From Birth to Breast

Recognition of the indispensable continuum between birthing and breastfeeding was importantly entrenched in the now globally adopted WHO/UNICEF Ten Steps to Successful Breastfeeding (1)  .  Helping mothers to initiate breastfeeding immediately after birth is gradually becoming the norm as former priorities of delivery room routines such as measurements, medications and baths fade in importance. In contrast, there is the extraordinary and miraculous journey of a newborn infant in a quest to find her mother’s breast. This unparalleled skin-to-skin journey and perhaps the most important journey of her life has long lasting impact for both the newborn baby and her mother. 

Her mother’s touch and heartbeat,

her mother’s soft and familiar voice,

and the reward of sweet colostrum,

after an exploration of nuzzling and

rooting, are her first post birth

relationship experiences.

Relearning this journey of birthing and breastfeeding is, with the realization of how far we have strayed from normal human behaviour, the critical goal of the Baby-Friendly Hospital Initiative. There is much to learn about this journey and its profound impact for mother and baby. 

Hospital routines described in Sweden in a 1960s pamphlet (2) were not much different from what Canadian mothers had been subject to: "The infant is brought to the mother on scheduled time, well-wrapped with only face and hands visible, and has tobe satisfied within a certain time limit.  If the breast milk should not reach requisite amounts, we have such good infant formula nowadays that the baby’s health is not gambled with." 

Fortunately for all of us, Swedish researchers, realizing the important relationship between suckling and milk production, decided to investigate what happens during labour, birth and immediately post-partum. In particular, they examined the role  of oxytocin. As hormones go, this maternal hormone, secreted in large amounts, performs a pivotal role in early suckling. Its production is stimulated by skin-to-skin contact and is the catalyst in the emotional bond between mother and infant.

1. World Health Organization. Protecting, Promoting and Supporting Breastfeeding: the special role of the maternity services. A joint WHO/UNICEF statement. Geneva: WHO, 1989 (back)

2. Widstrom AM in Studies on Breastfeeding: Behaviour and Peptide Hormone Release in Mothers and Infants. Applications in delivery and maternity.  Department of Pediatrics, Karolinska Institute, Stockholm, Sweden, 1988 (back)

Some important facts

When mothers received labour analgesia, the infants’ hand massage movements were less frequent, and they were less likely to breastfeed within the first two and a half hours after birth. As well these infants had higher temperatures and cried more.  Thus analgesics given during labour, reduce spontaneous breastfeeding behaviours and increase baby’s temperature and crying.

Ransjo-Arvidson AB, Matthiesen AS, Lilja G, Nissen E, Widstrom AM, Uvnas-Moberg K. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth 28:20-21, 2001

Ten vaginally delivered infants whose mothers had not been exposed to maternal analgesia were videorecorded from birth until the first breastfeeding. When the infants were sucking, the massage-like hand movements stopped and started again when the infants made a sucking pause. Periods of increased massage-like hand movements or sucking of the mother’s breast were followed by an increase in maternal oxytocin levels. The results show that newborns use their hands as well as their mouths to stimulate maternal oxytocin release. This may have a significant effect on uterine contraction, breastmilk production, and mother-infant interaction.

Nissen E, Matthiesen AS, Ransjo-Arvidson AB, Uvnas-Moberg K. Postpartum maternal oxytocin release by newborns: effects of infant hand massage and sucking. Birth 28: 13-19, 2001

"The most appropriate position of the healthy full-term newborn baby after birth is in close body contact with the mother," is the conclusion of a study that looked at the crying behaviours during the first 90 minutes of life in three situations: when skin-to-skin with the mother; when in a cot; when in a cot for 45 minutes and then skin-to-skin with the mother. The results showed that infants cried when physically separated and stopped when reunited with the mother. This newborn cry is not dependent on a previous learning experience and is similar to other mammalian "separation distress calls."

Christensson K, Cabrera T, Christensson E, Uvnas-Moberg K, Winberg J. Separation distress call in the human neonate in the absence of maternal body contact. Acta Paediatr 84:468-473, 1995

Eight women’s experiences were tape recorded to elucidate mothers’ experiences related to separation from their newborns during their first week of life. Their full-term newborns had been treated in the neo-natal intensive care unit for between two and 10 days and then declared healthy and sent home. The women’s narratives revealed that their experiences had caused them emotional strain and anxiety. From the analysis, three themes emerged: "being an outsider" was based on feelings of despair, powerlessness, homelessness, and disappointment; "lack of control" included emotional instability, threat, guilt, and insecurity; "caring" included trust, love, anxiety, relief, and closeness.  Separating a mother and her newborn during the 1st week of the child’s life involves much emotional strain for the mother, even though the newborn is not seriously ill.

Nystrom K, Axelsson K. Mothers’ experience of being separated from their newborns. J Obstet Gynecol Neonatal Nurs 31:275-82, 2002

This Polish study is yet another confirming the importance of motherinfant skin-to-skin contact immediately after birth. Using a prospective cohort study design, 1250 Polish children were followed for three years to determine the influence on breastfeeding practice of skin-to-skin contact after delivery. Infants who were kept with their mothers for at least 20 minutes were exclusively breastfed for 1.35 months longer and weaned 2.10 months later than infants who received no such contact after birth. In conclusion, extensive motherinfant skin-to-skin contact lasting more than 20 minutes after delivery increases the duration of exclusive breastfeeding.

Mikiel-Kostyra K, Mazur J, Boltruszko I. Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study. Acta Paediatr 91:1301-1306, 2002

Epidural anaesthesia, commonly administered to women in labour, is known to affect breastfeeding. Mothers receiving epidural anaesthesia were compared to mothers not given anaesthesia during labour. Two successful breastfeedings within 24 hours of age were achieved by 69.6 per cent of mother-baby pairs who had received epidural anaesthesia compared with 81.0 per cent of mother-baby pairs who had not. Infants of mothers who had had epidural anaesthesia were significantly more likely to receive a bottle supplement during their hospital stay. In conclusion, epidural anaesthesia during childbirth had a negative impact on breastfeeding in the first 24 hours of life. 

Dennis J. Baumgarder, MD, Patricia Muehl, RN, MSN, Mary Fischer, MS, Bridget Pribbenow. Effect of Labor Epidural Anaesthesia on Breast-Feeding of Healthy Full-Term Newborns Delivered Vaginally. J Am Board Fam Pract 16:7-13, 2003

INFACT Canada Photo

Skin-to-skin contact between mother and baby immediately after birth

facilitates exclusive breastfeeding.