Ever since the exciting observations of the human infant's ability to crawl to his or her mother's breast shortly after birth, latch on, and suckle all on its own, mothers and fathers have been entranced by this amazing feat.

To think that for many decades both caregivers and parents believed that in order to breastfeed, a baby would not know what to do to feed and was usually pushed onto the breast. The baby would just look and lick and often balk at the intrusion. Actually at birth the infant may know more than the mother.

We are now aware that a number of other interventions also interfere with the infant's natural ability to explore, seek, and find the breast all on his or her own. Narcotic medication either injected or as agents used in epidurals given to the mother during labor can transfer via the placenta to the infant and cause difficulty for the infant to latch on; and also the mother's discomfort from an episiotomy can interfere. Over hydration from intravenous fluids may cause edema around the areola, and gastric suction by catheter causes distress to the infant. Interestingly suctioning is no longer recommended for 90% of babies who are breathing, have good color, and no meconium at birth, since it is so aversive to the baby's comfort with sucking, and often with touching the back of the throat causes a severe lowering of the heart rate. Even the bulb suction is unnecessary and the nose and mouth can just be wiped gently with a cloth.

What is especially important now is to provide the information to parents and birth attendants so they can create the quiet, calm unobtrusive environment to allow this event of the "breast crawl" to occur.

There is something special about the first hour of life. Parents have waited many months to see their baby and surprisingly when the baby is born, he or she is in a special state of alertness- called State Four, the quiet state of consciousness, ready to meet its parents, and is especially interested in the mother's and father's face.

In this special state, the baby's eyes are wide open, the baby is quiet. The baby has heard and remembers the mother's voice from uterine life and will distinguish her voice from other women's voices, and 80% of babies remember the father's voice. The baby is warmed by the mother's chest and soothed by the mother's touch. This quiet time together helps the transition from uterine life to the outside world.

This special state in the infant lasts for 30 to 45 minutes or longer. All sorts of exchanges between the mother and infant are going on. The baby is taking- in the mother through many senses as is the mother learning about her baby. The baby is becoming familiar with the mother's smell and within a few days will pick out his or her mother's breast pad from other women's breast pads. This is related to the particular smell of one's own mother not her milk.

As the baby gazes in the mother's face he is recording a memory of her face so that if he is tested with a picture of his mother's face and other women's faces four hours later, he will choose his mother's face over and over again.

The mother is taking in her baby also, by touch, smell, as well as sight. Curiously, if she is tested a few hours later to pick out her baby from two others, she will know her baby by touch and smell within one day.

In this early period of the first breastfeeding the baby and mother are giving each other numerous other benefits. Oxytocin is secreted by both the mother and baby. Oxytocin has many effects; it activates the production of prolactin for the milk letdown; it helps production of special GI hormones some of which are growth hormones and aid the absorption of food by elongating the intestinal villae. Oxytocin raises the pain threshold, creates calm in both the mother and baby, causes a feeling of sleepiness, and draws them closer together since it is the cuddle hormone, the hormone of love.

 

As the baby pushes up on her little elbows, sucks on her hand to get the taste of amniotic fluid, a property of which is similar to one secreted by the breast, she uses smell and taste as an additional guide to the nipple. Other benefits of this early breastfeeding experience include helping the infant feel more secure, reducing infant mortality through the numerous immunological properties of human milk, and encouraging a longer period of breastfeeding.

Little behaviours that have been rehearsed in utero are used here. The baby has an ability to reach at birth, although reaching does not occur developmentally until four months, and curiously this reaching behaviour touches the mother's breast, and massages and elongates the nipple for a good placement. Each touch of the nipple creates a surge of oxytocin in both the mother's brain and baby's brain. The stepping movements the infant practiced as a foetus help the baby climb to the breast, and stepping on the abdomen over the uterus helps the uterus clamp down, decreasing the bleeding and expelling the placenta.

Many subtle events occur in this early period and can be observed, but more would be missed unless understood. In this special quiet time the mother and baby are becoming acquainted, the baby hardly cries at all, and they are laying the foundation of secure attachment on the baby's part and more confidence in the mother for her ability to nourish and nurture her baby in the growing bond between them.

---

Marshall Klaus, MD is Professor Emeritus of Pediatrics, University of California, San Francisco. He is an internationally known neonatologist and researcher, and has focused his research on how mothers develop a bond to their normal, sick, malformed, or premature infants. In addition, his research has involved the remarkable effects of continuous emotional and social support for the mother by a skilled labor support woman (the doula) on decreasing the complications of labor, changing the psychology of the mother and improving her behaviour with her infant. His early research also demonstrated the importance of the infant's early contact with the mother after birth which encouraged or led to longer and more sustained breast feeding. This research helped create three of the major tenets of the UNICEF Baby Friendly Hospital Initiative. He is the author or co-author of numerous articles and books, including Care of the High-Risk Neonate, The Doula Book, Bonding, Your Amazing Newborn, and co–editor for 10 years of The Neonatal/ Perinatal Yearbook.

Phyllis Klaus, MFT, CSW, is a licensed psychotherapist, clinical social worker, and Approved Consultant and Trainer of EMDR.. She teaches and practices at the Milton H. Erickson Institute in Santa Rosa, California, and also practices in Berkeley, California, providing psychotherapy, hypnotherapy, counseling, and EMDR to individuals, couples, families, children, and groups. She has been working with the concerns of families in the perinatal period for the past 30 years, and has been involved in research and training of doulas and maternity caregivers since 1980. She consults and presents workshops nationally and internationally and is co author of several articles as well as the following books: The Doula Book; Bonding; Your Amazing Newborn; a video, The Amazing Talents of the Newborn; and When Survivors Give Birth: Understanding and Healing the Effects of Child Sexual Abuse on Childbearing Women.