For most women, sustained breastfeeding can be achievable against the backdrop of constant family, social and health system support, specifically through the institutionalized practice of skin to skin care (SSC) at birth. When efforts and resources are optimized within health facilities to provide technical support for mothers in the crucial first minutes and days after birth, sustained breastfeeding is within reach for both mother and baby.
Babies placed in uninterrupted SSC after birth with mothers engage in a pre-feeding sequence of behaviors (9 stages): 1) the birth cry 2) relaxation 3) awakening 4) activity 5) resting 6) crawling 7) familiarization 8) suckling and 9) sleeping. These are each innate and instinctive behaviors, which aid newborns to locate and latch to the nipple. The process culminates into the baby’s first breastfeeding, which will usually occur within the first hour of life. Uninterrupted SSC immediately after birth has many benefits but, arguably, the most important benefit of immediate or very early SSC is early initiation (EI) of breastfeeding. EI is critical in triggering a mother’s phase of milk coming in, and ensures adequate milk volumes for sustained breastfeeding.
Other important advantages of SSC for mothers include increased confidence, ample milk supply, an opportunity for caregiving and bonding with baby, and longer duration of breastfeeding. For baby, the advantages include physiological stability, decreased stress and self-regulation for optimal brain development.
Normal neonates; those who are well, stable and do not require any resuscitation, should be placed in SSC with their mother within minutes of birth for both vaginal and cesarean births. Once placed on mother’s chest, a baby must be covered in a pre-warmed linen and arms and legs should be extended over mother’s chest. SSC of about an hour following birth provides the opportunity for the baby to spontaneously initiate breastfeeding. Of course, there will be instances where baby may be separated from mother (i.e., admission to nursery for sick or preterm babies) but in these cases, SSC must be initiated as soon as possible after separation. Meanwhile, mothers can be supported to express milk, not for volume but for initiation of lactation. A stratified/Infant-Tailor-made approach (Figure below) is suggested for successfully initiating breastfeeding among mothers of all newborns to ultimately achieve sustained exclusive breastfeeding.
Based on the experience at our facility, Dr. Ram Manohar Lohia Hospital & PGIMER, in New Delhi, India, we recommend facilities take these actions in order to ensure success of early initiation of breastfeeding for sustainability of breastfeeding:
- Write and promote protocols on uninterrupted SSC; Start SSC immediately or very early (within 10 minutes) after birth for babies who are well, stable and do not require any resuscitation (both vaginal and cesarean). SSC must be given at least for an hour until the end of 1st breastfeeding.
- Prevent unnecessary separation of mother and baby; Baby must be roomed with mother around the clock.
- Encourage mothers to feed frequently, at least 8-12 times/day in the first 2-3 days.
- Practice family-centered care.
- Undertake an “Infant Tailor Made Approach”
- Immediate or very early skin-to-skin contact at birth between mothers and newborns is a critical intervention that promotes initiation, establishment and sustainability of extended breastfeeding.
- Skin-to-skin at birth and early initiation of breastfeeding shortly after surgical delivery are feasible and need to be promoted among health care professionals to optimize infant feeding outcomes.
- Mothers who need to be separated from baby for medical reasons must be helped and supported to express milk starting within 1 hour and to continue to express up to 6-8 times/day.
- An infant tailor made approach may be helpful to strategize institutional early breastfeeding practices.
Thus Breastfeeding well begun is Breastfeeding well sustained.
Link for Video on Early initiation of SSC in Cesarean Born Babies that also demonstrates the 9 behavioural stages of a newborn when placed skin to skin with his/her mother soon after birth