Most women expecting their first baby wonder how they are going to cope with looking after this helpless yet so demanding new bundle of life. In fact there is a lot to be said for doing as fas as possible what the mother feels comes naturally, and letting the new baby guide her.
In most repects, the physical care of ais a skill that can be taught and acquired. Emotional bonding between mother and child is, on the other hand, a more delicate issue that by no means always follows naturally – however strong the woman’s ‘maternal instinct’. There may be times, for example, when the baby’s physical demands are so wearying that the mother has few emotional resources left to comfort her child when he or she needs it most. Research has shown that all babies tend to seek closeness toa particular person. They coo and vocalize when held and carefully look at the face of the person holding them. Most babies show secure attachment – immediately demanding contact with their mother after a period of absence. Other babies who are less emotionally secure, often as a result of being left to cry too long or too often, show anxious attachment:
they display ambivalent behaviour towards the returning mother. Because such feelings of insecurity are fostered at an extremely early age, and may persist, it is naturally important for a strong emotional bond to be established as quickly as possible.
Feeding is probably going to be one of the mother’s first concerns, and she will probably have decided whether she wishes to breast-feed or bottlefeed the baby. Whichever she choosestimes are an important part of the mother and babygetting to know each other, and involve close co-operation.
If the mother is breastand has had a normal delivery, a good time to start is considered to be as soon as the baby has been handed to her after delivery. She may probably find that it is not successful, but it provides a good stimulus for both mother and child for an agreeable start to breastfeeding. Babies have a sucking reflex, and although they may at first find it difficult to latch onto a nipple, they soon get used to turning to the nipple when they feel the touch of their mother’s breast or finger on their cheek and taking hold of it with their mouths. After a little experimentation the mother will find the most comfortable position in which to hold and feed her baby. This may be sitting propped up on pillows or lying on her side. When sitting-up, the mother should make sure that she is well supported and is advised to rest her arm on a pillow to help raise the baby to the height of the nipple.
At first the breasts produce colostrum, a rich liquid full of protein, which lasts for the first two or three days before the more usual milk ‘comes in’. Colostrum is not produced in great quantities, and when the baby has sucked for about five minutes on one side it is probably exhausted. New babies should not be allowed to suck for more than a few minutes at a time at first, because this may cause sore nipples. Feeding is most comfortable and successful if the baby takes the whole of the nipple plus some surrounding areola into his or her mouth, and it is important to encourage this. It is the pressure from the baby’s gums on the areola that makes the milk flow. The more relaxed and comfortable the mother is when she is feeding the better it will be for both mother and baby.
After the first few days the main milk begins to flow, usually causing great enlargement, and sometimes engorgement, of the breasts. This can be quite uncomfortable, and many mothers find it helps to wear a good, supportive bra. Also, emptying some of the milk by expressing it by hand or using a pump may make it easier for the baby to latch onto the nipple. When the baby starts sucking rhythmically, the milk will automatically flow. Many mothers are aware of their ‘let-down reflex’. This occurs after a short period of sucking when the milk held in the ducts of the breasts starts to surge forwards to feed the baby. This is usually felt as tingling and is often said to be quite pleasant, but for mothers who have a lot of milk it may be felt as a sharp twinge of pain. The let-down reflex is elicited by the effect of a baby sucking on the nipple or even when the mother just hears her baby cry. These impulses stimulate the release of the hormonefrom the pituitary gland. Oxytocin has a dual action, it works on muscle tissue in the breasts, but also on the uterine muscle. In fact oxytocin is the major hormone promoting uterine contractions during labour. The after-pains associated with the contractions of breastfeeding are a ‘favourable’ side-effect of breastfeeding however, as they cause the uterus to regress in size more quickly and promote the discharge of lochia.
The new baby will almost certainly cry when he or she is ready for a feed, so if the initial breast ordid not occur immediately after birth, a mother should give the first feed when the starts. Many mothers feel it is reasonable to base a feeding schedule on the baby’s needs, because he or she is the best judge of them. This is called demand-feeding. Babies vary in the number of feeds they need, according to the emptying time of their stomachs. One baby may want feeding every hour or two at first, another every four to five hours. This continues, with variations, day and night. Most babies will want six to eight feeds a day by the end of their first week, but they may vary from day to day while their systems are adjusting.
Some mothers prefer to feed their babies regularly, every four hours for example, which may mean that they have to comfort the baby for some time between feeds. Most babies will adjust to this quite quickly. However, the more the breasts are stimulated, the better the milk production will be, so demand-feeding is usually best in this respect.
First-time new mothers may find at first that the baby does not feed well: he or she gets too frantic, or does not seem to be able to latch onto the teat or nipple, causing the mother distress. Babies can detect unease and nervousness, which they react to, and a vicious circle is soon created. Patience and a calm, quiet environment are essential. It may be beneficial to both the mother and the baby to take frequent breaks so that they are both calm before they begin again. When breastfeeding it is often advisable to weigh a baby before and after each feed, in order to measure whether the baby has drunk enough. Such a strict regimen, however, can put a lot of strain on an event that is meant to be a pleasure. To avoid this it is best to weigh a baby not more than once a day.