Ever since the exciting observations of the human infant's ability to crawl
to his or her mother's breast shortly after birth, latch on, and suckle all
on its own, mothers and fathers have been entranced by this amazing feat.
To think that for many decades both caregivers and parents believed that in
order to breastfeed, a baby would not know what to do to feed and was
usually pushed onto the breast. The baby would just look and lick and often
balk at the intrusion. Actually at birth the infant may know more than the mother.
We are now aware that a number of other interventions also interfere with
the infant's natural ability to explore, seek, and find the breast all on
his or her own. Narcotic medication either injected or as agents used in
epidurals given to the mother during labor can transfer via the placenta to
the infant and cause difficulty for the infant to latch on; and also the
mother's discomfort from an episiotomy can interfere. Over hydration from
intravenous fluids may cause edema around the areola, and gastric suction by
catheter causes distress to the infant. Interestingly suctioning is no
longer recommended for 90% of babies who are breathing, have good color, and
no meconium at birth, since it is so aversive to the baby's comfort with
sucking, and often with touching the back of the throat causes a severe
lowering of the heart rate. Even the bulb suction is unnecessary and the
nose and mouth can just be wiped gently with a cloth.
What is especially important now is to provide the information to parents
and birth attendants so they can create the quiet, calm unobtrusive
environment to allow this event of the "breast crawl" to occur.
There is something special about the first hour of life. Parents have waited
many months to see their baby and surprisingly when the baby is born, he or
she is in a special state of alertness- called State Four, the quiet state
of consciousness, ready to meet its parents, and is especially interested in
the mother's and father's face.
In this special state, the baby's eyes are wide open, the baby is quiet. The
baby has heard and remembers the mother's voice from uterine life and will
distinguish her voice from other women's voices, and 80% of babies remember
the father's voice. The baby is warmed by the mother's chest and soothed by
the mother's touch. This quiet time together helps the transition from
uterine life to the outside world.
This special state in the infant lasts for 30 to 45 minutes or longer. All
sorts of exchanges between the mother and infant are going on. The baby is
taking- in the mother through many senses as is the mother learning about
her baby. The baby is becoming familiar with the mother's smell and within a
few days will pick out his or her mother's breast pad from other women's
breast pads. This is related to the particular smell of one's own mother not her milk.
As the baby gazes in the mother's face he is recording a memory of her face
so that if he is tested with a picture of his mother's face and other
women's faces four hours later, he will choose his mother's face over and over again.
The mother is taking in her baby also, by touch, smell, as well as sight.
Curiously, if she is tested a few hours later to pick out her baby from two
others, she will know her baby by touch and smell within one day.
In this early period of the first breastfeeding the baby and mother are
giving each other numerous other benefits. Oxytocin is secreted by both the
mother and baby. Oxytocin has many effects; it activates the production of
prolactin for the milk letdown; it helps production of special GI hormones
some of which are growth hormones and aid the absorption of food by
elongating the intestinal villae. Oxytocin raises the pain threshold,
creates calm in both the mother and baby, causes a feeling of sleepiness,
and draws them closer together since it is the cuddle hormone, the hormone of love.
As the baby pushes up on her little elbows, sucks on her
hand to get the taste of amniotic fluid, a property of which is similar to
one secreted by the breast, she uses smell and taste as an additional guide
to the nipple. Other benefits of this early breastfeeding experience include
helping the infant feel more secure, reducing infant mortality through the
numerous immunological properties of human milk, and encouraging a longer
period of breastfeeding.
Little behaviours that have been rehearsed in utero are used here. The baby
has an ability to reach at birth, although reaching does not occur
developmentally until four months, and curiously this reaching behaviour
touches the mother's breast, and massages and elongates the nipple for a
good placement. Each touch of the nipple creates a surge of oxytocin in both
the mother's brain and baby's brain. The stepping movements the infant
practiced as a foetus help the baby climb to the breast, and stepping on the
abdomen over the uterus helps the uterus clamp down, decreasing the bleeding
and expelling the placenta.
Many subtle events occur in this early period and can be observed, but more
would be missed unless understood. In this special quiet time the mother and
baby are becoming acquainted, the baby hardly cries at all, and they are
laying the foundation of secure attachment on the baby's part and more
confidence in the mother for her ability to nourish and nurture her baby in
the growing bond between them.
Dr. Prashant Gangal and colleagues from BPNI Maharashtra with support from
UNICEF and Government of Maharashtra have created a beautiful video and one
of great importance to the health of India's children.
Marshall Klaus, MD is Professor Emeritus of Pediatrics, University of
California, San Francisco. He is an internationally known neonatologist and
researcher, and has focused his research on how mothers develop a bond to
their normal, sick, malformed, or premature infants. In addition, his
research has involved the remarkable effects of continuous emotional and
social support for the mother by a skilled labor support woman (the doula)
on decreasing the complications of labor, changing the psychology of the
mother and improving her behaviour with her infant. His early research also
demonstrated the importance of the infant's early contact with the mother
after birth which encouraged or led to longer and more sustained breast
feeding. This research helped create three of the major tenets of the UNICEF
Baby Friendly Hospital Initiative. He is the author or co-author of numerous
articles and books, including Care of the High-Risk Neonate, The
Doula Book, Bonding, Your Amazing Newborn, and co–editor for 10 years of
The Neonatal/ Perinatal Yearbook.
Phyllis Klaus, MFT, CSW, is a licensed psychotherapist, clinical
social worker, and Approved Consultant and Trainer of EMDR.. She teaches and
practices at the Milton H. Erickson Institute in Santa Rosa, California, and
also practices in Berkeley, California, providing psychotherapy,
hypnotherapy, counseling, and EMDR to individuals, couples, families,
children, and groups. She has been working with the concerns of families in
the perinatal period for the past 30 years, and has been involved in
research and training of doulas and maternity caregivers since 1980. She
consults and presents workshops nationally and internationally and is co
author of several articles as well as the following books: The Doula
Book; Bonding; Your Amazing Newborn; a video, The Amazing
Talents of the Newborn; and When Survivors Give Birth: Understanding
and Healing the Effects of Child Sexual Abuse on Childbearing Women.