Guelph Ontario Canada
From: LEAVEN, Vol. 38 No. 6, December 2002 - January 2003, pp. 123-125.
A new mother called me after her midwife gave her my phone number. Her baby boy, born uneventfully at home, was 12 hours old at this point and had still not taken the breast. When the mother and midwife tried to help him latch on, he closed his mouth firmly and arched his back, pulling his head away from the breast.
When I went to visit this mother at her home, I could see that the repeated attempts to latch the baby on were making him feel increasingly unhappy about being held in the nursing position. As soon as he was held on his side and moved close to the breast, he started to fuss and push away. I suggested to the mother that she just concentrate for a little while on helping the baby feel relaxed and comfortable at the breast—just letting him lie there, close to the breast, without any pressure to latch on or feed.
She called me back several hours later, very excited, with wonderful news. She had been lying on her back, dozing, with her naked baby lying on his stomach on her bare abdomen just below her breasts. She noticed the baby beginning to squirm and wriggle and then, to her surprise, he pushed himself up to her breasts, his little head bobbing as he searched for the nipple. Then he latched on and suckled away. After several minutes of vigorous sucking, he let go and rested. She then gently moved him toward the other breast, and to her delight he repeated the process, latching on beautifully all by himself once again. That initial feeding was the beginning of their breastfeeding relationship.
Like many people, I had seen and been impressed by the Swedish video, "Delivery Self Attachment," by Dr. Lennart Righard and Margaret Alade, which documents newborn babies crawling unassisted up their mothers’ abdomens to find and latch on to her breasts. That video is a moving and powerful testament to the innate knowledge of babies.
The research Dr. Righard and his associates conducted during the early 1990s and illustrated in his video shows that newborn babies can find and latch on to their mothers’ breasts without any help. Medication during labor and separation of mother and baby after birth can both interfere with this natural process.
My belief had been, though, that self-attachment was something that could only happen in the first hour or so after birth. The experience of the new mother whose baby self-attached some 18 hours after his birth showed me otherwise. Now I’ve begun to find it useful in helping other mothers whose babies have resisted taking the breast in the hours or even days after birth.
While it is rare in North America for babies to be permitted to self-attach after birth, it is more common in other parts of the world. Norwegian midwife Rachel Myr says:
In my own practice, I leave mother and baby together after birth, in physical contact with each other, until baby attaches. It often takes more than an hour and is truly impressive to watch. The hardest part is not giving in to the temptation to weigh and measure the baby before the first feed.
Beckie Wood, a midwife in Winnipeg, Manitoba, Canada says she rarely duplicates the scenario shown in Dr. Righard’s video, where the mothers let their babies lie on their abdomens without touching them. "In real life," she comments, "most mothers want to hold and cuddle their babies! And usually they want to be sitting up, or at least partially upright. Often though, as they hold their babies near the breast, the baby begins to nuzzle around and then finds the breast and, all of a sudden, the baby latches." She has also worked with mothers who have seen the video and are interested in seeing if the baby will find the breast completely unassisted. "It really works," Wood says. "It’s amazing to see."
The prevalence of allowing babies to self-attach may be increasing in North America. In the abstract of their study published in American Family Physician in 2001, researchers Sisusas and Gagliardi state:
In order to ensure success in breastfeeding, it is important that it be initiated as early as possible during the neonatal period. This is facilitated by skin-to-skin contact between the mother and infant immediately following the birth. When possible, the infant should be allowed to root and latch on spontaneously within the first hour of life.
Of course, La Leche League Leaders are rarely present at the time of a baby’s birth. When we are called for help with a baby who is reluctant to nurse, it is usually hours, days, or weeks later and the baby has developed a pattern of resisting or refusing the breast.
Whether it be the day after the birth or the month after, the first thing I recommend is putting the baby skin-to-skin with the mother’s bare chest with only a diaper on the baby. In most cases this leads rapidly to a turn-around in baby’s attitude toward the breast.
Wood has had similar experiences:
Prescription number one with a reluctant baby is to have the mother take her shirt off, lie down with the baby on her abdomen and see what happens. Usually it works. The baby finds its home.
At the National Meeting of the Norwegian Association of Midwives in 1999, Myr presented a short talk in which she outlined infant behaviors at the breast, their meanings, and appropriate responses.
While the reluctant baby’s behavior may vary, the response is almost always the same: provide relaxed, skin-to-skin contact and the baby’s natural breastfeeding ability will often, in time, reassert itself.
With babies older than a week or so, I have sometimes found it helpful to encourage mother and baby to take a bath together. The warm water seems to help both of them relax and may even remind the baby of his watery environment before birth. Often in this setting, the previously reluctant baby will find and latch on to mother’s breast for the first time.
What is the latch like when babies self-attach? Dr. Righard commented in his research that these babies tended to latch on beautifully and the mothers did not experience sore nipples. Myr quotes another midwife who used this approach with a two-day-old baby who had previously cried and resisted the breast: "Instead of pushing away from the breast, he throws himself at it with the most wonderful wide-open mouth . . . and that’s where he’s been ever since."
At what age does the baby lose the ability to find and self-attach to the breast? Dr. Jack Newman, a pediatrician from Toronto, Ontario, Canada, describes two similar reflexes which may be involved in the baby’s movement towards the breast. One is the "Stepping Reflex," which is most often demonstrated by holding the baby under his arms with his feet touching a firm surface. The baby will alternately move each leg, bending his knees as though walking. This reflex disappears at around three months. The other is Bauer’s reflex: when the baby is lying face down, pressure applied to the soles of his feet will cause him to make crawling movements. This reflex lasts about six weeks. Dr. Newman feels that as long as these reflexes are present—in other words, for at least the first six weeks—self-attachment may be a useful way to help the baby learn to breastfeed.
We’ve come a long way from the days when many experts believed that babies were blank slates with little ability to feel, understand, or communicate. It turns out that even newborn babies know a great deal about breastfeeding: how to find the breast, how to locate the nipple, and how to latch on correctly. Providing an environment where the baby can demonstrate those skills may help those infants who are reluctant to breastfeed or actively resisting the breast.
If a newborn is not latching on to the breast, the mother needs to begin expressing colostrum within the first few hours after birth. She may be comfortable using hand-expression or she may prefer to use a pump. It should be pointed out to her that colostrum is produced in small amounts but even the smallest quantity should be saved and given to the baby by spoon, dropper, or feeding syringe. As long as the baby is not latching on, the mother should be encouraged to express regularly in order to avoid becoming engorged. If the mother becomes engorged it will make it even more difficult for the baby to latch on effectively. It is equally important for the baby to be fed. If the baby goes too long without eating, he could become dehydrated or too weak to attempt to latch on. Before the baby has learned to latch on to the breast, artificial nipples should be avoided so the baby does not become accustomed to using incorrect sucking patterns.
Teresa Pitman has been a La Leche League Leader for more than 20 years. The author or co-author of nine books on parenting, including Jack Newman’s Guide to Breastfeeding (known in the USA as The Ultimate Breastfeeding Book of Answers), she is the mother of four breastfed children and lives in Guelph, Ontario, Canada. Patty Spanjer is the Contributing Editor for lead articles in Leaven. Send your ideas to Patty at spanjer at alltel.net (email) or EditorLV at llli.org (email).