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2.3.1 Initiating breastfeeding

Step 4

Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed.

To implement this Step the focus has changed from helping to breastfeed to facilitating the optimum environment to stimulate baby's innate feeding reflexes, breastfeeding occurring with the least intervention from health care staff.

This Step is one of the most critical Steps. Successful implementation of this Step ensures:

  • the rapid achievement of physiological stability in the neonate
  • optimum bonding at a critical time for mother and infant
  • facilitation of breastfeeding, and prevention of problems

Implementing skin-to-skin contact

  • Skin-to-skin contact at this time is interpreted as the baby being naked except for a bonnet, if necessary, with baby's chest and body directly in contact with the mother's bare abdomen and chest. A light blanket covering both mother and baby will prevent heat loss.
  • All routine procedures, such as drying the infant, Apgar score assessment, assessment of vital signs, are to be performed while in skin-to-skin contact with the mother.
  • Skin-to-skin contact in the operating theatre can also be achieved, however if this is not possible, it should occur within a very short time of the mother arriving in the recovery area, or of being able to respond to her baby if she has had a general anesthetic.
  • Babies are to be left undisturbed in skin-to-skin contact until after the first breastfeed.

This care is to be given to ALL infants, regardless of feeding intention, ie infants to be artificially fed will benefit significantly from this care too.

Physiological stability and bonding in one easy action.

Physiological stability and bonding in one easy action.
© K.Small MBBS

Exceptions: Medically justified reasons for delaying contact.

Initial resuscitation of the neonate

The Neonatal Resuscitation guide published by the American Academy of Pediatrics 1 states that

  • the newborn upper airway can be cleared by wiping the mouth and nose,
  • he can be dried,
  • assigned Apgar scores,
  • visually assessed, and
  • vital signs recorded
while in skin-to-skin contact with the mother .

The first breastfeed

Babies are born with innate reflexes that guide them to the breast and to breastfeed. Assisting the mother into a comfortable, semi-reclined position with her baby on her chest is the best way to facilitate this response.2

Guidance to the mother includes an explanation of the sequence of movements and actions through which the baby will progress before latching and suckling. These can be pointed out to the mother and her support persons as they occur. Emphasise the importance of not disturbing the baby until after the first breastfeed.

Refresh your memory

Click on the title or icon to open a paper that describes the sequence of movements and actions the baby will take before latching and suckling.

This is an ideal time to reinforce the knowledge shared during the prenatal period. Indicate:

  • early feeding cues and the need to respond to them promptly,
  • the wide gape baby makes as he latches, and the amount of breast tissue taken into his mouth,
  • the deep jaw excursions baby makes as he sucks.

Refer to your Policy

Identify the policy statement that addresses the immediate care of the newborn baby, and where that care is to occur.

What should I remember?

  • where the majority of infants should be to receive immediate post-birth care and resuscitation
  • how to facilitate skin-to-skin contact
  • how long the infant and mother should initially remain undisturbed in skin-to-skin contact
  • that infants have an innate ability to latch and breastfeed unassisted when placed in skin-to-skin contact

Notes

  1. # Kattwinkel J et al. (2010) Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
  2. # Colson S et al. (2008) Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding.