Science & Sensibility

Creative Commons photo by Raphael Goetter

As the mother of two children, both who breastfed well into toddlerhood, and as a childbirth professional, I have spent a lot of time over the years 1) learning how to breastfeed or breastfeeding my children and 2) facilitating “how to breastfeed” conversations with pregnant women and their partners in my Lamaze classes, working as a birth doula with new mothers immediately after birth and in the first postpartum days at home with their newborn as well as regularly training new birth doulas and childbirth educators on how to prepare and work with their clients and students in the early days of the breastfeeding relationship.

I frequently find that new mothers often consider breastfeeding the next potential challenge after they have birthed, and getting it “right” includes avoiding pain, developing a good milk supply and making sure that their baby is getting all the nutrition they need in the vulnerable first days when things are so new and unfamiliar.  Breastfeeding challenges can increase the rockiness of an already emotionally and physically fragile time for the mother-baby dyad.

I have watched teaching methods, techniques and vocabulary change as more is learned about the newborn, their instinctive behaviors and the innate wisdom of the mothers of these new little ones.  Most of us have seen the widely viewed “Breast Crawl” video put out by UNICEF, WHO and WABA, and ooh-ed and ah-ed at the wisdom of the just born baby who self-latches when placed on its mother’s chest.   Suzanne Colson, Rebecca Glover, Christina Smillie and others have shared resources and information that has helped mothers and the professionals that support them get breastfeeding off to the best start possible, by introducing concepts such as baby led and laid back breastfeeding.

It was with great interest that I read Facilitating Autonomous Infant Hand Use During Breastfeeding and learned the important role the newborn’s hands play in helping to shape the breast, areola and nipple to facilitate breastfeeding.  I have always encouraged mothers to undress their newborn to allow for skin to skin when nursing, and sighed when I saw trained professionals encourage mothers to nurse a swaddled newborn.  But, I have to admit, I was guilty of encouraging mothers to “tuck” their baby’s hands out of the way when getting the baby to latch on, concerned that the baby’s hands would prevent a good latch as the baby seemed to want to suck on both the breast and their hand at the same time.

 In the past, the baby’s hand movements while at the breast where considered “uncoordinated,” “purposeless” and “random,” and were thought to interfere with the coordination of the breastfeeding process.  Current research shows that not to be the case at all.

Catherine Watson Genna, BS, IBCLC, RLC and Diklah Barak, BOT, the authors of Facilitating Autonomous Infant Hand Use During Breastfeeding share that babies that hug the breast with their hands are helping to stabilize their neck and shoulder girdle, by pulling together the shoulder blades. Hand movements, by the infant on the breast, increase maternal oxytocin.  It also causes the nipple tissue to become erect, which facilitates latch.  Babies are best able to use their hands “against gravity”, lifting them up, when their hands are in their field of vision.  The hands are used along with the lips and tongue to draw the nipple into the mouth, a behavior that disappears around 3-4 months of age.

The authors observed that infants use their hands to push and pull the breast to shape the breast and provide easier access to the nipple.  Newborns and young infants also use their hands to push the breast away, possibly to get a better visual sense of the location of the nipple.  Genna and Barak also state that an infant may feel the nipple with their hand, and use the hand as a guide to bring their mouth to the nipple.

 Wonderful black and white pictures accompany this article, and useful video clips are included for great visuals of the behaviors described by the authors.  The authors provide information on how to facilitate infant hand use during the breastfeeding session, including step-by-step instructions that can be shared with expectant and new mothers when you are teaching.

 Teaching new mothers that their newborn’s hands are a tool that the baby uses to find and latch on to the nipple, rather than something to be restrained and held out of the way, can help new mothers to appreciate the innate abilities of their newborn to self-latch and breastfeed successfully.  The materials in this article can be incorporated in the curriculum you cover when you discuss breastfeeding, and increase confidence and success for the new mother and encourage the breastfeeding relationship to have the best start possible.

 Please take a few minutes to follow the link and read the article, view the pictures and videos and let me know how you envision using this information in future classes?  Have you changed how you teach breastfeeding as new concepts and information have become available?  Share your tips and success stories with us, so that we all can become more skilled at providing new parents with effective teaching practices that support the breastfeeding relationship.  I look forward to hearing from you.

 Sources

Genna, C.W. & Barak, D.  Facilitating autonomous infant hand use during breastfeeding.  Clin Lact 2010; 1(1):15-20.

http://www.biologicalnurturing.com/

http://breastcrawl.org/index.shtml

http://www.breastfeedingresources.com/

http://www.rebeccaglover.com.au/

Sharon Muza Babies, Breastfeeding, Continuing Education, Doula Care, Evidence Based Medicine, Healthy Birth Practices, Infant Attachment, New Research, Newborns, Parenting an Infant, Practice Guidelines, Research Barak, breastfeeding, breastfeeding class topics, childbirth education teaching strategies, Colson, first weeks of breastfeeding, Genna, glover, how to breastfeeding, IBCLC, Lamaze Classes, newborns, postpartum, Smillie, teaching community breastfeeding classes, WHO breastfeeding recommendations

Colostrum We know that a mother produces colostrum in pregnancy and continues to do so for up to 10 days or so after her baby is born.  We know that newborn babies require nothing other than colostrum and that though it is not there in plentiful amounts it is adequate for baby’s growth and health[1].  Yet, how often do we hear that a mother must begin expressing her milk because she probably won’t have enough?  We know that a baby who is well latched with an asymmetric latch will get the colostrum that is there, and a poorly latched baby won’t[2], and yet we see thousands of mothers in our clinic who have been taught to latch baby symmetrically.  Instead of adjusting the latch for better milk

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transfer mothers are being told to pump.  And incidentally, colostrum does not respond well to a pump, it responds better to hand expression.  And so when mothers can pump nothing,  they are told they have no milk.  Best to adjust the latch and use breast compressions[3] and watch for baby’s drinking (don’t listen, you are unlikely to hear a baby drinking at that age)[4].

Engorgement Contrary to popular belief engorgement is not a sign mother has a lot of milk.  Engorgement is a sign things have gone wrong.  And worse off, if the engorgement is severe enough it can cause depletion in mother’s milk significantly on that breast, perhaps even for the breastfeeding experience of that baby.  To avoid this, latch asymmetrically and deeply.  Ensure baby drinks well, use breast compressions (see the video clip and info sheet at www.nbci.ca for the “how to”) to ensure the milk continues to flow.  Keep baby skin to skin so mother will be able to read baby’s early cues and thus the necessary frequency of feeding that needs to happen (no timing how long per side or how long in between feeding, no counting sucks or drinking, no schedules[5]—just following baby’s early cues and keeping baby drinking) and that will suffice.  If mother does become engorged then using RPS [6],[7](Reverse Pressure Softening), developed by Jean Cotterman, will allow the baby to latch on immediately and drain the breast, see www.nbci.ca for the info sheet on engorgement.  It is very important not to pump engorged breasts, nor to massage downward toward the nipple.  Once baby is on, use breast compressions (which are always stationary) to keep baby drinking.

Sore Nipples We also know that a well-latched baby should not cause mother pain[8] and yet women are told around the world to put up with the pain, or grin and bear it because it is supposed to hurt.  A troubling practice is one where the mother is told to unlatch baby and re-latch over and over until she gets it right—this repeated activity can cause damage to the nipple and is not only painful, mothers become so dejected by doing it.  Instead, it’s best to adjust the latch mother has already by ensuring the nose stays far away from the breast and keep baby drinking.  Of course, if mother felt that the latch was absolutely unbearable and she could get a better one if she tried again, by all means.   Mothers are also told to prepare their nipples (a completely non-evidenced informed practice!!) and to apply various creams and ointments on their nipples: petroleum jelly, lanolin-based creams, nipple balms—none has been supported by research.  Some make matters worse.  Again, simly by adjusting the latch the pain is dealt with—if not, there is something else going on.

[Lastly, if the above measures have failed to reduce soreness,] check for tongue tie [9],[10],[11].

Edith Kernerman Breastfeeding, Uncategorized asymmetrical latch, breast compression, breast engorgement, breastfeeding advice, colostrum, Edith Kernerman, first weeks of breastfeeding, how to treat sore nipples, Reverse Pressure Softening