after 48 hours, 43.3% of all included mothers were not breastfeeding, including only 37% of all first-time mothers. It should be noted that a total of 19,900 first-time mothers were included in the study. Routine prevention of postpartum hemorrhage—active management of the third stage of labor—with the administration of oxytocin alone or in combination with ergometrine is associated with a 6–8% reduction in breastfeeding rates within 48 hours. A stronger negative impact of oxytocin use was observed in first-time mothers who received no other interventions during labor (induction, augmentation, epidural, or spinal analgesia). The use of ergometrine alone has a more negative impact on breastfeeding than the combination with oxytocin. Ergometrine is a dopamine agonist that negatively affects the rise in prolactin concentration. Similar results are seen with labor induction using prostaglandins. When inserted vaginally, they are absorbed into the body very quickly and remain in the bloodstream for several hours. How long they stay in the body depends on the amount given. At the same time, they also pass into the fetal bloodstream. Interestingly, the use of nitrous oxide as a pain relief method for first-time mothers had a positive impact on breastfeeding. This is linked to the short-term analgesic effect of nitrous oxide and its rapid breakdown in the mother’s body.
The exact mechanism of the long-term impact of synthetic oxytocin is unclear. One hypothesis is that due to the body’s sudden exposure to synthetic oxytocin, receptors in the body become unresponsive to circulating oxytocin. This is similar to insulin resistance in diabetes. It is important to realize that oxytocin used during labor passes through the placenta to the fetus. Newborns exposed to synthetic oxytocin during labor show fewer signs of hunger—defined as organized oral-motor behavior signaling readiness to feed—compared to newborns who were not exposed to synthetic oxytocin. The use of synthetic oxytocin is thought to inhibit the child’s sucking (Gu et al., 2015). Signs indicating a newborn’s hunger include opening the mouth, rooting (turning the head with an open mouth), sticking out the tongue, touching the mouth with the hand, and empty sucking or sucking on the hand (Bell et al., 2013). These were the exact signs Bell and colleagues (2013) observed in their study, which aimed to prove the impact of synthetic oxytocin during labor on the child. Mothers of the newborns signed consent for participation. The conditions for the child’s participation in the study were: full-term birth, no signs of fetal distress during labor, birth weight over 2500 g, Apgar score above 7 at 1 and 5 minutes, cephalic birth without interventions (forceps/vacuum), and absence of chromosomal abnormalities. The final number of participants was 47. For the study, they used material from a previous study where the child was observed for the first 20 minutes after birth, then swaddled and given to the mother. Forty minutes after birth, the child was placed in a cradle for five minutes and left to rest peacefully. Then they began filming the newborn for the next five minutes. In this study, these recordings were divided into 60 five-second segments. The results of the review showed that 44% of newborns whose mothers were exposed to synthetic oxytocin during labor had less pronounced signs of hunger compared to newborns whose mothers did not receive synthetic oxytocin. The same is proven by a pilot study conducted by Fernandez and colleagues (2012) between December 2009 and October 2010. The results of their study indicate that the use of synthetic oxytocin affects the newborn’s primitive reflexes related to breastfeeding and also the total duration of the breastfeeding period. The result is also an inhibitory effect on the start of sucking. At the same time, they emphasize that further research is needed to better confirm the link between synthetic oxytocin and its impact on newborn and maternal behavior.
The use of synthetic oxytocin and other medications during labor itself affects the oral-motor skills of the newborn and consequently has a negative impact on the initiation of breastfeeding. Its influence is also seen in the psychological state of mothers, but its long-term impact has not yet been proven.
So, does the administration of larger amounts of synthetic oxytocin and other medications influence the development of breastfeeding difficulties?
Source: Thesis “A woman’s experience and feelings during breastfeeding” (2016) by Teja Šircelj, mentored by Tita Stanek Zidarič, RN, RM, MSc, IBCLC
