Posts Tagged ‘Lamaze

Recently, I was talking to one of our Healthy Mother Labor and Childbirth program participants who had gone to her parents’ house in Kerala to spend the rest of her pregnancy. During a routine check up at the local hospital four weeks before her due date, her baby’s heart rate was seen to be fluctuant, accompanied by significant decelerations. Her OB suspected that there may be cord entanglement, and immediately admitted her to the hospital. With severe decelerations of the baby’s heart rate continuing, her doctors  decided to immediately take her for an emergency C-Section. Soon after her delivery, the doctors found that her baby had significant difficulty with breathing, and the pediatrician counseled the parents to admit him to the Neonatal Intensive Care Unit (NICU).

However, neither the hospital in which the baby was born, nor any other hospital in the vicinity, had NICU facilities. Thus began a ten day emotional and physical rollercoaster ride for mom and dad. The baby was shifted to the nearest hospital with NICU facilities, which was about 6 hours away. Mom could not be discharged from where she was for the next 3-4 days, and baby was 6 hours away in NICU. Dad shuttled between the 2 places daily, until mom was finally discharged and was able to see her baby. In adition, the hospital practices where the NICU was located were not mother-friendly, so mom was not allowed to touch or hold her baby for several days. She could only see her baby from outside the glass walls of the intensive care unit.

Finally the baby was discharged from the NICU in good health, and as I write this mom and baby have been at their home for several days, and both are doing well. Since the mother had continued to pump breastmilk while her baby was in the NICU, she is now nursing her baby without much difficulty. Way to go, mom!

As I was speaking to this couple, I thought I would re-emphasize the importance of choosing the right hospital for your baby’s birth. Not only is it important to choose a hospital that provides you with the best possible support and care that can promote a natural childbirth, but it is also important to check whether they have good emergency backup and post-delivery care infrastructure such as NICU facilities, should your baby need it. If not, at least you should check to see whether there are hospitals in the vicinity which offer NICU facilities, so that mother-baby separation can be kept to a minimum. Over and above this, there are several questions that you need to ask of your doctor and/or hospital, so that you can ensure the best possible birthing experience for you and your baby.

The Coalition for Improving Maternity Services (CIMS) is doing a remarkable job of advocating mother-baby friendly practices in US hospitals and medical facilities . I have adapted some of their recommendations in a document after making them relevant to the current Indian conditions. You can download the document here (Points to consider about your hospital).

In my next post, I will write about how Lamaze is helping women and their families in rethinking the different aspects of labor and childbirth.

Dr. Vijaya Krishnan

  • 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.