What babies know Western perspective Western perspective

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
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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
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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
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Western perspective
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Language
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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
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Cascade of behaviors
Chest, abdomen
Separating mothers and babies
Anesthesia
Presumption of incompetence
Then, Leboyer and Odent
Brazelton and Klaus
© 2013 CM Smillie MD
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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
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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
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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
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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
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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
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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?
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Who’s doing what?
Mother?
Baby?
Both?
Reflexes and responses
Simple and complex behaviors
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Mother latches baby
Self‐attachment
Breast crawl
Biological nurturing ™
Mother‐baby interaction:
Mother‐baby dance
• Mother
• Baby
© 2013 CM Smillie MD
Just the beginning
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The biologists
Early midwives
Odent, 1977
Widström, 1987
Rigard and Alade, 1990
Harris, 1994
Meyer, 1999
Gangal, 2007
Smillie, 2008
Colson, 2008
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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
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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
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