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Kangaroo Mother Care for Newborns

Posted on January 23rd, 2013 by | 5 views
by Vicki Wolfrum, CNM, IBCLC

 

Newborn self attachment

Newborn self attachment demonstrates the ability to initiate breastfeeding, all on their very own in the first hour of life.  The newborn brain is miraculously hardwired with 9 self directed steps that help the baby find and seek the mother's nipple and begin to drink the rich and wonderful colostrum her body provides.   It is amazing and inspiring to watch a brand new baby, juicy with vernix, blood and amniotic fluid, find their own way to the breast just moments after birth.  When a baby is  placed in a naked vertical ventral position, meaning baby lying tummy down in a push up position on mothers bare chest, a newborn will begin this commonly called "breast crawl".  They start with a cry of intention and will push up and hold their head up within moments of being born.  The newborn then looks from left to right, orienting themselves and trying to spot the darkened areola.  This is hard work and after this initial baby "push up", the tired baby will collapse back on to mother’s chest and start to suck on their fists. Have patience because this is just a little rest period.  If mother, father and staff are patient and do not interfere, the baby will start within minutes to move again.  They arch and wiggle in the direction of one of the breasts.  Enticed by a special fragrance emitted by the Montgomery Tubercles on the areola, the baby will then use hands to grab and feet to push over into the direction of the breast.  Babies can propel themselves quite quickly, but are not particularly coordinated.  Still with a gentle nudge from mom, they often find themselves close to the nipple.   Once there they will open their mouths wide, bob their head and "root".  If they are lucky enough to bob onto a nicely everted nipple, they will latch and suckle.  If they do not succeed, if the nipple does not cooperate or they end up under their mother's armpit, she can gently coax them back to the nipple and hold it erect for the baby to grasp.  It is important to give the baby the opportunity to do it themselves but be ready to provide very gentle direction should the baby need some.

Mothers and babies will both feel more confident after this experience. Studies show that babies who breastfeed in the first hour of life, are better breastfeeders, breastfeed longer and bring the mother’s milk in sooner.  Allowing baby to find the nipple on his or her own usually means that the baby will be more vigorous and more competent when the baby does latch on for that first feed. 

Kangaroo Mother Care

Kangaroo Mother Care has been defined by the World Health Organization, and awareness by the medical community is underway. There are three key components to this type of newborn care.  First is continuous skin to skin contact with the newborn.  Second is exclusive breastfeeding, preferably directly from the breast.  Third, support of the mother-baby dyad and NO routine newborn separation from mother.  All mothers and fathers should choose birthing environments that support kangaroo mother care in the first hours and days of life.  

Initial skin to skin contact regulates the baby's heart, respiration, oxygen saturation, temperature, blood glucose and decreases post birth pain levels.  It is the best way to prevent newborn stress and promotes early neuro-behavioral development.  It introduces the good bacterial flora and enhances immunological protection.  The release of oxytocin, the "love hormone" is the beginning of attachment to mother and a sense of trust and security for the baby outside the womb.  

Initial and continuing skin to skin contact promotes frequent breastfeeding and stimulates the mother's prolactin, the hormone responsible for milk production.  For babies who have suffered birth trauma it relieves pain.  For babies depressed by labor drugs and anesthesia it encourages more vigorous sucking and better latching.  For mothers whose own oxytocin has been inhibited by the use of synthetic pitocin, it is the one way to override the induced low levels of naturally occurring oxytocin post delivery. Not only does this allow the milk to "let down" but it makes the experience of breastfeeding enjoyable for both mother and baby.  The pulsatile hit of oxytocin that mothers and babies receive with every breastfeeding provides a deep sense of love and release for both. Mother looks down at her baby and thinks, "this is the most beautiful and amazing baby in the world!"  And baby serene and secure at the breast thinks "this is the most beautiful and amazing boob in the world!"

Mothers all want to know “how can I make more milk?”  The first and best step is to keep her newborn infant in continuous skin to skin contact.  This was first discovered in the modern era, when in the 70's South American doctors bound newborn preemie infants to their mother’s chest because a shortage of incubators meant that they had no other way to keep these tiny infant warm and alive.  Shockingly, they found that the infant bound skin to skin with their mothers survived more readily than infants kept in incubators in the NICU.  Since that time the majority of NICU's around the country have instituted policies to promote skin to skin contact and kangaroo mother care.  Infants cared for this way gain weight faster, breastfeed better, have fewer infections, less NEC and leave the NICU sooner, saving thousands of dollars. 

Exclusive breastfeeding is the gold standard for all infants.  This is recognized by the American Academy of Pediatrics, who stress that exclusive breastfeeding is a short and long term health issue, not a life style choice.  The Joint Commission, who accredits hospitals, has made it one of their new standards. It is the standard for healthy People 2020.  Almost every professional organization from midwives to doulas to OBs to dieticians who have looked at the extensive evidence support exclusive breastfeeding.  And it simply makes sense that the best nutrition for newborn humans would be human milk, not artificial baby milk synthesized from other animals or plants. 

Support of the Mother Baby dyad also is common sense.  Mothers and baby are physically, emotionally and psychologically linked to one another from the moment of conception.   The nine months of in utero gestation are just the beginning of nurture and growth.  It appears that human infants born without the capability of managing independently for many months are born immature and in need of a period of exo-gestation.  If humans were born more mature, they would be too large to fit through the pelvis.  Most mothers prefer to carry their infant in arms on the outside until they are able to walk at about one year.  Sadly in the modern world this carrying takes place in plastic carriers instead of the mother's arms. 

From the moment of birth infants will be calmer and in fact studies show that infant kept skin to skin cry 10x less!  

Nils Bergman has done extensive research on the stress that newborn babies experience when they are separated from their mother.  Here is what Nils says about newborn stress. 

"The baby is able to respond in a healthy way to short periods of stress. His mother’s presence makes it possible for him to quickly find his balance again. The brain actually needs mild and short stress, so this is called “positive stress”. The stress can be quite severe, but if mother is there all the time to comfort and soothe, then there is no harm to the baby’s brain. This is called “tolerable stress”.

Then there is “toxic stress”. High levels of stress hormones for long periods of time are toxic to the neurons that make the brain work. The stress hormone cortisol makes more neurons die off at a faster rate. This disrupts and disturbs developing pathways and circuits. With prolonged stress after birth, the brain is measurably smaller one year later. Prolonged stress is toxic to the brain.

The only difference between toxic and tolerable stress is the absence or presence of mother or father." 

There is no reason why a mother and baby should be routinely separated after birth.  Hospitals that have adopted the Baby Friendly Ten Steps require that mother and baby be left undisturbed during the first hour of life, called the "Golden Hour".  These hospitals and birth centers also encourage the 9 Steps to Self Attachment, so that a newborn infant may make his or her own efforts to find and latch on to the breast right after birth. Baby Friendly also requires trained professionals to support the mother and infant, in all three of these important components: Skin to skin contact, exclusive breastfeeding and no routine separation of mother and baby.  

Please click here for this article in hand-out form: Infant Self Attachment Handout

 

Vicki Wolfrum CNM, IBCLC, is a Nurse-Midwife, Board Certified Lactation Consultant , and Childbirth and Parenting Educator with 30+ years of commitment to natural birth and parenting.  Her "green" agency,Whole Life Home Care, offers a full range of dedicated and experienced professionals that can assist you and your family in the most natural way possible. 

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