Nikki Lee's posting from Michel Odent's book seems a good opportunity to
present this.

It seems to be commonly accepted that a newborn baby's first encounter with
the breast is not as significant from a nutritional point of view as it is
for immunological and homeostatic reasons.  Babies who are undisturbed, skin
to skin with mother after birth, get a chance to be colonized by her skin
bacteria, to be kept warm by her body, and to get to know her smell and
sound and sensation outside the uterus.  We know from Swedish research that
babies kept in contact with mothers for the first couple of hours, are just
as warm as babies swaddled and put in cots, and they cry less and have
higher blood glucose levels and lower levels of stress hormones.

Diane W. asked me whether I ever see babies actually seeming to swallow at
the breast, during the first feed, and was especially interested in the
undrugged baby's behavior.  I thought about it and realized that being
drug-free is only part of the equation.  We have other 'artifacts'
(human-made factors) that disturb the natural course of breastfeeding, and
these are mostly cultural.  I am thinking of the culture that divides birth
into measurable phases, and that accepts that two hours post-partum
represents some kind of divide, when mother and baby are often moved and
separated for no other reason than that 'two hours have passed so it's time
to transfer them to post-partum from the labor ward.'

When the first feed takes place under time pressure, the babies don't always
have time for all the preparation to latching on.  They are helped to the
breast, the breast is placed in their mouth, and they are removed to be
weighed and measured because it is bad midwifery manners to leave the scene
without recording all those numbers on the forms, unless the birth takes
place just before change of shift.  These babies nibble a bit, and don't
seem really to be all the way 'in the moment'.  They suckle, but it isn't
the same as when mother and baby are left truly undisturbed, skin to skin,
for as long as they feel like it.

In the latter case, I am reminded of the mutual nuzzling and licking that
goes on between ewes and lambs, or cows and calves, while the mother briskly
and thoroughly stimulates the entire surface of her young's body, and the
newborn begins making attempts to butt at her, to lick back, and to search
and root.  Humans are remarkably passive by comparison, our instincts are
buried beneath so much learned restraint.

When these babies finally do come to the breast, the breast itself has
changed contour and consistency.  The areola is enlarged and firmer, so that
no matter what position the mother is in, there will be something graspable
there for the baby.  And the baby opens very wide, draws the breast in, and
guzzles, sometimes for up to an hour.  I have seldom seen this
self-attachment occur less than an hour after birth.  These babies do not
fall asleep immediately after, either, but are often in the quiet alert
state for three hours and more, before finally falling asleep.  I often see
large wet spots of leaked colostrum on the other side, if mother is wearing
a shirt during this time.

Since the very act of weighing the baby would disturb the process, I don't
know how much the babies are getting.  I do know that they stay latched and
swallowing for a long time.

I believe there is some research to suggest that this early, unrestricted
feed is very important for getting the gut moving, and for augmenting the
low Vitamin K concentration in baby's blood.  I am sorry I don't have the
reference handy (throwing myself on the mercy of Lactnet now).

When a baby has fed in this way, it may take a day or two before s/he will
repeat the performance, but I never worry much about them, as long as mother
and baby are drug-free and close together, skin to skin.  These babies are
not often seen in hospitals.  We could see them, but we seem unable to
adjust our clock-directed behavior to allow them to show us how capable they
are.

I have also, on a very few occasions, been present when the mother of a baby
who was transferred to the NICU at birth, learns to use a breast pump in the
first couple of hours post-partum.  There has been such a volume of
colostrum that we would need a cup to store it in.  Thereafter, the volume
has decreased for a day or so, before coming full force in large amounts, if
expression is continued.

So I think we may have some room for improvement concerning that first feed,
and it is quite likely that the unhurried atmosphere, allowing all the time
mother and baby need, yields more milk for the baby than that panicked,
hurried 'shove them on and get them going' approach I know we resort to all
too often.

Rachel Myr, IBCLC, midwife, BF counsellor
Norway

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html