Breast suckling or nipple stimulation: prevention of postpartum haemorrhage?

Abstract

There are well known and effective ways of reducing the frequency of postpartum haemorrhage (PPH) and of treating it. However, many women in developing countries do not have these technologies available to them. In other countries some women choose not to use them, because they prefer more natural methods. An appropriate technology which would serve the needs of both groups of women is needed. Breast suckling by the newborn induces uterine contractions. This effect is probably mediated by the high plasma oxytocin levels that occur during preparations for breast feeding and again within 3 min of the start of suckling. But would this occur in the first few minutes after childbirth and if so does it reduce postpartum blood loss ? An attempt to find out was made by testing the effect of an educational programme for traditional birth attendants (TBAs), which encouraged immediate suckling at birth. This was a controlled trial with randomisation by TBA and not by mother. There was no difference in the frequency of clinically significant PPH, the mean blood loss at delivery and the frequency of retained placenta. Assuming that the research was valid with respect to the measurement of blood loss the conclusions which can be drawn include the following : - breast suckling does not reduce the frequency of PPH ; - breast suckling may have been found to be ineffective only because the TBAs did not effectively implement the policy ; - breast suckling would be effective if only the newborn suckled earlier and more vigorously. This latter hypothesis suggested that nipple stimulation, which is known to cause uterine contractions during the antenatal period but does not depend on the baby's ability to suck, was the next technique which should be tested. Basic physiological research was carried out first. A randomised controlled trial was performed to study the effect of nipple stimulation on uterine activity in the third stage of labour. Compared with controls uterine pressure was higher during nipple stimulation. Another similar study obtained the same result with both nipple stimulation and breast suckling. It is suggested that a randomised controlled trial of breast suckling or nipple stimulation if breast suckling cannot be established is now indicated, preferably in a setting where trained midwives can conduct the research.