4.1 The chemistry of feeding
Effect on breastfeeding
Learning is a dimension of behavior and physiology, and the human neonate has evolved to learn how to suckle when in skin-to-skin contact.
Most babies (27 out of 34) who were separated from their mothers after 19 minutes for routine weighing procedures and then returned for feeding either refused to suckle or demonstrated superficial nipple sucking techniques. The difference between the two groups (one group remained in skin-to-skin contact) inability to attach to the breast and suckle correctly for effective milk removal was significant (p>0.001).
Washing mother/birthing parent or newborn
Washing the mother/birthing parent and/or baby is also to be discouraged. Infants localize the nipple by smell and have a heightened response to odor cues in the first few hours after birth. When one of the mother's/birthing parent's breasts is washed after birthing 22 out of 30 infants preferentially self-attached to the unwashed breast.
The Calming Effect of Human Milk
The Calming Effect of Maternal Breast Milk Odor on Term Infant: A Randomized Controlled Trial
In particular, the olfactory system is more susceptible than the other senses at birth. In a few short minutes after delivery, the head of a human newborn spontaneously turns to the maternal chest and makes a directional leaning toward the mother's nipple to start sucking. There is proof that the odor of newborns' mothers, especially maternal milk odor, obviously and positively affects the behavior of newborns.
Preterm infants exposed to BM odor from their own mothers demonstrate a persistent decrease in saliva cortisol levels, which continues after termination of the intervention. This finding may suggest that exposure to own mothers' BM odor has a soothing effect on preterm infants. Further randomized controlled studies are needed to evaluate this simple, safe, and inexpensive intervention.
Suctioning of the newborn
Oral aversion as an outcome of routine oropharyngeal or gastric suctioning or intubation is often cited by clinicians as a cause of breastfeeding difficulty, but little research is available to confirm this. What the research does show is that based on a review of the literature and current national and international guidelines, the conclusion is that routine use of Oronasopharyngeal suction after birth is not indicated for vigorous, term infants with clear or meconium-stained fluid and it may actually be harmful.
Fortunately routine oral and gastric suctioning is no longer recommended, its effects proving to be harmful to more than just the infant's ability to suck.
Wiping the normal newborn's face, mouth, and nose with a towel is all that is required at birth.
Gastric suctioning, involving the passage of a tube into the neonate's stomach and aspiration of the contents, has been linked to a delay in infant pre-feeding behaviours and an increased prevalence of functional intestinal disorders in later life.
Self-test Quiz
Note on parent vs. birthing parent, adoption, different family/gender
The Baby-Friendly Hospital Initiative global documents and resources foresee a scenario where the infant is gestated and born to a woman who is also genetically their mother and who will be their parent. While this is the most common situation you will encounter, it is worth keeping mind that families are created and live together in many different ways. Step 2 Education's Inclusivity Statement
It will not always be the case that the person who gives birth to the infant will be the one who will be their parent or the only or even primary parent who breastfeeds / chestfeeds or provides human milk. Skin-to-skin contact and early postpartum care will need to be adapted to the needs and plans of each family unit, while aiming to achieve a plan that meets global infant feeding recommendations of early initiation, exclusive breastfeeding to 6 months and continued breastfeeding to age 2 and beyond.
What should I remember?
- where the normal place to care for a newborn is from immediately after birth and for several hours following
- the behavioural state and physiological response of the infant who is wrapped up and separated from his/her birthing parent
- the effect of separation of mother/birthing parent and infant, even for a short time, on his/her ability to breastfeed
- that changing detrimental routine practices is possible when you work together