Breastfeeding: food for thought…

small_8586579077If you have any contact with women who are giving birth and/or breastfeeding, then I would urge you to consider reading a study published recently in BMC Pregnancy and Childbirth (which means it’s free, and here’s the link) in which Ruth Cantrill and colleagues (2014) sought to determine whether naked infant-mother body contact within the first hour of life was a good means of promoting effective sucking.  The study included 78 women who gave birth within an Australian hospital and the researcher observed usual practice for the first hour of birth, making a record of all manner of events in order to see what could be learned.

I found this paper fascinating and, as an aside, if you’re looking for a paper to critique and/or discuss in a group, this would be a great one, because there are so many variables and situational factors that the researcher needed to take into account that would make great discussion fodder.

There are a few gems in here, including the discussion of whether naked body contact is a better (as in less potentially confusing) term than skin-to-skin, and the further insight it gives into the impact of resuscitation on breastfeeding (which I will expand on in a moment), but one of the best things for me about this paper is that it offers new knowledge and insights within the context of the wider issues.  I think this will be really helpful for those who are new to the topic and seeking to understand the bigger picture as well as for those who are ‘old hands’ and keen to see the latest evidence.

small_3558088284I was really surprised to read that fifty per cent of the babies studied were deemed to need some kind of resuscitation and 43.6 per cent were considered to need warming – which I take to mean as more than that which could have been provided by their mum.  Some of this might be explained by the fact that, although the participants ‘were at least 36 weeks gestation, able to communicate in English, and with no major prenatal complications or underlying medical problems likely to impact on their ability to hold their naked baby immediately after or within 30 minutes of birth’ (Cantrill et al 2014), they remained in the study regardless of the manner of onset of labour, pain relief used or type of birth.

This is great, because this reflects reality.

But even though we might expect the inclusion of women who had cesarean sections and other interventions to increase the resuscitation rate somewhat because this is (rightly or wrongly) often still a routine part of the cesarean procedure, this doesn’t explain away the high resuscitation rate completely.  In fact, two-thirds of babies born vaginally (n = 42 out of 61) were deemed to require resuscitation, which included facial oxygen, oronasopharangeal or gastric suction. I will admit that it has been a while since I practised in the more interventive environs of a hospital, but this seems incredibly high to me.  Given that the results of this study further confirmed that the likelihood of babies achieving suckling within the first hour after birth is reduced if they experience suctioning, it is great that one of the key take-home messages that this paper offers is that we really need to work on how we can reduce unnecessary suctioning…

Cantrill RM, Creedy DK, Cooke M, et al (2014). Effective suckling in relation to naked maternal-infant body contact in the first hour of life: an observation study. BMC Pregnancy and Childbirth 14(20).

The Research

Background: Best practice guidelines to promote breastfeeding suggest that (i) mothers hold their babies in naked body contact immediately after birth, (ii) babies remain undisturbed for at least one hour and (iii) breastfeeding assistance be offered during this period. Few studies have closely observed the implementation of these guidelines in practice. We sought to evaluate these practices on suckling achievement within the first hour after birth.

Methods: Observations of seventy-eight mother-baby dyads recorded newborn feeding behaviours, the help received by mothers and birthing room practices each minute, for sixty minutes.

Results: Duration of naked body contact between mothers and their newborn babies varied widely from 1 to 60 minutes, as did commencement of suckling (range = 10 to 60 minutes). Naked maternal-infant body contact immediately after birth, uninterrupted for at least thirty minutes did not predict effective suckling within the first hour of birth. Newborns were four times more likely to sustain deep rhythmical suckling when their chin made contact with their mother’s breast as they approached the nipple (OR 3.8; CI 1.03 – 14) and if their mothers had given birth previously (OR 6.7; CI 1.35 – 33). Infants who had any naso-oropharyngeal suctioning administered at birth were six times less likely to suckle effectively (OR .176; CI .04 – .9).

Conclusion: Effective suckling within the first hour of life was associated with a collection of practices including infants positioned so their chin can instinctively nudge the underside of their mother’s breast as they approach to grasp the nipple and attach to suckle. The best type of assistance provided in the birthing room that enables newborns to sustain an effective latch was paying attention to newborn feeding behaviours and not administering naso-oropharyngeal suction routinely. 

photo credits : mum/baby by HoboMama and baby by minjungkim via photopin cc and cc

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