Gentle First Year: The Essential Guide to Mother and Baby Wellbeing in the First Twelve Months

You can also use this method to take the heat off the baby’s head if you notice that her head is hot. Repeat as above, without touching the baby’s head or neck, and stroke in one direction only as this flow is very relaxing for the baby.

Sceptical? If you relax and close your eyes and do it on yourself for a minute or two, you should be able to register an almost tingly sensation, like an electric current. Do this for about five to twenty minutes, or as long as you like. It’s a loving, rhythmic sequence which can really get you involved with your baby’s physicality, until such time as the baby is ready for full-on cuddles.

‘Kangaroo Care’

When the baby can come out of the incubator for periods, take every opportunity to enjoy skin-on-skin touch. If you have been expressing your milk, you can now try direct breastfeeding. Equally, the father can try giving the baby a bottle of your milk. Both of you should try as much as possible to feed the baby without your shirts on as it’s important that the baby can smell you and learn to associate your smell with loving touch. Remember, there are lots of bright lights around incubators – the baby may even have worn goggles – so she won’t have terribly strong visual impressions of you. But she will have been able to smell you, so the closer she can actually get to you and your scent, the more relaxed she will be.

This intensive form of touch bonding is known as ‘kangaroo care’. It has been proven to bring remarkable positive responses in premature babies. So take every opportunity to hold your baby against your chest. Let her smell your skin, nuzzle into your neck, sleep on your tummy, look up into your eyes. Don’t put her down until the nurses are practically tugging her free. Every minute of skin-on-skin will make a difference.

Case History: Kangaroo Mother Care (KMC) for Premature Babies

This case history was contributed by paediatrician Dr G. Pramood Reddy MD DCH of the Fernandez Hospital for women and children in Hyderabad, India. The hospital was set up by my friend, Dr Evita Fernandez, whom I greatly admire for her dedicated work on the cutting edge of obstetric and neonatal care in India. It is Evita’s – and my – wish that Kangaroo Mother Care is provided as an absolute necessity in developing countries where two-thirds of the world’s low-birth-weight babies are born.

Rama Mani, a 35-year-old first-time mother, was treated for fertility issues for more than 14 years before she finally conceived. Unfortunately, during her pregnancy she suffered from many medical problems, including gestational diabetes, pre-eclampsia, fibroids and the problems that accompany an Rh-negative blood group! Despite the obstetric precaution of placing a cervical stitch to prevent premature labour, she went into labour at 30 weeks and delivered a baby girl weighing only 1.28kg. The baby was initially looked after in an incubator but as early as possible – by day 12 – she was moved to the Kangaroo Mother Care Ward.

Rama said that finally holding her baby next to her skin was one of the most joyous moments of her life. She was able to breastfeed her baby on demand and the baby gained weight notably faster than she would have if she were still in an incubator.

More importantly, Rama finally felt that she was able to nurture and mother her baby, and she confidently took her daughter home less than three weeks after the birth. Rama was so fascinated with the concept of Kangaroo Mother Care that she made her husband carry the baby around as well! Subsequently her daughter thrived and, despite her uncertain start to life, progressed rapidly to catch up with her full-term peers.

Play Bonding

Babies learn through play, but they also love through play, and so do we. Playing is an intrinsic part of bonding because to play with your baby is to delight in what she can do. There is no sophistication in baby play – no cultivated wit or superior irony – only the unbridled joy that comes with achievement and the thrill of the new. It is obvious, naïve, heartfelt and worn on the sleeves of both her babygro and your jumper.

Toys are great educational tools for the early months, but contact play – such as tickling or raspberry blowing – boasts benefits beyond the immediate joy of close touch. The skin is an organ which is stimulated by touch. The skin’s nerve centre, the brain, releases a rush of feel-good hormones called endorphins every time you squeeze, stroke or tickle your baby. In fact, there is mounting evidence that deprivation of touch in childhood can actually reprogramme the brain and contribute to antisocial behaviour in later life. So getting physical when you play with your baby has far-reaching benefits, as well as boosting self-esteem and making you both feel good.

The skin’s nerve centre, the brain, releases a rush of feel-good hormones called endorphins every time you squeeze, stroke or tickle your baby.

You can’t help but clap with delight as your baby builds her first tower; both giggle helplessly when you tickle her on the changing mat, and revel in the excitement when your baby does a ‘boo’ to your ‘peek’. Playing is like smiling when you’re sad – it instantly makes you feel better. Each time you play with your baby, the world is new to you again, fresh and waiting to be explored. So turn every waking moment into an opportunity to share a giggle or show something new. Each time you do, your soul is renewed, your heart grows larger and your love becomes deeper.

Breastfeeding

By rights, the issue of breastfeeding should be included in the ‘bonding’ section, as it is one of the most profoundly intimate and loving exchanges between mother and baby. The physical skin-on-skin contact helps the baby still feel closely connected to the mother’s body, which has protected and nurtured the baby during the pregnancy. This feeling of security cannot be underestimated as the baby has, of yet, no sense of being physically separate from its mother. To the baby’s limited sense of self, they are one person, and breastfeeding helps enormously in preserving that security. For the mother too, breastfeeding acts as a halfway house, as she adjusts to the physical separation from her child, which is, of course, the necessary result of birth.

From a practical point of view breast is best and easiest, and it’s always just the right temperature. It is easily digestible, organic and, best of all, free! Plus, it helps the mother regain her figure more quickly. Breastfeeding burns approximately 500 calories a day. The baby’s sucks stimulate the release of oxytocin from the mother’s brain – the hormone responsible for contractions in labour – helping the womb shrink back into the pelvis far more quickly, and the mother to lose tummy fat and get back into her jeans!

Of course, the nutritional benefits of breastfeeding are what we really want to shout about. As well as passing on vital antibodies, which boost the baby’s immune system, a mother’s breast milk is perfectly tailored to her baby’s individual needs. There are so many health benefits to breastfeeding that they alone are most women’s incentives to carry on:

benefits of breastfeeding

Reduced incidence/severity of eczema and asthma, childhood diabetes, gastric, urinary and respiratory tract infections and ear infections

Higher IQ

Less likelihood of cardiovascular disease or obesity in later life

Long-term breastfeeding (at least a year) can reduce the risk of several cancers, such as ovarian and pre-menopausal breast cancer

La Leche League has reported that breastfeeding can protect from osteoporosis in later life.

the father’s role in breastfeeding

Yes, fathers actually play a very important role in breastfeeding. Studies have shown that the father’s attitude to breastfeeding can determine whether or not the mother begins and continues to breastfeed. If he is against it, it is usually a direct response in which he sees his partner’s breasts as sexual organs and is reclaiming them for himself, especially if his partner didn’t want her breasts to be touched during pregnancy. The father might also feel that the side-effects of breastfeeding – such as tiredness or low libido – puts too much pressure on the parents’ relationship and ask for breastfeeding to be abandoned. If this is the case, try to negotiate a time frame you are both happy with, up to which you will feed. Stress to your partner that this is only a temporary stage and your hormones will return to normal after you have stopped feeding.

Even if your partner is fully supportive of you breastfeeding, it is still worth encouraging him to feed the baby as much as possible. You can easily express your breast milk so that the father can feed the baby and feel more involved in this aspect of nourishing and nurturing his baby.

The Different Stages

THE FIRST FEW DAYS

Breastfeeding changes with different stages. The first stage occurs in the first few minutes after birth until three to five days later, and is the real ‘feed on demand’ stage – the more sucking the baby can do in these early days, the more bountiful the milk supply. Some babies (particularly those born by Caesarean section), however, may be exhausted and sleepy after the birth, and the appetite centre in their brain may not switch on for as long as 48 hours after the birth. In this acute period, the baby feeds on colostrum – a thick, creamy-yellow first milk that is absolutely jam-packed with goodness. It is the most optimal food of a baby’s entire life, quenching their thirst, filling their tummies for the first time (and so helping pass the meconium from their bowels) and equipping them with a hit of vitamins, minerals and antibodies which will last for up to six months. In the UK, 69 per cent of mothers begin to breastfeed after birth.

correct latch technique and tips

Tummy to mummy: lay the baby across your lap, with the baby’s tummy lying next to your tummy. The baby should be supported high enough so that her face is at breast height. A C-shaped breastfeeding pillow is ideal as it is long enough to curl around you, support the full weight of your baby and bring her up to the right height for you. This will help you to sit comfortably without having to bend over, preventing neck and upper back strain.

Nose to nipple: Move the baby towards the breast and stimulate your baby’s rooting reflex by brushing your nipple on your baby’s upper lip. This will encourage the baby to open her mouth. (Never move your breast to the baby – it must always be the other way round.)

When the baby’s mouth is open very wide, place the baby on the breast so that her bottom lip is curled back and her chin is pressed into the lower breast area (her chin should touch the breast first). In ratio terms, her mouth should cover the areola above the nipple one part to three parts below the nipple.

The nipple should be directed at the back of the mouth, as far away as possible from the baby’s tongue, as the baby doesn’t actually suck the nipple itself, but stimulates the wider areola for milk release (the NCT says pertinently: it’s breastfeeding, not nipple-feeding).

Sit centrally. This is vital for back care.

If your baby is particularly windy, modify this technique by sitting the baby into a more upright position. Each time the baby naturally breaks off, wind gently.

To break the latch, never just pull the baby off, as they get a powerful suction going! Put your little finger into the corner of her mouth first to break the suction.

Breast and Nipple Protection

In the early weeks, your breasts and nipples are naturally going to feel sensitive, even sore, until they adjust to breastfeeding. The most important preventative measure is to make sure the baby is latching on properly (see above). Some mothers like to use a barrier cream such as Lansinoh (which is pure lanolin) or Kamillosan after every feed for the first few weeks until you adjust. It is not strictly necessary to wash it off before the next feed, but I do advise it, as the commercial varieties do contain some preservatives.

An alternative way to treat sore nipples is to express and rub a little of your milk onto them and allow them to air dry. Equally, if the nipples are very bad, or bleeding, some midwives recommend applying Vaseline before putting on the lanolin barrier creams. I have had mothers swear by it. If your nipples are too sore to feed, latex or plastic nipple guards are available at most pharmacies and can tide you over for a few days whilst the nipple heals. But if it is getting to this stage, please see a breastfeeding counsellor or lactation consultant for advice. They may also recommend that you express your milk for a couple of days and feed from a bottle (remember to express 30–45 minutes before the feed is due, so that the baby is fed on time).

If your breasts feel hot and tender when engorged in the early days, savoy cabbage leaves from the fridge naturally cup the breast and provide an instant cooling balm, or just drape over a cold wet flannel. Equally, you can buy gel-pads that you leave in the freezer. They are breast-shaped and can be placed reasonably discreetly inside the bra.

Although it is normal to feel a slight sharpness in the early days, breastfeeding should be comfortable. If you experience any sharp ‘cut glass’ shooting pains (indicative of thrush, see homeopathy for third-degree tears) or redness of the breast tissue, lumps or feverishness (indicative of mastitis, see mastitis) see your breastfeeding specialist or health visitor immediately. Mastitis can be treated with Bowen treatments and massage (see massage technique for blocked milk ducts) or in some cases antibiotics. Thrush can be treated with antifungal creams/tablets.

massage technique for blocked milk ducts

The following light massage technique clears the breast lymphatics and reduces the incidence of blocked milk ducts and mastitis. Using the middle three fingers, gently massage in ever-increasing clockwise circles from the edge of the areola to the upper breast and armpit area. Perform eight to ten times, twice a day.

bowen technique for all grades of mastitis

Bowen moves can be performed around the breast in an elliptical pattern, and I can vouch for the fact that mothers experience almost immediate relief. You can treat yourself whenever you feel your breasts are becoming sore or engorged.

THE SECOND STAGE

After three to five days (usually five days for Caesarean mothers), when most of the placental hormones (oestrogen and progesterone) have left the mother’s body, prolactin is produced and the main milk ‘comes in’.