Breastfeeding

Many women who plan to breastfeed are unsuccessful. This could be due to the initial practices around infant feeding in UK hospitals.

Common care practices that are routine post natally in UK hospitals could be contributing to the low breastfeeding continuation rates we see in the UK. UNICEF (The United Nations Children's Fund which runs the Global Baby Friendly Initiative-BFHI programme with the World Health Organization to improve breastfeeding practice to enable and support parents to make informed choices about how they feed and care for their babies) advise that the first hour after birth is crucial to successfully initiate breastfeeding.

Initiating breastfeeding within one hour of birth is one the Ten Steps to Successful Breastfeeding on which the BFHI was based and launched in 1992. Step 4 states, “Help mothers initiate breastfeeding within a half-hour of birth” and whilst skin to skin has assumed a high level of importance after birth, this may not include suckling which is a crucial first step in the initiation of successful breastfeeding.

It has been observed that the suckling reflex of the newborn is at its height twenty to thirty minutes after birth. If the infant is not fed during this early period the reflex diminishes rapidly only to reappear adequately forty hours later (Riordan and Auerbach, 1993). This may be called “The fourth stage of labour” which includes putting the baby to the breast after birth and ensuring the intake of colostrum.

Although the practice of skin-to skin contact is commonly promoted by midwives, its duration can be short lived because of other priorities in care organization, including suturing or moving from a delivery room to a post natal room/ward.

As well as interruption of early breastfeeding, it could be the position in which we initially encourage women to breastfeed that has a detrimental effect on breastfeeding duration.
Dr Suzanne Colson has introduced the concept of ‘Biological nurturing’. In one study she found that mothers who breastfed their infants semi-reclined or 'flat lying' (as opposed to lying on their side), in positions that mirrored the feeding positions of other mammals, had the greatest success.

Dr Colson’s findings suggest that, the principle component of Biological Nurturing (BN), is that a range of semi-reclined maternal postures, release primitive neonatal reflexes (PNRs) pivotal to the establishment of breastfeeding.

Research has shown that both the timing of the first breastfeeding and the frequency of breastfeeding on the second postpartum day are positively correlated with milk volume on day 5, suggesting that frequent stimulation of prolactin secretion in the period between birth and lactogenesis II increases subsequent milk production (Neville, 2001). Infrequent suckling, on the other hand, is associated with delayed lactogenesis II (Chapman & Perez-Escamilla, 1999; Sözmen, 1992).

In most maternity facilities, following 30 minutes of skin-to-skin contact post delivery, the provision for mother–infant contact involves rooming-in with the infant at the mother’s bedside. This is an improvement from the early practice of removing newborn babies to nurseries to allow their mothers to ‘rest’ however even this practice may be interfering with successful breastfeeding.

In a presentation to the Healthy Child Conference, Dr Helen Ball presented findings from a study where infants were randomly allocated to sleep in the mother's bed (with side guard) or (attached bed side) crib or cot. Those allocated to the bed or bed side crib condition exhibited significantly more frequent attempted and successful feeds than those infants randomly allocated to the cot.

Post natal follow up at periods from 2-16 weeks found that although all mothers initiated breastfeeding on the postnatal ward, the proportion of infants from the cot group who were exclusively breastfed at home declined rapidly compared to those in the bed and crib groups.
Evolutionary medicine suggests the effective establishment of breastfeeding which is promoted by the evolved behavioural and physiological interactions between mothers and babies is hindered by the current model of post-natal care (rooming-in) and that despite recent alterations in maternity care practices, a proportion of breastfeeding failure still remains an iatrogenic (a condition caused by medical intervention) consequence of the restrictions imposed by a hospital environment.

TIPS

If possible avoid medications that may interfere with breastfeeding behaviour (Including Epidurals and Opiates/Pethidine)

Ask that you and your baby be left skin to skin after birth without disturbance for at least the first hour (weighing, dressing and other medications like Vitamin K can then be given)

Ask your hospital if they have any side cots available instead of a bassinet so that you can have easy access to breastfeed your baby in your time at hospital.

If they do not have this available, consider bringing this up with a lay representative at your local Maternity Services Liaison committee (your local National Childbirth Trust should know who to contact.).

Further reading

http://www.unicef.org/malaysia/Breastfeeding_First_Hour_of_Life.pdf
http://www.biologicalnurturing.com/
http://www.dur.ac.uk/sleep.lab/