Putting breastfeeding on the research agenda

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.