  Planning to breastfeed may begin before planning to conceive but for most women it is often an after thought in the cycle of life.
If we grew up in a village then we would already know the culture and practices of that village and would also know that if we had trouble, the girl in the hut next door, or even our grandmother could help out and I mean that quite literally. Sharing in the baby feeding is often a feature of village life. These days some social breastfeed sharing occurs and thank goodness we have milk banks to assist those in need of breastmilk when the mothers own supply is not quite there yet. Thank goodness we also have the donors who are so generous with this precious resource! IBCLC's (International Board Certified Lactation Consultants)are the experts in this speciality but this article is about other aspects of breastfeeding. This article is looking at Feeding Priorities, from a lecture by Jane Morton MD Adjunct Professor of Paediatrics at Stanford University: 'Beyond Baby Friendly, Thinking Outside the Box'. GOLD lecture series May 2016 Feeding Priorities: A,B,C Where the pregnancy and the birth are predicted to be in the 'low risk' or 'no intervention' category we could look to the Feeding Priorities as being: A- Attachment Promote the ideal situation for a baby attaching within the first hour of birth. Skin to Skin Contact between mum and baby and Breastcrawl fit perfectly with that. B- Breastmilk Provide the ideal situations that encourage the milk to 'come in' and build quickly. Early (in the first hour) and frequent feeds for the first few days, and that means effective feeds where the baby is able to 'strip' the milk out efficiently without causing damage to mums nipples, promote a great supply by about the 6 week mark and then beyond that. C- Calories Baby is able to do attachment- suck- swallow and gain weight according to its percentiles on the World Health Organisation Charts. If, however, there is a set back and the mother or baby is at risk of not following what is considered 'normal', then the priorities need to change. Who is 'At Risk'?:
These may include situations where the mum and baby are separated such as with a Caesarean birth; there are breast anomalies or a history of breast surgery or baby is not attaching properly at the breast. Babies may be early, late preterm or post dates babies or they may be born of diabetic mums, be small for gestational age or be jaundiced. In these cases it would be wise to change the priority order to C,B,A. We want to reverse the order of that part of the alphabet! C-Calories Provide colostrum on a teaspoon to make sure that various body systems for temperature control, glucose regulation and bilirubin regulation are minimally impacted. Get mum expressing in that first hour even if baby has attempted to feed. B- Breastmilk supply increase Express frequently so that the body gets the message that breastmilk supply needs to increase as it would if there was an active, well, full term baby who knew how to feed effectively. A- Attachment Once supply is up and the calorie intake has been solid, then a baby is way more likely to be able to attach well and get the feeding back on track. So- when considering the need for self attachment and skin to skin contact plus unrestricted feeding, we also need to consider whether the mum-infant pair is in the 'low risk' or 'at risk' predicted group. If in the latter, then we need to switch our thinking and be pro active in assisting with the ideal outcome of fully breastfeeding. This thinking is what has guided every suggestion that I myself make when assisting new breastfeeding pairs with establishing breastfeeding. Keep it simple: A, B, C for 'low risk' vs C, B, A for 'at risk'.  A baby's hands do so much and tell us so much about what is going on in the life of the baby. Straight after the birth, as baby is doing the 'Baby Crawl' as opposed to the 'Crocodile Rock', the knees are pushing in to mums body to propel the body forwards. The hands reach up to find the breast and when they do, often give a bit of a nipple tweak and breast massage to get the oxytocin going in mum. The most intense time for oxytocin release is in that first hour after birth so a baby is ensuring that the menu has been read and the wait staff are onto providing for the food needs. This oxytocin is known as the love hormone as it was there at the time of a natural conception and is there during times of social events like a family meal time. It is also needed to enable colostrum or milk (whatever you wish to call it) to be released to start the breastfeed and so enable the 'let-downs' that happens during the feed. A 'let-down' simply means that milk is let down from the cells, way back in the breast, where it is made and practically squirts it out to the baby. Well- for the first couple of days it is more of a gentle release than a squirt but it still happens so that milk is available for the baby. A baby then has to be attached and using the right suck action to get at the milk but that is for another discussion. Babies use the hands to massage the breast to bring on the flow, not just on the first day, but during most feeds and an older baby will actively 'bang' on the breast to make the milk come out faster if that is what is wanted. Have you ever seen a calf do that at the cow's udder? It has a similar meaning here and this is why it is not a great idea to use mittens or to swaddle a baby up during a feed time. Baby needs to help mum and needs to experience the sensations through the hands to help itself with the feeds. Anyhow- if you swaddle the baby, it cannot possibly get close enough to you, so sore nipples, and lack of satisfaction with the feed will result. Babies do not watch where they are going, at first, so the hands can act as their 'GPS'. Smell, Touch, Taste and Feel are way more important in the early stages. Where the hands go, the baby follows and if it is taking too long to find the breast, the hands end up in the mouth and a tangled web of baby hands, and then mum grappling to move baby hands from mouth may cause confusion. The seemingly random hand movements of a baby seeking the breast is actually a well intentioned sequence for finding and shaping the breast and of then 'stuffing' boob into the mouth. As baby feels for the nipple, which then becomes erect, the hands can guide the mouth to the nipple. Fascinating stuff really and especially when you get to watch how 2 hands pressing together, either side of the breast, can shape it for feeding use! Moral of that story is to NOT swaddle the hands out of sight and avoid washing the hands which removes the 'GPS' scent and all sense of direction. Bring the breast closer so the nipple can be felt along baby's cheek as this will reorient baby to the job and get attachment back on track. Baby hands can also give the parents a clue about whether the feed has been completed or not. If the fists, and toes, are tight and clenched, the baby has generally not reached the level of fullness and satisfaction needed to ensure sleep. Baby needs to get through to the creamiest and sweetest milk which is like dessert and this signifies the end of the feed for baby. If baby gets through to that, then the dinner time can be classed as being balanced ie there has been entre, mains, dessert (chocolate pudding if it was me) and maybe the cheese and crackers followed by liqueur and after dinner mints (if this was at an adult banquet). Usually parents find that the fists and feet open out and fully relax by the satisfaction stage and then they are way more likely to be able to relax in the knowledge that baby is comfortable. Self detachment is another clue that baby has had sufficient feed. Seriously, a baby cannot be expected to sleep if it is still uncomfortably hungry or thirsty. Using a dummy will satisfy the sucking need but will not fill the belly and pretty soon, once baby is in the cot, the crying will start up again. The advice therefore is not to use the dummy but to get some good breast attachment and give more food. That is another story for another time. Look at the hands and think about what are they telling you?  Resources:
Breastcrawl.org http://biologicalnurturing.com Facilitating Autonomous Infant Hand Use During Feeding- Genna,C.W. & Barak, D. October 2010 
|
RSS Feed
BreastfeedingSupportSunnyCoast acknowledges the traditional custodians across the lands
on which we live and work, and pays respects to elders past, present and emerging.
|
|