The effect of labor medications on normal newborn behavior in the first hour after birth: A prospective cohort study

Background Skin-to-skin contact after birth between mother and baby has immediate and long-term advantages. Widstrom's 9 Stages of Newborn Behavior offer an opportunity to evaluate a baby in the natural, expected and optimal habitat. Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin (synOT), have been studied in relation to neonatal outcomes with conflicting results. Aims Determine the effects of common intrapartum medications on the instinctive behavior of healthy newborns during the first hour after birth through a prospective cohort study. Study design Video record newly-born term infants during the first hour after birth while in skin-to-skin contact with mother. Code and analyze videos using Widstrom's 9 Stages; compare with the labor medications mothers received. Subjects Convenience sample of sixty-three low-income mothers self-selected to labor with or without intrapartum analgesia. Outcome measures Duration of time infants spend in each of Widstrom's 9 Stages for four cohorts: 1) exposed to no synOT or epidural fentanyl during labor, 2) exposed to fentanyl (but not synOT), 3) exposed synOT (but not fentanyl), 4) exposed to both fentanyl and synOT. Results A strong inverse correlation was found between intrapartum exposure to fentanyl and synOT and the normal behavior of an infant, as measured by time in each Stage. Conclusions Intrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. Widstrom's 9 Stages offer an opportunity to analyze newborn behavior whilst in the optimal habitat of the infant.