You prepare for labor, you prepare for delivery. What happens when your baby arrives though? You’ve likely created a birth plan that says that you don’t want to be separated from baby in the first hour or two and you want to have delayed cord clamping , a quiet room, etc. (or perhaps you aren’t that far in your preparations and planning yet) but why? Why are these things important?
Your Amazing Baby’s Reflexes
Your baby is born with an amazing set of reflexes, automatic responses to stimuli. We once were unsure of what the purpose was of many of these reflexes but in more recent years these reflexes have been studied more and many of them help a baby begin breastfeeding. Dr. Suzanne Colson has spent a lot of time researching videotaped newborns and babies in the early postpartum months and has recognized many of these assisting baby to breastfeed. Your baby is born READY to breastfeed. Sometimes, though, things interfere with these reflexes or they can be triggered to make baby not respond the way they are supposed to. Preparing for these reflexes and recognizing them can help the first two hours postpartum (and beyond) to go more smoothly.
This video is a little bit long (around 9 minutes) but shows these reflexes in action in something called the “Breast Crawl.” Note that this video is “not safe for work” because it shows mothers and babies totally uninterrupted postpartum (meaning no shirts in the way and very little assistance from everyone else in the room).
What’s especially amazing to me in this video is that there is a woman, with what would normally be classified as having flat and possibly inverted nipples, who is able to breastfeed her baby with no problem because these reflexes were allowed to be triggered and baby was able to find its own way to mother’s breast. Some believe that the Montgomery glands on mother’s areola (they are more predominant in pregnancy and are raised, almost pimple like) produce a lubricative oil that smells similar to amniotic fluid which helps baby to find the breast. This oil also helps protect your nipples from bacteria and helps lubricate from the friction that occurs from baby sucking.
Baby’s stepping reflex helps baby to find his or her way to the breast. When your breast (or something else) touches your newborn’s cheek they will turn toward that stimulus to try and find a nipple (rooting). Baby will keep trying until he or she can find their way. They will open their eyes occasionally and try to find the darkened target (your areola) to latch on to. The sucking reflex is triggered once baby is able to latch which triggers your body to release milk (your milk ejection reflex which is controlled by hormones that are released as a response to your body feeling your baby beginning to suck). All of these reflexes are helped by having baby’s front whole side to feel supported (a laid-back position helps promote this). Sucking helps soothe your baby and your milk calms your baby.
What about Interference and Emergencies?
Of course the breast crawl and allowing baby to self latch is potentially the best means for baby to latch on after birth but it doesn’t always happen that way. Protocols and interference do happen often (this can be minimized by having a doula attend your birth acting as an advocate and helping you and your husband or partner be able to hear all of the pros and cons of a treatment or not allowing a treatment to occur). Emergencies also happen sometimes as well. Reflexes can still be triggered and baby can still be allowed to have as natural as possible of a time latching (even after a c-section). Interference should be minimized to set baby up for the best possible circumstances but know that even without the picturesque birth you can still go on to successfully breastfeed.
So what happens the first minutes to two hours postpartum?
Your baby is born. The majority of the hard work of labor is done (or in the case of multiples you will still have another baby or more to deliver). When baby is delivered he or she can be placed on your stomach to allow the breast crawl to happen. Baby could be placed on your chest instead. You may be eager to get baby to latch on sooner to help expel the placenta, patience is important though under normal circumstances. Baby will still be attached to the placenta via the umbilical cord once he or she is born. Some practitioners regularly clamp and cut this cord right away but babies are also only born with about 2/3 of their intended blood supply. Allowing the cord to fully finish pulsating pushes the remaining blood into baby. Emergencies can occur in which the cord does need to be clamped and cut earlier, however, even with some breathing struggles practitioners can attend to baby while still attached because the oxygen rich blood is still being pumped in to baby.
While the cord is pulsating baby can still be placed on your stomach, the cord is usually long enough, though in some circumstances it may not be. Baby doesn’t need to be roughly cleaned up but may be patted dry with a soft towel or blanket. If baby’s hands are left alone this may help baby trying to latch the first time (because of the Montgomery glands that were discussed earlier). When your baby is placed skin-to-skin with you, your stress levels go down as well as your newborn’s. Your body will help regulate your baby’s temperature but you may want to place a blanket over the two of you (keeping the room warm is probably a better idea though to allow baby to self attach easier). A hat and other things are not necessary at this point.
Your uterus will continue contracting after a pause to work on expelling your placenta. Some placentas come quickly but allowing the placenta to come on its own prevents ripping from pulling which can leave pieces behind that can inhibit your body from transitioning to mature milk. (Note: If an emergency occurs though keep in mind that pieces aren’t always left behind but if you are struggling with your supply after the first few days this is a possible cause that you and your provider may want to look further in to). Eventually your baby’s cord will be clamped and your placenta will release. If your baby is able to latch before the placenta is delivered the first latch will encourage oxytocin to help the uterus push it out. You will feel a tightening sensation in your uterus for the first few days when your baby is breastfeeding because oxytocin releases smooth muscles of your uterus as well as the smooth muscles in your areola that hold back the milk. This is what helps your uterus contract down to its pre-pregnancy size.
Baby may self attach as in the breast crawl video or you may assist baby. Hopefully your care providers are allowing a peaceful and non-rushed atmosphere to allow you to have your time to bond with your baby. A doula can help facilitate this atmosphere. As with other mammalian mothers we have a strong need for quiet and privacy postpartum to allow our hormones to work as they were designed. Skin-to-skin contact without anything in the way helps to promote these hormones to work as well. If baby is separated from you this can cause stress for you and baby (which can potentially cause unstable vital signs in both of you) and also inhibit your baby’s reflexes and behaviors looking for the breast. Some of these can be compensated for (especially in emergency situations) but some difficulties can come up with unnecessary separation.
Once baby has been allowed to latch on, let baby determine when he or she is done breastfeeding. Newborns have very small stomachs (about the size of a shooter marble) that can only hold a little over a teaspoon of milk at a time.
You and your new baby may be very tired after this. You may both with to go in to a period of rest. You may want to see visitors and show your new baby off. Keep in mind that your newborn may want to nurse frequently because they have such small stomachs and need a lot of colostrum (this will help build your supply when your milk transitions as well). You have done a lot of work and it’s perfectly OK to tell visitors to wait for a few hours or longer to visit you. It’s also OK to limit the time that they are visiting because these early days are especially important to get breastfeeding off to a good start. Babies that are kept skin-to-skin for the first two hours are able to use your body to help regulate their temperature and are able attach and breastfeed as often as he or she would like. After this time your baby may be weighed and vital signs can be taken (some can be taken after the first breastfeeding has occurred). Some caregivers may be antsy to get these done quickly so be sure to talk about your wishes well in advance to be sure you are all on the same page with what needs to be done and when.
If you tore or an episiotomy was performed that will be repaired, hopefully after baby was allowed to breastfeed for the first time. Your newborn may be allowed to remain skin-to-skin while the repair is made. You can hold your infant on your body while on your back. You may also be transferred to a postpartum room after the first two hours as well. Your newborn may be allowed to remain skin to skin with you during this transition but some hospitals have policies that babies must be transported separately. You can learn about the protocols in advance so you are able to know and prepare beforehand.
If you’re in the Oklahoma City area be sure to check out my class details and register here.
For More Information Please See:
Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Nancy Mohrbacher, 2010.
Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers, Second Edition. Nancy Mohrbacher and Kathleen Kendall-Tackett, 2010.
Counseling the Nursing Mother: A Lactation Consultant’s Guide, Fifth Edition. Judith Lauwers and Anna Swisher, 2011.
The Womanly Art of Breastfeeding, Eighth Edition. La Leche League International. Diane Wiessinger, Diana West, and Teresa Pitman, 2010.
Your Amazing Newborn. Marshall H. Klaus and Phyllis H. Klaus, 1998.
(As always please remember that the information and opinions provided on this website and blog are not a substitute for medical advice or consultation with a qualified medical professional; nothing contained on this website shall be presumed or shared as medical advice at any time. Please see my disclosures here.)
What was most helpful to you in the first two hours postpartum to get breastfeeding off to an excellent start?