Tuesday, December 1, 2009

Skin-to-skin vs. pushing latch-on right after delivery

"Breastfeeding initiated with in the first half hour" or "the first hour" (depending on what country you're in) is one of the important facets of the Baby-Friendly 10 Steps. While this is an admirable goal, Gloria Lemay has a very nice post up about the problems with aggressively pushing breastfeeding immediately after birth, sparked by e-mails with a lactation consultant in Israel. That LC, Leslie Wolff, writes:

I have a few of my own beliefs about breastfeeding immediately after delivery. I feel that skin to skin after birth for the first two hours is SO important -more important than making a big effort to get that baby to breastfeed.. MAINLY because I realize that it helps the diad - mother and baby - to recover from the birth experience, is a Win Win situation that requires no effort , there is nothing to “succeed” in - it is just a “being” situation that is beautiful for Mom and baby. And if the baby goes for the breast - great..and if not, or the breast is offered and the baby doesn’t GO FOR IT - that’s fine. ... I know that babies are “supposed to” “immediately” start breastfeeding beautifully - but I see so many mothers and babies that are SO content just lying there Skin to Skin, relaxing, bonding in their own special way. In the past, before I discovered the beauty of Skin to Skin ,I remember many frustrated Moms and babies doing their best to breastfeed, because Mom and Dad both knew that was the best thing to do immediately after birth...)

Gloria agreed and added:

I attend only homebirths and have the same attitude. It’s the skin to skin contact and little (or big) noises of the baby that cause the uterus to contract powerfully post partum. It is a sacred time right after birth that can never be recaptured. When the mother and baby have warmth and privacy they will “discover” each other and fall madly in love. This is the best child protection method both in the short and long term. We are mammals. We must sniff, lick, coo, cuddle, look at and hear our young. In turn, the baby does many “pre-nursing behaviours”-climbing, licking, looking, hearing, sniffing. . . who knows what they are doing because it’s dark and private, remember?

I think these are both beautiful and important reminders that the idea of initiating breastfeeding in the first hour is more about getting mom and baby close, practicing skin-to-skin care, and letting both "discover" each other. I don't think it's so important to - as some people do - make sure the baby is latched on, nursing vigorously, and has a perfect latch in the delivery room. (I have seen some very aggressive latching efforts by nurses that have made me very uncomfortable.)

But as a doula, I have often pushed breastfeeding in the delivery room, even when mom and baby could be happy just cuddling. Why? Because sometimes it seems like the only way to keep baby with mom. Now that (some) hospitals have placed importance on breastfeeding, it's considered an important (aka chartable?) activity. But skin-to-skin time, bonding, and relaxing are unfortunately not considered important, and thus are subservient to other important activities like weighing, measuring, eye gooping, bathing, newborn exam, etc. etc.

Itchy fingers are often waiting on the sidelines so that "when you're done nursing I'll take him up to the nursery to get checked out and then you can have him back". Or if mom needs a lot of stitches, itchy fingers are hovering to say "Since this is going to take a while, I'll just take him upstairs now and then when you get there, you can have him again to nurse." (What do you want to bet he's going to get hungry upstairs and be given a "just a little bit" from a bottle while waiting for mom?)

It's unfortunate that as a doula, I feel like I have to ask "do you want to breastfeed now? let's see if we can get her latched" - but when I sense itchy fingers waiting, I try to postpone them as long as possible and sometimes it feels like the only way to do it is to push breastfeeding. I will say that I try to be so careful to step back, not be very hands-on, and focus more on baby tasting, nuzzling, and "practice" latching than any measure of "success". (Unfortunately, parents sometimes have their own preconceived notions of "success" and the perfect nursing session, which can be hard to dispel.) I wish that all mothers were accorded the same sacred, private space that Gloria offers homebirth mothers, so this wouldn't be necessary.


WiseWoman said...

Thanks for your input on this subject, too. I agree that you have to get creative in the hosp in order to keep the baby with the woman.

I was at a hosp birth once where the woman and her infant were just relaxing and getting to know each other. We had made a birth plan saying the cord would be left to pulse for 30 mins. At the 28 min mark I sugg'd the woman feed the baby because I knew,once they cut the cord, they'd want the placenta out. Couldn't believe it when the nurse said "Oh the baby can't nurse we haven't weighed him yet!" I thought she was kidding but she wasn't. Gloria Lemay

Rebecca said...

Hi Gloria,

Thank you so much for the comment! Hospital rituals = so mind-boggling sometimes. So many things are done "just because" and when you ask, no one can really give you a good answer for why.

I know a UK midwife who said that they are starting to have to chart why the baby was NOT skin-to-skin after birth - that sounds like a much better routine! We should try that here!