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Leave the Latch Alone!

Uninterrupted skin to skin contact following birth allowing for the initiation of feeding as driven by the innate instincts and reflexes, rather than on the timeline, under the influence of, or directed by caregivers or medical staff is appropriate in most circumstances following uncomplicated births. The benefits of this are numerous and long lasting! But in this article, we are going to explore the process and benefits of skin to skin for infant-led latching for the initiation of bodyfeeding.

Widström et al (2019) state, “Being in skin-to-skin contact with the mother after birth elicits the newborn infant's internal process to go through what could be called 9 instinctive stages” that are innate and reflexive for initiating feeding. These are driven by survival instincts and behaviors, mediated by hormones, and supported by the senses. However, in our modern medicalized birth settings, they are often inhibited by procedures, technology, intervention, and social ‘norms’ to the detriment of feeding and bonding. Fortunately, supported by research, many hospitals are adopting “baby-friendly” initiatives to reinforce the uninterrupted golden hour time and delay interventions that separate birthing parent and newborn.

While hospital baby-friendly initiatives are certainly a step in the right direction, they continue to leave much to be desired with respect to supporting early bodyfeeding. And as parents and a society in general, we lack education and understanding, as well as social acceptance, of these important factors and processes, opting instead for visitation, phone calls, selfies, etc. Not that there’s anything wrong with us wanting to share the incredible news of a new life with the world, but protecting our golden hour experience at least would do much to mitigate the early difficulties that befall most of us as new caregivers.

What’s so special about skin to skin immediately after birth? Well, for one, the newborn thrives on it. According to Widström and colleagues, “This process is suggested to contribute to an early coordination of the infant's five senses: sight, hearing, touch, taste and smell, as well as movement.” In addition, as explored in this previous article, there are multiple benefits to both parent and baby. Bonding, temperature regulation, stimulation of milk production, stress reduction, development of the infant gut microbiome (and immune system), and emotional self-regulation are just a few to name!

Allowing the learning opportunities to occur and the infant to receive and use its own intrinsic feedback will facilitate better motor learning for enhanced repeatability later than when caregivers interfere and “assist”.

The authors of the article referenced here entitled “Skin-to-skin contact the first hour after birth, underlying implications and clinical practice” describe nine basic stages newborns go through intrinsically to initiate the very first feeding. They are:

1. Birth cry - We all know it! That intense first outburst of glorious wailing just after birth, pushed forth from the infant, seeming to convey their surprise or perhaps disappointment of having to leave the warmth and comfort of the womb. This marks the infant’s transition to breathing air, and is characterized by survival instincts and airway protection behaviors.

2. Relaxation - Following their proclamation of their presence, the infant rests. This phase is marked by quiet rest during which the infant’s senses are muted and they may listen to the caregiver’s heartbeat. No activity of mouth, head, arms, legs or body is typically observed. DON’T interrupt this stage if possible! If disturbed during this normal, physiologic rest stage, infants will cry and self-protect, starting the process all over again and disrupting the progression.

3. Awakening - Picture a cartoonish, dazed infant, slowly returning to consciousness from a dazed and restful state, blinking and slowly unfurling. Movements are characterized by small thrusts of head in all directions, small movements of limbs and shoulders, and attempts to focus gaze with blinking and searching.

4. Active - Now the infant moves their limbs and head with more purposeful and determined movements. We may see rooting activity with unproductive pushing with limbs without shifting the body. This is a very important stage for initiating feeding, as the infant will be exploring the flavors of the parent’s breasts using multiple senses, reaching toward the nipple guided by scents from the Montgomery glands on the breast, grazing the nipples to gather tastes of colostrum and bringing it back to the mouth. More obvious rooting activity is seen, as well as increasing tongue movement, with the tongue now extending and searching for nourishment. These tongue movements, or a lack of, may be our first clues as to how the tongue may behave during feeding.

5. Resting - Infant rests again more alert than the previous time, with some activity bouts, such as mouth activity, sucking on hand and fingers. The infant may intersperse multiple rest stages with other active phases. Again, do not interrupt this stage. If the newborn must start over again due to interruption at this point for routine care, they may be too exhausted before reaching the suckling stage, delaying nutrition and hydration and leading to further interventions.

6. Crawling - The infant stepping reflex stimulated by prone positioning of the infant on the caregiver’s body with feet in contact with the body allows a stable base for the infant to push and press, wiggle and scoot on their journey toward their first feeding. If skin to skin is done on the mother’s body, the pressure of baby’s feet on the uterus stimulates contractions, thus speeding the placental delivery, decreasing maternal blood loss. Avoid any unnecessary repositioning during this stage, and if anything, just assist the pressing with feet or provide access to the breast safely.

7. Familiarization - At this point, the infant has reached the nipple and performs specific mouth and tongue movements to shape and prime the nipple for feeding. This stage is crucial for development of oral motor skills necessary for effective suckling as the rooting reflex is repeatedly elicited and the resulting tongue movements are responsive to this stimulus. This phase is also marked by the infant positioning and repositioning their head and mouth which may look like “popping on and off” the breast. In actuality, the infant is trialing positions and making small adjustments, learning from each attempt how to optimally approach the breast for the most effective and comfortable latch. Allowing the learning opportunities to occur and the infant to receive and use its own intrinsic feedback will facilitate better motor learning for enhanced repeatability later than when caregivers interfere and “assist”.

8. Suckling - Hooray! Baby has reached the summit and planted their flag. This phase is marked by successful latching and suckling, aka the first feed. Allowing the infant independence in taking the nipple into the mouth most often results in a deep latch, particularly when sufficient and effective familiarization has occurred and the infant has attained a stable, optimal position. The hand and eye movements decrease with suckling as the infant settles into a rhythm and focuses on the task at hand (er, well, at mouth!). Again, the infant may make adjustments, and when left alone to do so, will achieve the most optimal latch that is within their capacity. The only thing a caregiver needs to do is provide a safe, stable base of support for the baby to rest and move upon.

9. Sleeping - This one is pretty self-explanatory. The finish line has been reached and baby is enjoying the post-prandial hypnosis of a full belly and stable blood sugar levels enveloped in the warm embrace of a loved one. What could be better?!

Infants exhibit these several instinctive breastfeeding behaviors, and when given the opportunity, will mimic the same patterns as in the hour after birth upon later attempts. This offers families multiple chances to try to provide the infant with these learning opportunities with the potential to overcome early breastfeeding problems. We also note the many other benefits of skin to skin time performed frequently by caregivers for both parties. There are so many reasons why skin to skin time is so incredibly beneficial to the nervous, muscular, immune and digestive systems of babies! What are you waiting for? Whip your clothes off and try it out with your baby now!

Have you used skin to skin to repair your feeding relationship or to enhance bonding? Why did you choose skin to skin? I would love to hear about your experience and what you and baby gained from it! Please feel free to share with me in the comments or contact me here to learn more about how physical therapy can help with bodyfeeding!

Source: Widström, A.-M., Brimdyr, K., Svensson, K., Cadwell, K. and Nissen, E. (2019), Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr, 108: 1192-1204.

For more info on lactation-informed PT, please check out my Instagram posts #lactationinformedpt

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