Infant Self-Attachment
Teresa Pitman
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.
Myr says:
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.
Editor’s Note:
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).
Last updated 11/18/06 by jlm.
Page last edited Sun Oct 14 09:31:42 UTC 2007.
