2/1/2013 Speaking in many tongues How the laid‐back mother facilitates the baby‐led breast crawl to self‐attachment, Oh my! Christina M. Smillie, MD, FAAP, IBCLC, FABM Declaration and Disclosure I have an affiliation with one or more persons or entities that could be perceived as having a bearing on my presentation of this subject. Affiliation Royalties from sale of educational DVD sale Geddes Productions, Los Angeles, USA Stratford, Connecticut, USA © 2013 CM Smillie MD 2/1/2013 2 Western perspective: The observers What babies know And what the rest of us are trying to figure out © 2013 CM Smillie MD • The biologists: the mammalian feeding sequence • Early midwives: mother gives suck; baby takes the breast • Odent M. The early expression of the rooting reflex. Proceedings of the 5th International Congress of Psychosomatic Obstetrics and Gynaecology, Rome 1977. London: Academic Press, 1977: 1117‐19. © 2013 CM Smillie MD © 2013 CM Smillie MD Western perspective Western perspective Video • Widström, 1987 Breastfeeding is Baby’s Choice • Righard & Frantz, 1995 Self‐Attachment Publication Widström A‐M, Ransiö‐Arvidson AB, Christensson K, Matthiesen A‐S, Winberg J, Uvnäs‐Moberg K. Gastric suction in healthy newborn infants: effects on circulation and developing feeding behaviour. Acta Pædiatr Scand. 1987;76: 566–572. Righard L, Alade M. Effect of delivery room routines on success of first breast‐feed. Lancet. 1990;336:1105–1107 • Harris, 1994 Co‐Bathing Harris H. Remedial co‐bathing for breastfeeding difficulties. Breastfeeding Rev. 11:10 (Nov 1994) 465‐468. © 2013 CM Smillie MD • • • • Meyer, 1999 Colson, 2008, DVD Smillie, 2008, DVD Gangal, 2010, UNICEF India, video Meyer K, Anderson GC. Using kangaroo care in a clinical setting with fullterm infants having breastfeeding difficulties. MCN Am J Matern Child Nurs. 1999 Jul‐ Aug;24(4):190‐2. Colson SD, Meek JH, Hawdon JM. Optimal position for the release of primitive neonatal reflexes stimulation breastfeeding. Early Hum Dev 2008; 84(7):441‐44 Smillie CM. How infants learn to feed: a neurobehavioral model. In CS Genna (ed.) Supporting Suckling Skills in Breastfeeding Infants. 2008: 77‐ 95. Boston: Jones and Bartlett © 2013 CM Smillie MD 1 2/1/2013 Western perspective • • • • • Language • • • • • • • • • Brazelton Klaus Amiel‐Tison & Grenier Glover Schore Baby takes the breast Mother gives breast The mammalian feeding sequence Attachment, latch Infant self‐attachment Baby‐led latch, baby‐led feeding Breast crawl Laid‐back breastfeeding, biological nurturing Baby takes the breast The blind men and the elephant…. © 2013 CM Smillie MD © 2013 CM Smillie MD The neurobehavioral cascade “The mammalian feeding sequence” Other mammals Tactile stimulus Search, step, crawl Cheek Chin Root Open, reach, grasp Oral mucosa Palate Suckle Sustain suckling © 2013 CM Smillie MD Western Birth • • • • • • • • • Cascade of behaviors Chest, abdomen Separating mothers and babies Anesthesia Presumption of incompetence Then, Leboyer and Odent Brazelton and Klaus © 2013 CM Smillie MD 9 The macaque monkey The newborn rat The newborn wallaby Kittens, puppies, giraffes © 2013 CM Smillie MD Baby “takes” the breast Midwives Earlier books: courtesy of Diane Weissinger 1958 – The womanly art of breastfeeding La Leche League International Whether you sit up or lie down while you nurse him is up to you. Whichever position you find most comfortable is best for you. Don't try to shove the nipple into his mouth. Rest his cheek against it and he'll turn his head towards it and latch on. © 2013 CM Smillie MD 2 2/1/2013 1981 – The womanly art of breastfeeding, 3rd edition LLLI As you and your baby get settled, talk to him or just make those little cooing noises that mothers and babies understand so well. 1981 – The womanly art of breastfeeding, 3rd edition LLLI Next…. The baby will turn toward any pressure on his face, a reflex that you want working with you. ….So relax, and do nothing more than touch his cheek with your nipple, assuring him all the while that he will do very well at nursing, as he most certainly will. © 2013 CM Smillie MD © 2013 CM Smillie MD 1991 – The womanly art of breastfeeding La Leche League International The following steps explain the correct way to position your baby at the breast in order to ensure that baby sucks well and gets plenty of milk and also to prevent nipple soreness and pain. 1. Position yourself properly. …Sit up ….Pillows are a must…. 2. Position your baby properly…. Baby should be ….. 3. Offer your breast to the baby. Cup your breast ...Your thumb and index finger should form a “C”. Be sure your fingers are …… 4. Encourage baby to latch on properly…... [There are 3 more numbered steps that cover recognizing effective sucking, dealing with pain, correcting an incorrect latch. Descriptions of and instructions for other breastfeeding positions follow.] 2004 – The womanly art of breastfeeding, 7th edition LLLI 1. Position yourself properly. ….Sit up bed….. Pillows are a must….. 2. Position your baby properly… Baby’s ear, shoulder, and hip should be in a straight line. His head should be in line with his body...Hold the baby at the level of your nipple…. 3. Offer your breast to the baby. Your thumb and index finger should form a “C” or “U.” …. Support the breast as close to its natural height as possible while the baby latches on and throughout the feeding, with your thumb in line with the baby’s nose and four fingers on the other side of the breast… 4. Encourage baby to latch on properly.… Encourage the baby to open his mouth wide by moving him toward and away from the breast, touching his lips lightly and repeating until baby opens wide. Baby’s mouth should be open really wide, like a yawn, as he latches on. 5. ….. © 2013 CM Smillie MD © 2013 CM Smillie MD 2004 – The womanly art of breastfeeding, 7th edition LLLI 5. ….. [There are 5 more numbered steps that cover encouraging baby to suck effectively, avoiding nipple soreness or pain, watching for effective sucking patterns, and finishing the first breast first. These are followed by an explanation of when to use a “C” and when to use a “U”, and other breastfeeding positions, with a reminder to “follow these procedures carefully at first”.] © 2013 CM Smillie MD Baby “takes” the breast Michel Odent Odent M. The early expression of the rooting reflex. Proceedings of the 5th International Congress of Psychosomatic Obstetrics and Gynaecology, Rome 1977. London: Academic Press, 1977: 1117‐19. Swedish researchers © 2013 CM Smillie MD 3 2/1/2013 Widström: Aren’t babies clever? Widström A‐M, Ransiö‐Arvidson AB, Christensson K, Matthiesen A‐S, Winberg J, Uvnäs‐Moberg K. Gastric suction in healthy newborn infants: effects on circulation and developing feeding behaviour. Acta Pædiatr Scand. 1987;76: 566–572. Righard: Self‐attachment • Righard L, Alade M. Effect of delivery room routines on success of first breast‐feed. Lancet. 1990;336:1105–1107 • Righard L, Frantz K. ―Delivery Self Attachment‖—DVD. Los Angeles: Geddes Productions. 1995/2005. © 2013 CM Smillie MD © 2013 CM Smillie MD Harris: Co‐bathing The newbie Harris H. "Remedial Co‐Bathing for Breastfeeding Difficulties." Breastfeeding Rev. 11:10 (Nov 1994) 465‐468. • 1996 observations • Discussions with others • Platform presentations: How newborns learn to latch: a neurobehavioral model for self‐attachment in infancy. Abstract PL9. Acad Breastfeeding Med News Views. 2001;7:23. Matt & Mandy © 2013 CM Smillie MD © 2013 CM Smillie MD Kangaroo care for full‐terms Our video • Kathleen Meyer Smillie: Mother‐baby dance Frantz: Self‐attachment Meyer K, Anderson GC. Using kangaroo care in a clinical setting with fullterm infants having breastfeeding difficulties. MCN Am J Matern Child Nurs. 1999 Jul‐Aug;24(4):190‐2. © 2013 CM Smillie MD © 2013 CM Smillie MD 4 2/1/2013 Keys Keys • Rebecca Glover • Karolinska researchers – Postural and positional stability – “Instinctive position” – Olfactory and other neurosensory cues – Hunger—physiologic drop in blood sugar – Thirst‐vasopressin and serum osmolality – Undisrupted interactions © 2013 CM Smillie MD © 2013 CM Smillie MD Keys Interpretations: motherbaby Infant competence— Brazelton, Klaus Infant state — Prechtl and Wolf Schore, mother co‐regulates infant state Right‐brained thinking Amiel‐Tison & Grenier • • • • Geographic differences in emphasis Emphasis on mother or baby or both Self‐attachment and the “dead mother” Right‐brained interactive dance— – baby‐led, mother responds • Mother‐sped – mother‐led, baby responds © 2013 CM Smillie MD © 2013 CM Smillie MD Colson: Biological NurturingTM Colson’s research • Earlier papers • PhD thesis: Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding, Early Hum Dev 2008, 84(7):441-9 © 2013 CM Smillie MD Qualitative and exploratory Postures and positions Biological nurturing position: baby Biological nurturing posture: semi‐reclined Minimal instructions to mother © 2013 CM Smillie MD 5 2/1/2013 Putting Biological NurturingTM in context Colson’s findings and conclusions • Human infants: Dorsal vs ventral (or frontal) feeder— the importance of gravity in facilitating or interfering with infant behaviors • Her cultural environment—the “dead mother” • Sees neonatal behavior as primarily reflexive, bringing out maternal instincts • As midwife, emphasis on mother • Laid‐back mother – Relaxed position: oxytocin – Opens up lap – Empowered by infant competence • Infant stability‐postural and state organization – Gravity keeps infant in close contact • Right‐brained behaviors • Infant competence © 2013 CM Smillie MD © 2013 CM Smillie MD The breast crawl The blind men and the elephant • Gangal, UNICEF India BPNI Maharashtra • The setting • Why all the people? • • • • • Who’s doing what? Mother? Baby? Both? Reflexes and responses Simple and complex behaviors • • • • • Mother latches baby Self‐attachment Breast crawl Biological nurturing ™ Mother‐baby interaction: Mother‐baby dance • Mother • Baby © 2013 CM Smillie MD Just the beginning • • • • • • • • • • The biologists Early midwives Odent, 1977 Widström, 1987 Rigard and Alade, 1990 Harris, 1994 Meyer, 1999 Gangal, 2007 Smillie, 2008 Colson, 2008 • • • • • Brazelton Klaus Amiel‐Tison & Grenier Glover Schore © 2013 CM Smillie MD 2010 – The womanly art of breastfeeding, 8th edition LLLI …just find a totally comfortable way to cuddle together so that you’re completely supported – head, neck, shoulders, body – by whatever you’re leaning back against, and she’s completely supported by your body, or perhaps also by the bedding around you. The blind men and the elephant…. © 2013 CM Smillie MD © 2013 CM Smillie MD 6 2/1/2013 2010 – The womanly art of breastfeeding, 8th edition LLLI Your baby might start searching for your breast almost immediately, or she might be a little shocked to find herself outside her warm, wet home of the past nine months…After a while, she may lift her head (look how strong she is!) and bob her face on and off your skin.. You can help her move closer to the breast or support her as she finds her way. She’s doing all this by feel and by smell, not sight, and she welcomes having you share in her efforts. You don’t need to be skilled; fumbling is a normal – even helpful! – part of the process. Thanks • To Suzanne Colson, Kittie Frantz and Ivy Makelin for video clips • To all the mothers and babies who are teaching us • To all of you who will keep observing and learning from the mothers and babies At some point, when her face is near your nipple, she’ll lift her head, open her mouth wide, latch on and begin to suck. She’s breastfeeding! © 2013 CM Smillie MD © 2013 CM Smillie MD 7
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