Breastfeeding Medicine

Physicians blogging about breastfeeding

Putting breastfeeding on the research agenda

with 5 comments

It’s a little like the old question about a tree falling in a forest when no one is around to hear it.

I’m at the Society for Maternal-Fetal Medicine annual meeting, and I’ve been listening to the state-of-the-art research in my field. My colleagues are presenting carefully-designed studies designed to find new ways to improve outcomes for mothers and babies. And no one is measuring whether these new approaches affect breast-feeding.

Consider a presentation a few minutes ago on the dose of oxytocin administered after childbirth to prevent maternal hemorrhage. Researchers randomized women to receive 10U, 40U or 80U of oxytocin to avoid uterine atony, which occurs when the uterine muscle does not contract after birth, leading to severe hemorrhage.

In this carefully-designed study, the authors measured blood loss, need for transfusion, and safety, defined as maternal fluid overload or low blood pressure. They concluded that the higher does did not reduce atony, but was “safe,” because there was no effect on fluid balance or blood pressure.

Now, oxytocin does not only cause uterine contractions. It also plays a critical role in lactation, causing contraction of the tiny muscle bundles surrounding each of the alveoli that store colostrum in the breast, and later store human milk. When uterine muscles are exposed to high doses of oxytocin, the receptors that cause the muscle to contract ultimately go inside of the cell, and the muscle can stop responding. That’s why, we think, long exposure to oxytocin can lead to uterine atony.

I couldn’t help but wonder whether high dose oxytocin might lead to breast myoepithelial cell atony. And then there are the many effects of oxytocin on the maternal brain that orchestrate bonding of mother and baby after birth. What might an enormous load of oxytocin do to a mother’s mind as she meets her baby for the first time? From this study, we have no idea. The question wasn’t asked.

Science has a long tradition of neglecting important facets of women’s health. Consider that, not so long ago, women were excluded from clinical trials because researchers did not want to have to deal with the effects of the menstrual cycle. Further, for years, children weren’t studied, but were assumed to be “little adults” for drug studies. This only changed once policies required researchers to include women and children in all research studies, or justify why they were excluded.

We’ve made progress — but as I look around this meeting, it’s clear we have a long way to go. Until infant feeding is a standard outcome, measured routinely in studies related to pregnancy and maternity care, it’s a tree falling in a forest with no one to hear it. We need to start listening.

Alison Stuebe is a maternal-fetal medicine physician and a member of the board of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by astuebe

February 10, 2011 at 6:55 pm

5 Responses

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  1. So what can I do about this?

    Jeanne

    February 10, 2011 at 8:00 pm

  2. Looks like this study also ignored the effect of breastfeeding on helping the uterus to contract after birth. You can’t just isolate one element of a whole system where all elements are exquisitely designed to work together, artificially enhance or change it, and expect the system to work as designed. Changing one element will affect others. Just like any ecosystem.

    Rika

    February 10, 2011 at 10:12 pm

  3. Thanks for this. I hope you asked your colleagues following their presentation why these factors were omitted!

    Michelle

    February 11, 2011 at 3:23 am

  4. Thanks for bringing this to our attention Alison. It is so true–and yet so ignored. Your comparison to the tree in the forest is perfect–I feel like in lactation research and in related areas of research it is often that we are not seeing the forest for the trees.

    kmarinellimd

    February 14, 2011 at 10:20 am

  5. I wonder about the effect of oxytocin on breast engorgement. I have given birth once. I don’t know exactly when the oxytocin was introduced, probably after about 8 hours, so I guess I was on it for 14. As I approached the final stage, the urge to see the baby and hold it was definitely present and very strong. But I was seriously engorged. Maybe I would have been anyway… it would probably take an RCT to find out if there would have been a difference. And then you’d still have to ask: what’s worse, breast engorgement, or an even longer labour?

    justine

    June 27, 2011 at 10:43 pm


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