Newborn Nursing: It’s About The Relationship
written by Renee Mandala, M.A. CD(DONA) C.L.C.
Expectant families are rightly, more frequently being advised by their medical providers to breastfeed their babies. The American Academy of Pediatrics recommends at least 6 months of exclusive nursing, and continued nursing through at least the first year with the addition of complimentary solids. They also recommend nursing beyond the first year “if mutually desired.” The World Health Organization and UNICEF recommend continued breastfeeding up to two years of age and beyond.
In Ventura County, approximately 90% of mothers initiate breastfeeding in the first hours and days after birth. By the time they are discharged from the hospital, approximately 55% are still exclusively nursing. We do a disservice to families when promoting breastfeeding without giving support, education and a map of how to get there.
In years past, we lived in close community with extended family. We learned birth and nursing lore from mom, sisters, aunties and cousins in close proximity. Today’s nuclear families are often isolated from this kind of familial/community intimacy. Their mother may not have nursed, as formula has been the fashion for several generations past. Cultural taboos can prohibit the sharing of breastfeeding experiences mother-to-mother; expectant couples may not have ever seen a newborn nursing up-close. Their sole preparation for breastfeeding may have been their doctor asking if they plan to breastfeed.
We meet some mamas with great challenges to their nursing experience- highly interventive or cesarean birth, neonatal intensive care (NICU) stays, medical and surgical history contributing to low milk supply, and yet, they find their way with breastfeeding. Other moms encounter some challenges, feel insecure about whether “it’s working”, and quickly move to formula feeding. What contributes to resiliency, determination and ultimately, a healthy, pleasurable breastfeeding experience?
The Learning Curve
Expectant parents do better when they understand that there’s a learning curve to nursing a newborn. Moms may encounter engorgement, painful latching, slow infant weight gain or other issues that can be remedied. Without professional and peer lactation support, they may throw in the towel, not knowing an alternative to formula feeding. Parents experiencing unplanned-for surgical birth (nearly 30% of Ventura County mothers have surgical births, many unplanned), or other unexpected outcomes encounter more challenges, which can be addressed with persistence and professional and peer support till babe is thriving on mamas breast.
While still pregnant, breastfeeding education is invaluable. Pre-natal breastfeeding classes that include Dad and/or other supporters help to create an informed, cohesive team. This also provides an opportunity to connect to resources such as a breastfeeding support groups, breastfeeding helplines, on-line social peer networking groups, postpartum and birth doulas, and lactation consultant services. Lactation professionals and other nursing moms can help identify pediatricians or family practice doctors that are truly supportive of nursing for the new family.
It’s About the Relationship
Mentoring from a midwife, doula, lactation consultant and peers regarding specific tips and techniques can be helpful to the new mama. However, in our push to get mothers breastfeeding, we can lose the forest for the trees. Paramount to this conversation is the understanding that nursing is about the beginnings of an intimate relationship. Like all of the parenting in the years to come, “it’s about the relationship!”
On your first date with your would-be partner, did you know her favorite food? Which hand he holds his pen with? Her favorite sleep position? Of course not! Over time, and with repetitive, intimate experiences, you learned that when hubby’s tired, his left eye droops slightly, that he purrs when you tickle his inner arm, and that he can never find his keys.
“Babymoon” is a term coined by British author and childbirth educator Sheila Kitzinger to refer to the period of time that parents spend bonding with the newborn baby. Mamas and babes need their babymoon to lie in, be nurtured, cooked and cared for, so they can be freed up of chores and be close with their baby. “Who is the new little person? Who am I as her mama? Who are we together?” they seem to be exploring. This lying-in time is vital to help new parents explore and understand their baby’s needs and feeding cues. We must support this special time where the foundations of this relationship and nursing get laid down. Like a honeymoon, a babymoon promotes privacy and intimacy for the new family, and in particular the mother-baby pair.
It turns out that breastfeeding and early mothering ideally involve what psychologist D.W. Winnicott called “Primary Maternal Preoccupation.” After birth, the hormonal rise of oxytocin invites what in other situations might be thought of as obsession- an absorption with the infant and the nuances of his/her expression. This absorption is adaptive for baby’s thriving and is vital to the health of the infant. Mom’s responsiveness to baby’s feeding and suckling cues invites milk production resulting in vital immunological and brain development. It promotes a kind of attachment that allows the infant to internalize mom’s responsive state, a mirror in which the baby begins to make sense of who he is. This mirroring sets down the foundations of self-esteem which research shows begins to emerge by age 1-2. Families that make the choice not to breastfeed are afforded similar opportunities to lay down foundations of attachment and co-regulation through creating a lying-in time of resting, being cared for, holding, gazing, feeding and caring for the new baby.
Studies show that maternal depression occurs in approximately 1 in 4 women during the first three months after delivery, and that a stable breastfeeding relationship protects infants from some of the negative effects of maternal depression. Breastfeeding may help protect against maternally perpetrated child maltreatment, particularly child neglect. Such information points to the importance of enhanced proactive support for breastfeeding, and for the special time postpartum that facilitates the breastfeeding relationship, especially for depressed mothers.
We would do well to view baby’s first latches as the fourth stage of birth, and to hold sacred the culmination of this continuum. Pre-natal education, referral and resource-building, and preparation for a vital, supported, lying-in postpartum period are paramount to the foundation of the mother-baby dyad, and therefore, the nursing relationship.