Reproduced from 'Essence' magazine
Volume 36, Number 1
Exclusively for ABA subscribers

Wendy Nicholson was the keynote speaker at the 24th ABA Annual Tasmanian Branch Seminar. Avril Priem reports.

Emerging into the world, she is placed skin-to-skin on her mother's chest. She rests quietly then blinks open her eyes, peeping at her mother's face. She smells and touches her mother's skin. After 20 minutes or so, she is very much alert and begins to scan her mother's chest, turning her head from side to side. Before long, she opens her mouth, sucks at her knuckles, the rooting reflex very strong. She starts to inch towards her target - the brown of the areola. She smells colostrum and the odours coming from glands in the nipple and areola. She nuzzles a breast; mouths a nipple. Her mother gently helps her to attach properly. When attached, she suckles till she nods off, full and content.

This is the hour or so after birth when a newborn baby, if unaffected by analgesia, will intuitively crawl to his mother's breast and begin suckling. It is a baby's choice to initiate breastfeeding and if done soon after birth, means breastfeeding will be likely to be successful from the start with few or no breastfeeding problems.

Wendy Nicholson, a Melbourne midwife and lactation consultant, has investigated the research into this pattern of spontaneous behaviour by newborns. She argues that two procedures interrupt the journey from chest to breast: separating a mother from her newborn and giving pethidine to a woman during labour.

'According to the research, separating a baby from his mother before the first breastfeed significantly disturbs his instinct to seek out a breast,' says Nicholson. 'In one study, a significant majority of babies who were taken from their mothers sucked poorly or didn't suck at all.'

The hour or so after birth is the time for a mother to provide her baby with body contact, warmth and comfort, and for her baby to crawl to the breast and suckle. If he is whisked away to be bathed, measured, weighed and dressed, by the time he is returned 20 minutes may have passed. 'On average, it is the 20-minute mark that is the critical stage,' says Nicholson. 'It is the stage when crawling movements start.'

The time after birth should be private, peaceful and relaxed. 'Unless there is a medical reason,' says Nicholson, 'such as a premature baby, there is no necessity to fuss about having a shower, phoning relatives - wait until the baby has had his first feed. There is no need for the midwife or mother to hurry or force the baby to the breast. A baby needs to experience the sequence of behaviour in his own time, at his own pace.'

Quiet time; allowing a baby to suckle in his own time and being confident and relaxed enhances breastfeeding - these factors help to secrete the milk-producing hormone, prolactin, ensuring a plentiful milk supply. The let-down reflex (or milk-ejection reflex) is also helped by calmness. A successful first breastfeed instils confidence in a woman about her ability to feed her baby.

Effects of pethidine

The labour pain-reducing drug, pethidine, also interferes with this tentative, yet alert, exploratory behaviour by the infant. A newborn whose mother has received pethidine during labour can be dopey, unresponsive and disinterested in the breast.

Studies have shown that newborns exposed to pethidine have poor arousability for up to three hours after delivery. Poor arousability means there is slowness in the central nervous system and delayed and depressed rooting behaviour and suckling. The effects of pethidine can last for a long time - the elimination half-life of pethidine in a newborn is about 22 hours, compared with three hours in a mother.

'If pethidine is given, the dose and timing needs to be carefully considered,' says Nicholson, 'because the effect of pethidine is stronger on the baby if it is given longer than two hours before delivery.'

Giving pethidine immediately before delivery still affects newborns, while mothers have reported being so drugged and dazed from the pethidine that they were unable to experience their baby fully.

If you are preparing for birth....

If you are preparing for the birth of your baby, what does all this information mean for you?

• Firstly, find out as much information as you can about the use of analgesics and obstetric intervention used during childbirth, especially the effect on your baby as well as yourself.
• Explore alternative methods of pain relief and relaxation with your doctor, midwife or childbirth educator. These include breathing techniques, postures, massage, warm showers or baths, aromatherapy, the TENS machine or gas (nitrous oxide). Nicholson urges women to learn how to use gas properly, not just inhale for the whole contraction until there is a feeling of nausea.
• Clearly state to the delivery suite staff that you want your baby with you after the birth, without interruption by hospital procedures.
• After delivery, keep your baby on your chest and keep warm with a light cotton blanket or overhead heater if necessary.
• Be patient and allow your baby to gradually find her way to your breast.
• Let her suckle until she comes off naturally.

With the right approach and attitude, breastfeeding, a baby's choice, can be successful right from the start.