The A,B,C of Feeding Priorities

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'?:

• Mothers who are potentially going to have insufficient production and
• Babies who have insufficient calorie intake.

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'.

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