4.3 Postnatal interventions
Separation of mother and newborn
From an evolutionary perspective skin-to-skin care is the norm. Routine separation of the newborn from its mother soon after birth is unique to the 20th Century. At the risk of laboring the point, separating the mother and baby after birthing for any reason, other than medical emergency, is NOT applying best practice care. All indicators of infant well-being and successful extrauterine adaptation are stabilized better and faster when the newborn is in skin-to-skin contact with its mother from immediately after birth for the first few hours, or at least until after the first breastfeed.
When mother and infant are separated the infant's innate behaviors are changed. The infant firstly exhibits distress cries, followed by what is described as "protest-despair" behavior. 1
Separated newborns make 10 times more crying signals than babies in skin-to-skin care, and their cries have a completely different character. 2 3 During the "protest" response there is intense activity seeking the mother, followed by "despair" behavior which sees the baby withdraw with decreased heart rate and temperature, mediated by a massive rise in stress hormones. 4
Maternal-neonate separation results in a physiological stress-response and has a profoundly negative impact on quiet sleep duration.5

Note the protest response being exhibited by this newborn.
Photo © T.Young, RM
Maternal separation may be a stressor the human neonate is not well-evolved to cope with and may not be benign.5
Effect on oxytocin
Oxytocin levels are highest around the time of birthing. Oxytocin cannot cross from the peripheral circulation into the brain; therefore it is only naturally occurring oxytocin released by the posterior pituitary gland that will have an effect on the mother's temperament, ie. not oxytocin administered to the mother.
- increased uterine contraction limiting postpartum blood loss,
- the temperature of the mother's breast to rise, providing warmth for the infant,
- an anti-stress effect, reducing maternal blood pressure and cortisol levels and releasing gastrointestinal hormones,
- a state of calmness and social responsiveness,
- bonding with their infant, and enhanced maternal behaviors,
- milk ejection; important at this time prior to it becoming conditioned by the suckling stimulus.
During the time the infant in skin-to-skin contact after birthing is making massage-like movements on the mother's chest and breasts the maternal serum oxytocin levels rise.8 The infant begins these hand movements soon after birth and continues until he self-attaches and suckles.
The work of Michel Odent is well recognized by those involved in obstetrics. Odent's studies of the effects of oxytocin and other hormones of birthing are worthwhile following. In 2001 he wrote:
The age of cesarean sections on request, epidurals and drips of oxytocin is a turning point in the history of childbirth. Until recently women could not give birth without releasing a complex cocktail of 'love hormones'. Today, in many countries, most women have babies without releasing these specific hormones. The questions must be raised in terms of civilization. This turning point occurs at the very time when several scientific disciplines suggest that the way human beings are born has long-term consequences, particularly in terms of sociability, aggressiveness or, in other words, 'capacity to love'. 9Odent, 2001
With this in mind, the importance of skin-to-skin contact for mothers and babies who experience an assisted birthing appears to be even more important.
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.1
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 two groups (one group remained in skin-to-skin contact) in ability to attach to the breast and suckle correctly for effective milk removal was significant (p>0.001).10
Washing mother or newborn
Washing the mother 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 breasts is washed after birthing 22 out of 30 infants preferentially self-attached to the unwashed breast.11
Breast odours from the mother exert a pheromone-like effect at the newborn's first attempt to locate the nipple. Newborns are generally responsive to breast odours produced by lactating women. Olfactory recognition may be implicated in the early stages of the mother-infant attachment process, when the newborns learn to recognize their own mother's unique odour signature.12
Winberg, 1998
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.
Fortunately routine oral and gastric suctioning is no longer recommended, it's effects proving to be harmful to more than just the infant's ability to suck.13
Wiping the normal newborn's face, mouth and nose with a towel is all that is required at birth.14
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 behaviours15 and an increased prevalence of functional intestinal disorders in later life.16

Workbook Activity 4.4
Complete Activity 4.4 in your workbook.

Group Activity
Form a small group and firstly compare your lists of the benefits of keeping mothers and babies together in skin-to-skin contact (Workbook activity 4.2), then examine the interruptions to this that you each identified in Workbook activity 4.4.
Together, look at each interruption separately and develop strategies for change to prevent these separations.
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 mother
- the baby's role in causing an oxytocin response in the mother and the effect this has on her
- the effect of separation of mother and baby, even for a short time, on his/her ability to breastfeed
- that changing detrimental routine practices is possible when you work together.
Self-test quiz
Assessment Quiz
When you are happy that you've understood all the information in this topic you will be ready to complete the Module 4 Assessment. To do this, go to the course opening page, scroll down to the Assessment section and choose Module 4.
Notes
- # Alberts JR (1994) Learning as adaptation of the infant.
- # Michelsson K et al. (1996) Crying in separated and non-separated newborns: sound spectrographic analysis
- # Christensson K et al. (1995) Separation distress call in the human neonate in the absence of maternal body contact
- # Bergman N (2003) Humans and Kangaroos: A Biological Perspective
- # Morgan BE et al. (2011) Should neonates sleep alone?
- # Mattos-Graner RO et al. (2001) Relation of oral yeast infection in Brazilian infants and use of a pacifier
- # Uvnas-Moberg K (1998) Oxytocin may mediate the benefits of positive social interactions and emotions
- # Matthiesen AS et al. (2001) Postpartum maternal oxytocin release by newborns: Effect of infant hand massage and sucking
- # Odent M (2001) New reasons and new ways to study birth physiology
- # Righard L et al. (1990) Effect of delivery room routines on success of first breast-feed
- # Varendi H et al. (1994) Does the newborn baby find the nipple by smell?
- # Winberg J et al. (1998) Olfaction and human neonatal behaviour: clinical implications
- # Clifford M et al. (2010) Neonatal resuscitation.
- # Kelleher J et al. (2013) Oronasopharyngeal suction versus wiping of the mouth and nose at birth: a randomised equivalency trial.
- # Widstrom AM et al. (1987) Gastric suction in healthy newborn infants. Effects on circulation and developing feeding behaviour
- # Anand KJ et al. (2004) Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life