Hi all
 
I would like to share my experiences with using skin to skin and a little of
My history.
 
Pam and others ask if s2s is used for all dyads and if it only used in the
First day or so.
 
I do not see babies at all until most of them are a week at least and up to 
several months old.  The most common age  though is between 1 week and 9
weeks
With mum suffering  nipple trauma.  The session begins with questions about
the pregnancy,
birth, the early days, behaviour, wet and pooy nappies in a 24 hour period,
sleeping and feeding behaviours.  This will often help me decide the level
of investigation and observation that I need to consider.  I also find out
who she has been talking to in relation the baby and feeding and the
Shallenges she is experiencing.
 
I ask the mum to show me what is normally done to encourage the baby to feed

That is the starting point.  When she shows me, I ask her the types of
positions etc that she has tried.  I point out some good things that are
happening (no mother gets it totally wrong).  If the baby is getting upset I
 suggest ways to calm the baby - the most obvious being to place the baby so
That his/her head is between her breasts.  Often the mum has a shirt up high
over her chest and at least one breast exposed so that she can show me
clearly  what has been happening.  At this point I talk to the mum about the
value of skin to  skin and share stories of experiences where s2s has been
helpful 
Explaining that it is most often a good place to start.  One of the most
powerful stories is one about a mother with a 4 week old who was screeming
and mother had badly damaged nipples who was on the phone.  English was her
second language but Dad's was English.  He was about to but formula.  I
suggested that he did but while he was gone encourage the mum to go skin to
skin.  I explained it Mum and Dad to ensure that they understood.  Dad rang
back when it was time to feed the baby again.  I asked about how much ABM
did they give.  Dad replied that the was still unopened and mum had had a
pain free feed. 
 
Then I give herchoice about trying it with me there or starting in the
privacy of her
home.  The other stories that I share, are those experiences of mums with
very damaged
nipples who have been able to feed with comfort despite the damage.  
What I suggest  next is very dependant on her response.
 
I work under the assumption that there is no need to rush the baby to breast
  I give the mum space to make her own decisions.  I explain that it is most
Important  to feed the baby and share the various ways that she can do this.
   I encourage and explain the need to express to establish and maintain
supply  
saying that she can feed this to baby and that when she is ready at least
her 
breasts will be full of milk and so be able to encourage baby to stay there 
at the breast when they are both ready.   I
encourage her to spend as much skin to skin time as she can with baby and
explain that she should not be surprised to see the baby making his/her way
to the nipple and attach her/himself.  If it feels comfortable just let baby
feed - if not you can break the seal and start again or offer expressed milk
in another way.  Skin to skin certainly  can not hurt the baby or mother.
It is always however, a choice of the mother.
 
If she does not want skin to skin there and then, I consider various holds,
or shaping, making sure that that baby remains close to the breast, is able
to extend head, have chin touch the breast first, detach when ready.   I
talk about creating optimal breastfeeding environments.  For some babies
this involves various techniques depending on how well they are or physical 
challenges they may have.  I personally do not touch the mother though nor
put the baby on.  What sometimes has worked for me though is, with mum's
permission, hold her baby and give her some examples of how she could could
hold the baby, give bub back and then let her try out different things for
herself.
 
Skin to skin at any age, seems to have the effect of empowering the baby to
behave instinctually and innately.  I do not know how or why it works when
birth and the early days have been less than ideal - I just know that unless
there is something wrong the baby , baby will attach if given time.   The
time line can be different for different dyads.  I am not sure that we ever
have a precise pathway or method for approaching all dyads because of
cultural backgrounds, personal history, human emotions and idiosyncrasies.
 
I can not speak personally about engorgement as I do not see much of here.
The hospital is very baby friendly and they actively encourage baby to go
frequently to the breast in the first days and we find that engorgement is
less.  I would expect that in these situations though, the mother would need
to hand express till her breasts are soft enough for the baby to suckle.
 
In relation to reluctance for mothers to experience skin to skin - I wonder
Just how much of this is cultural.  In some cultures - being skin 2 skin
Implies some form of sexual contact or immodesty or even kinky.  Some people
Are uncomfortable with the idea for all sorts of reasons.  Being naked with
A baby is something that most people do not talk about.   LC's are good at
Though instill cultural change, drop by drop over time.  We can share
stories, share research and offer support to let seeds grow.  We can
encourage mothers to talk to each other.  We can show video of mother's
experiences eg "Mandy and Matt".  We can talk about it at antenatal.  We can
discuss it at conferences.  We can share it with HPs and get hospital policy
changed.  We can write about skin to skin through for new born, and old
babies in child birth books, baby/child care books and in our hand outs.
There is much that we can do.
 
In summary - Skin to skin is appropriate for all ages as a tool for
self-directed feeding not just the first day or 2 of life.  I personally do
not touch the mother at all to help with attachment.  Utimately  it is up to
mother what she is prepared to do.  Sometimes there is a need for mother to
create a special optimal breastfeeding environment (e.g. Shaping the breast,
supporting the hips and spine) There is no rush to get a baby to breastfeed
in my opinion because a baby will self-direct their own feeding when they
are ready.
 
 
Kind regards to all
 
Ruth Fiedler
Australia

 

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