Christine C O LAM

Nurse Consultant (Breastfeeding)

Queen Elizabeth Hospital

Step 4. Help mothers initiate breastfeeding within a half-hour of birth.

New interpretation of Step 4 in the revised BFHI Global Criteria (2006):

“Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.”

WHO Baby-Friendly Hospital Initiative (2006): Revised, Updated and Expanded for Integrated Care.

• Newborn infant is placed naked with maximum skin contact on the mother's bare chest at birth or soon afterwards.

This is not SSC!

• Baby should be not subjected to procedures unless medically necessary

• Quiet uninterrupted time

• Monitor both without interfering

• No need to hurry to apply to breast

• Allow for the contact & accommodation of mutual contact

• Applies equally to all births

Skin-to-Skin Contact_Content

• Breastfeeding

• Physiological benefits

• Neurological benefits

• Microbiologic benefits

• Preterm babies

Anthropology

• Innate behaviors needed for survival and feeding of their babies

• Provides a synchronous reciprocal pattern of interaction in intimate contact

•Awakens the innate behaviors in the baby : looking, rooting, hand to mouth movements leading to feeding

Early initiation of breastfeeding through SSC for newborns, …

• Takes advantage of the first hour of alertness,

babies have longer quiet alert state during SSC

• Initiate baby-led breastfeeding

• Babies learn to suckle more effectively

• Provides colostrum as the baby’s first immunization

• Increases duration of breastfeeding

• Improved developmental outcomes

Breast & Infant Temperature with twins during shared Kangaroo Care

Ludington-Hoe et al (2006)

Babies are capable beings

They have innate reflexes and instincts to:

locate the breast

use their head, arms and

legs to orientate themselves

and adjust their body position

root, attach effectively, and suckle

Amniotic fluid smells similar as colostrum and areola,

scent from the food of mother taken.

Don’t dry the hands of baby after delivery

Baby crawl : scientific review (2016) http://breastcrawl.org/science.shtml

9 observable innate and instinctive newborn stages, happening in a specific order .....

Early SSC for mothers and their healthy newborn infants

• Mothers who had SSC breast fed their infants longer, too, on average over 60 days longer

• Babies held in SSC were more likely to have breast fed successfully during their first breast feed

• Babies held in SSC had higher blood glucose levels

• SSC infants had higher SCRIP (stability of the cardio-respiratory system)

Moore, Bergman, Anderson & Medley (2016). "Early skin-to-skin contact for mothers and their

healthy newborn infants". The Cochrane Database of Systematic Reviews.

Release Oxytocin

• Calm down mother

– Lower heart rate

– Higher pain threshold

– Higher social interaction

– Less anxious

• Enhance & parenting bonding

Love hormone – Touch on the mother's nipple stimulate

the release of oxytocin

– Contraction of the uterus• Expulsion of placenta

• Decrease haemorrhage

– Letdown of milk

– Facilitation of bonding & mothering behaviour between the mother and the baby.

Matthiesen, Ransio-Arvidson, Nissen & Uvnas-Moberg. (2001). Postpartum maternal oxytocin release

by newborns: effects of infant hand massage and sucking. Birth.

• Increased variation in skin temperature

• Lowering blood pressure

• Lowering cortisol levels

• Increased oxytocin levels

• Decreased vagal nerve tone

• Stimulation of social behaviour

• Decreased pain sensation

• Regulates temperature

• Helps them to better adapt to life outside the womb

• Stabilizes the baby’s heart rate & breathing

• Better glucose level

• Calms & relaxes mother & baby

• Stimulates digestion & feeding

• Release of hormones to support breastfeeding and mothering.

• Both physiological and behavioural indicators and, independently, using heart rate and crying time; and safe for a single painful procedure.

Johnston, et al. (2017). Skin-to-skin care with newborns cuts down procedural pain. The Cochrane Database of

Systematic Reviews.

Holding SSC & breastfeeding can effectively reduce procedure pain

• Better neurobehavioral development

• Postnatal course of neurosteroid levels in relation to gender, mode of delivery and the extent of SSC during the first days in term newborns.

• Prospective observational study : – 39 neonates,

– parents recorded total duration of STS in the first 2 days and

– 9 neurosteroids (dehydroepiandrosterone-sulfate, progesterone, pregnenolone, pregnenolone-sulfate, allopregnanolone, isopregnanolone, epipregnanolone, pregnanolone and pregnanolone-sulfate) were assayed from blood samples at birth and at 1–2 days of age

Result:• Significant decline in steroid level from birth to 2D

for all 9 neurosteroids assayed.

• The decline was significantly more in vaginal deliveries than in C/section.

• Significant relationship between duration of SSC and decline in steroid levels.

Effect of STS duration on change in the neuroactivesteroid levels over the first 2 days of life

STRESS

After birth, the infant actively seeks to adhere to as much skin surface on the mother’s body as possible”

Schore AN.(2001) Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal 2001; 22: 7 -66.

SEPARATION is LIFE THREATENING(WRONG PLACE)

• More feeding problems

• 10 X more crying

• Elevated corticol

• Unstable body functions

– Temperature

– Blood sugar

– Breathing

– Heart rate

Christensson K et al. (1995). Separation and distress call in the human neonate in the absence of maternal body contact. Acta Paediatr, 84: 466-473.

• Separation effects

• Brain development

• Normal newborn behaviour

2018/5/31 27

DendritesNucleus

Axon

Electrical

signal

Neurotransmitter

chemical contained

in vesicles

Synapse

Growth of the brain occurs from the inside out and the bottom up

100 billion brain cells

There are 15,000 synaptic connections for each cell

• Repeated stimulation

• A very giant system to

handle the impulses

received from our senses

Mother encourages inborn behaviours

Patience, talking, stroking, eye contacts

•Sound

•Vision

•Smell

•Touch

•Proprioception

•Taste

Old Thinking... New Thinking...

How brain develops depends

on genes.

How brain develops hinges on

complex interplay between

genes and experiences.

Secure relationship with

primary caregiver creates a

favorable context for early

development & learning.

Early interactions directly

affect the way the brain is

"wired."

SSC improves:

– neuro-developmental outcomes, including accelerated neuro-physiological brain maturation

– improved emotional and cognitive regulatory capacity in infancy

•Scher, Ludington-Hoe, Kaffashi, Johnson, Holditch-Davis Loparo (2009). Neurophysiologic assessment of brain

maturation after an 8-week trial of skin-to-skin contact on preterm infants. Clin Neurophysiol.

•Feldman, Weller, Sirota, Eidelman. (2002) Skin-to-skin contact (kangaroo care) promotes self-regulation in

premature infants: sleep-wake cyclicity, arousal modulation, and sustained exploration. Dev Psychol .

• The microorganisms on and in us.

• Bacteria, Fungi, Viruses, Protoza, Archaea, other microbes

• Unique as individual’s finger print

• Especially the gut microbiota, has even been considered to be an “essential organ”

• Carrying 150 X more genes than are found in the entire human genome

• Involved in basic human biological processes

• Strongly suggested a crucial role of the human microbiota in our health and diseases

Wang et al (2017). The Human Microbiota in Health and Disease. Engineering. 3(1).

Mother’s vagina microbes

+

mothers’ gut microbes

+

mother’s skin microbes

+

mother’s breastmilk microbes

BABY

Mueller N.T. et al, Trends in molecular medicine, 2015

If baby is vaginally born & breastfed

• Nutrients

• Immune components

• Antibodies

• Hormones

• Enzymes for digestions

‘Seeding & Feeding’ of baby’s microbiome:

• Skin-to-skin contact

• Breastfeeding

Lay the foundations for baby’s lifelong health

1. Skin-to-skin contact• Early, continuous and prolonged SSC

2. Exclusive breastfeeding• SSC promotes lactation and facilitates the feeding

interaction.

3. Early hospital discharge

• Improved cardiac and respiratory stability

• Fewer episodes of desaturation & apnoeia

• KMC can successfully treat mild respiratory distress

• Improved gastrointestinal function, digestion

• Higher initiation & duration of breastfeeding

• Decrease energy expenditure & satisfactory weight gain

• Protection against infections

嬰兒出生後，雖然像似離開了母體，但其實和母親

仍有千絲萬縷的內在關連