Archive for the ‘Breastfeeding’ Category

  • Current practices in most hospitals in India separate mother and baby after birth. After a normal delivery, hospitals should follow evidence-based and WHO recommended guidelines to allow mother and baby to be in skin-to-skin contact, and encourage the practice of nursing within the first hour of birth. The American Academy of Pediatrics also strongly advocates starting breast feeding within the first hour after birth.
  • In case hospitals feel the need to clean and dry the baby (mother’s skin happens to be the best body warmer for baby), they should at least not clean the insides of the baby’s fists. In my experience, minimum baby care procedures, pediatrician checks, Vit K injections etc, should not take more than 20 minutes. The staff should then hand over the baby to mom to start the process of mother-baby bonding and breastfeeding.
  • Research has also shown that swaddling a newborn is not really needed. Although it is common practice for baby’s comfort, swaddling appears to be counterproductive when breastfeeding. It seems to calm the baby down so much that he sometimes forgets to nurse, and has to be repeatedly reminded physically to restart suckling. Research2 has also shown that babies who are tightly swaddled have more weight loss, three days after birth. Feeding cues are best when the baby is not swaddled, or is lightly wrapped, and in skin-to-skin contact with mother.
  • In case of a C- Section, hospitals can follow similar procedures. They can provide continued analgesia to mother, but not sedatives or narcotics immediately after surgery, so that mother-baby contact and nursing can begin within, or as close to the first hour as possible. We at Healthy Mother teach alternate holds and positions for good latching in case mom’s surgical pain is hampering her from using traditional positions for breastfeeding.
  • Recent research1 has also shown that the optimal position for the release of primitive neonatal reflexes that stimulate breastfeeding is a semi-reclined position for mother and not flat on her back. During the Lamaze International Conference held in September 2008, I saw repeated evidence of the benefits of the semi-reclined position in research shown by Dr. Christina Smillie, an authority on Breastfeeding Medicine. I have since adopted this technique for nursing initiation by the infant in two moms. These moms were unable to nurse their babies without pumping or artificial nipples, due to ineffective latching by their babies. It is important to note that both moms had undergone C-Sections. With patience, and good positioning, both these babies were able to latch on – one after 8 days of birth; one after 20 days of birth. Both of these infants are now nursing well, and moms are enjoying their nursing sessions.
  • Current hospital breast feeding techniques are aimed at teaching mothers, not allowing babies to learn. Mostly, I see what Dr. Christina calls “Ready, Aim, RAM”. This leads to no or poor latching, tight painful grasp or bite, suck dysfunction and eventually feeding shutdown. On the part of the mother, there are sore breasts, feelings of distress for their infants, and eventually premature weaning or initiation of “top-feeding” or supplementing with artificial milk substitutes.
  • Babies breastfeed, not nipple feed. Baby should be able to have chin-to-mom’s breast contact, naturally. Mom should be encouraged to keep her baby’s hips and shoulders well supported, and use minimal support around the neck. She must be shown the value of a slight head tilt for baby as he tries to latch on. She should be encouraged to talk, stroke and have eye-contact with her baby. All this will ensure good latching and a pleasant experience of nursing for both mother and baby.
  • Mother should also be told that if she experiences pain, however minor, during nursing her or her baby’s positioning needs to be readjusted. Pain at nipple indicates poor milk flow, and a crushed nipple. She should be shown and allowed to try a variety of positions, including reclining, with her newborn placed on his stomach vertically at her chest. This position has been found to be more beneficial in helping baby to self-initiate latching versus the traditional “horizontal cradle holds”..
  • If baby has experienced distress at breast, and his breastfeeding experiences have not been great in the first few hours and days after birth, and/or he has been bottle fed, he will be seen to cry and arch away from the breast whenever it is offered. It is still possible to re-initiate nursing with patience and encouragement of all involved. Let the baby be skin to skin with the mother before every nursing. Let him realize that mom’s breasts are an area of comfort, not distress. In the meantime, keep pumping and feeding. Slowly, but surely, after a few of these trials, they baby will gravitate himself toward the breast and latch on. I have been honored to help some of my post-natal moms with this, and know the power and joy that it gives to mom when she experiences that first true suckle and nursing by her baby!
  • Breastfeeding takes time and adjustment in the first few hours and days after birth. Please know that there is always help available in case you are having problems with nursing. Contact your doctor/hospital if there is any soreness or inability to nurse your baby even after you get home. In many parts of India, lactation consultants (wet nurses) may be available to help you through this phase. Do not initiate bottle feeding, if necessary use a breast pump and feed with a spoon. Breast milk has about 200 compounds that until today, no artificial milk substitute or formula has been able to replicate. Sometimes, the road to nursing effectively may take a longer time, but remember that with patience and confidence, you can do it, and can ensure lifetime benefits to your newborn.

Here are some sites on the Internet where you can get good information on breastfeeding:

www.workandpump.com Along with great information, this site also has a link to Dr Jack Newman’s breast feeding clinic. Here you can view some great clips on good positions and holds that help with breastfeeding

www.kellymom.com Another great source for good all round information on breastfeeding as well as post-partum concerns

How have your experiences with breastfeeding been? I would love to hear your stories, comments, questions and concerns. I am always available if you need advice, references, or support for your breastfeeding issues.

References:

  1. Colson SD, et al. Optimal positions for the release of primitive reflexes stimulating breastfeeding. Early Human Development 2008, Jul;84(7):441-9
  2. Bystrova K, et al. The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling. Early Hum Dev, 2007;83(1):29-39
  3. Smillie, CM. Baby-led latching: A neurobehavioral model for how infants learn to latch on. Plenary Session Invited Lecture at Lamaze International Conference, September 14, 2008.
  1. Smillie, CM. Baby-led breastfeeding: the mother-baby dance. DVD.2007. Los Angeles: Geddes Productions.

What is needed for effective breastfeeding in the first hours after birth?


  • First and foremost, multi-disciplinary research has shown that skin-to-skin contact between mother and baby within the first hour of birth (amongst its many other benefits), is extremely necessary to start off a series of responses – hormonal, physical, and psychological – in both mother and baby to initiate good breastfeeding. This increases the already present levels of oxytocin hormone in both mother and baby, and ensures the “milk ejection” reflex.
  • This process starts off, what Breastfeeding Medicine expert Dr. Christina Smillie, MD, describes as “the Mother Baby dance”. If allowed to remain skin-to-skin with mother, the newborn infant can crawl to the breast (using its inborn stepping reflexes), find and attach himself to the mother’s breast.
  • If the newborn’s fists are not cleaned, he will experience the familiar smell of the amniotic fluid present inside his fists, as he puts his hand to his mouth (again a very characteristic newborn behavior). He is then able to associate the similar smell of his mom’s breasts, and locate them, as they also secrete a substance which has similar smells as the amniotic fluid.
  • The baby then sometimes reaches out, and massages the breast. This further stimulates the breast to release more oxytocin, which in turn helps with milk let-down.

  • Next, responding to mother’s instinctive stroking, talking and visual interactions with him, (the newborn is in a quiet, alert state for almost 90 minutes after birth), the baby’s brain releases oxytocin, which relaxes him, and initiates feeding behaviors in him. Soon after, he locates the source of the unique smells and warmer temperature – his mother’s breast. And, with his chin and lower lip touching mom’s breast, he opens his mouth wide and starts suckling.
  • What the baby first takes in is the extremely beneficial colostrum (the precursor of milk). This colostrum is high in antibodies that will benefit the newborn’s immunity for a lifetime. Colostrum, being extremely high in fat content, also satiates the newborn’s hunger. And, once the baby sleeps after his first full nursing, he may not need his next feeding, for up to 4 hours later.
  • Because the baby’s instincts have started the process of learning, and now that he knows he can successfully feed, he is able to latch on to mother’s breast and suckle well at his next feeding. He may feed as frequently as he needs – sometimes, hospitals may impose a 2-hour interval between feedings, which in my opinion does not have merit.
  • Oxytocin in the baby releases another set of hormones which are called cholecystokinens. These hormones ensure that the baby feels satiated for only a short time after a feeding over the first couple of days. This makes him want to feed more and increases his suckling action. This increased suckling is a good biological response, and ensures that mom’s breast is not engorged (feeling full, and tight) when the milk does come in, usually within 48 hours after birth, and effective breastfeeding continues. It is all good news – both for mom and baby.

My next post will focus on best practices that hospitals, care providers and new mothers can adopt in order to ensure that effective breastfeeding can occur at the earliest after birth.

References:

  1. Anderson GC et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2003L2):CD003519
  2. Klaus M, Klaus P. Your Amazing Newborn. Reading MA: Perseus Books: 1998
  3. Christina Smillie, MD. Baby-led latching: A neurobehavioral model for how infants learn to latch on. Plenary Session Invited Lecture at Lamaze International Conference, September 14, 2008.

Just yesterday, I got this email form one of my recent class participants. This mom-to-be has just finished her sessions, and in the meantime, visited her friend who has recently given birth in one of Hyderabad’s “super-specialty” hospitals. I am quoting her verbatim (with her permission) below:

Dear Dr,

One of my friends recently delivered at xxxxxx Hospital which I wanted to let you know so that you can share this with women who might be considering this hospital for their delivery. (My Note: For those of you who wish to know which hospital it is, please write to me and I will let you know).

My friend’s water broke at 3:30am on Friday morning and she rushed to the hospital since the baby’s head had not engaged and was in transverse position. She was informed that she would have a c-section delivery. Since the doc had a planned c-section her FHS was monitored and she was finally operated at 12:30pm at which time there was not a drop of amniotic fluid left.

She is then blind folded and given an epidural. The baby is delivered and she is informed that it’s a boy while she doesn’t get a chance to see him. She can only hear the doctors and nurses speak and hear her baby cry. She is then shifted to an ICU where she is kept for 1 day for monitoring. Baby and mom have not been in contact for 1 whole day.

On day 2 she is shifted back and is given pain medications and is asked not to feed the baby since she is taking medications. Baby is brought from the nursery and shown to the mother on day 2. Mom is finally allowed to feed her baby from day 3 after the IV and pain medicines are stopped. Obviously she has issues on day 3 feeding her baby since for 2 days he was on bottle feed. I visited her on day 3 and did teach her some techniques that I learnt in class – about the latch, and the football hold which did help her to some extent.

I remember you mentioning to us during the c-section class about blind folding and both Divya and me were shocked. To see that this is being practiced in a “good” super specialty hospital is unbelievable!!  I hope no mom has to go thro’ this – not being able to see your baby for 1 day and not being able to feed your baby.

Reading this mail, I was shocked too. Even though I have seen such questionable procedures practiced during C-Section surgery and during immediate post-surgical recovery, hearing that mom and baby were kept apart for one whole day, made me quite upset. The fact that the baby was not allowed to nurse until the 3rd day was a shocker. It is no wonder that breastfeeding becomes a big concern, and that many first-time mothers are unable to breastfeed well and eventually give up nursing their babies, especially after a C-Section.

So what are the factors that promote effective breastfeeding in the first hours after birth?

I will be writing about this and many more aspects of successful breastfeeding, over the next couple of posts. In the meantime, if you have any questions, concerns or experiences to share, please do write in.

Dr. Vijaya