We have all learned and become very educated about the importance of the first hour after birth, skin-to-skin contact, infant regulation, breastfeeding, etc. We know that infants who are allowed skin-to-skin contact immediately after birth for at least an hour are better breastfeeders. But does every baby become a better breastfeeder because of this practice? Most infants can perform the breast crawl and self-latch, but for some this is not automatic. These infants can get into trouble if they are not sufficiently transferring colostrum.
Dr. Jane Morton recently brought this concept to light in a Gold Lactation presentation. This is a summary of Dr. Morton’s presentation and her work.
The focus is on prevention of early complications related to underfeeding versus waiting for a diagnosis to treat. These concepts apply to low and high risk infants. Dr. Morton presents a very simple evaluation tool of ABC.
A- Attachment(comfortable effective latch)
B- Breast milk production
The challenges stem from poor latching and milk transfer, mother’s milk supply and babies who don’t get enough milk. The first rule of lactation is feed the baby and protect mothers milk supply.
Dr. Morton promotes early and frequent hand expression of colostrum as a preventative measure. This practice has been proven to increase early and long-term milk supply. Hand expression was not a new concept but the practice of feeding the infant the expressed colostrum early on, was a newer one. Spoon feeding the infant expressed colostrum can prevent hyperbilirubinemia, excessive weight loss, hypoglycemia and hypernatremia. According to Dr. Morton, you cannot over breastfeed an infant in the first three days. The more colostrum he/she receives the more we reduce risks. Some infants and mothers are at higher risk than others. Mother’s milk supply will be in jeopardy if infant is separated from her and/or if infant is not transferring milk from the breast. Infants that are at higher risk for low caloric intake are early term, late preterm, SGA and infants of diabetic mothers. But even a healthy term infant can suffer from insufficient caloric intake with poor milk transfer.
As an IBCLC, I see insufficient milk transfer situations a lot. Mother’s have enough stress without adding guilt surrounding feeding. Educating mothers that hand expression of colostrum in the first hour(s) after birth will not only increase their long-term milk supply but they can also feed this to their baby and hopefully avoid the serious consequences of underfeeding. Dr. Morton advises focusing on A, B, and C for a healthy term infant. The at risk dyad should focus on C, B, and then A. The attachment will improve over time with frequent nursing and an increase in milk supply. Reprioritizing our goals in a preventive, proactive effort only makes sense. We want to set up mothers for success not failure.
Dr. Morton has produced a new video that beautifully illustrates this concept for new parents. I encourage you to watch it and share it with the families you are working with.
CCCE, CLE®, Lactation Educator and Childbirth Educator Faculty
Michaela has been working in the maternal/child health field since 2002. She is an IBCLC (International Board Certified Lactation Consultant) as well as being a dually certified childbirth educator, certified labor doula, certified lactation educator™ and certified teen educator. Educating and assisting new families through the most life changing event of their lives is her true calling and passion. Michaela strives to make sure women and their partners have the most up to date evidence based information to ensure they are making informed decisions.