Why Janie Can't Suck

Linda J. Smith, BSE, FACCE, IBCLC

Many Lactation Consultants have noticed a group of otherwise healthy, normal full-term babies who cannot suck well at breast. They may seek the breast, open wide, then STOP. Some think this is a sensory problem - the baby's oral area is affected by the medications. Others speculate on motor nerve inhibition. Still others wonder about the forceps, vacuum extraction, and other mechanical forces that are often used with medication in labor.

During the period April 1990 through April 1993, 81 mother-baby pairs were seen in my office for assistance with complicated breastfeeding situations caused by poor sucking responses. A review of the babies' charts showed:

18 (22%) had oral thrush (candida) infections

25 (31%) had asymmetrical postures, overriding cranial sutures, and/or facial asymmetry.

29 (36%) had a short and/or tight lingual frenulum

36 (45%) had been exposed to epidural anesthesia.

After eliminating the tongue-tied babies, 52 remained with impaired sucking response. Of these, 28 (54%) had been exposed to epidural anesthesia. The "poor sucking" seen in these babies was not correctable with improved positioning at breast; most of these babies also had difficulty taking oral fluids by other methods and required extensive therapy.

The following is a tentative list of possible reasons and contributing factors for this phenomenon. Unfortunately, much more research is needed in this area.

	Pre-epidural medications, especially narcotics
	Pharmaceutical effect of drug(s) used in the epidural.
	Half-life of some drugs changes with dosage; may have sensory and motor effects.
	Relaxation of pelvic muscles leads to abnormal cardinal movements.
	Mechanical disruption of baby's bony architecture including cranial-sacral mechanism.
	Mechanical removal (forceps, vacuum) may alter alignment of cranial bones and result in nerve and vascular insults.
	Over hydration of mother leads to areolar edema, and possibly CV effects on mother.
	Increases mother's temperature: baby can become febrile.
	Pitocin stimulation may change oxytocin receptors in the breast, the baby, and the mom.
	Pitocin augmentation: may increased pressure on baby; and therefore more mechanical insults; reduced uterine blood flow; hypoxia and altered suck-swallow-breathe responses which can lead to asphyxia.
	Suctioning and intubation can cause altered suck-swallow-breathe patterns.
	Psychological effect on mother's willingness to interact with baby: feedback to baby limited; increased distancing behavior.
	Episiotomy: less pressure on baby's chest; less surfactant released; more respiratory compromise.
	Altered labor patterns that required the epidural in the first place.