Wednesday, 15 April 2015

First week (Part 2) - Hands in the Way / My Baby is fighting me




In the last blog post we began looking at the most common reasons for mums in NI to stop breastfeeding in the first week.  Just to remind us, these reasons were listed in the 2010 Infant Feeding Survey as:
  •   baby not sucking / rejecting the breast (33%)
  •   having painful breasts or nipples (22%)
  •   mother feeling she had insufficient milk (17%).

Although the survey lists baby not sucking and rejecting the breast as 1 reason, I think this actually covers 2 separate scenarios so I have separated them into 2 blog posts.  Last week's blog covered baby not sucking.  This blog will cover what mums describe as baby rejecting the breast or fighting the breast.

My baby pushes me away and shakes his head
A baby needs to feed when he is born.  It is a biological necessity for life that we need to eat.  A baby is also primed to find his mother's breast and to breastfeed when born, so why would a mum say that her baby  is "fighting" her.

Much of this may be due to the way that breastfeeding is "taught" in recent years.  In a previous blog I briefly mentioned how our support networks would have been very different a hundred years ago.  If you had been giving birth in Northern Ireland in 1915 you would likely have already been very familiar with breastfeeding. You probably had several siblings and would have seen them being breastfed.  You probably asked your mum about what she was doing at different stages and would know how a baby latches, what it looks like, and how to deal with problems.  If you were the youngest you probably saw your elder siblings or your aunts or cousins breastfeed before you gave birth.  You would have seen women in shops, friends in their home breastfeed - it would have been common place.  Today we mostly get our information from a short antenatal class, and usually some NHS literature - maybe the Bump To Breastfeeding DVD or the Off To A Good Start booklet.  It's very different from the experiential learning from observing and interacting with a breastfeeding mum.

We live in a society where teaching methods are dominated by analysing, categorising, breaking things into steps.  That may work for maths problems, but it doesn't work so well with breastfeeding.  Over the years breastfeeding has been treated as a step by step process and instructions for latching created.  The instruction book might say things like this:  Make sure your baby is in a straight line, head free, chin to breast, wide mouth, bring him in close.  
Those things are indeed an accurate observation of what a baby needs to latch, but they don't really tell you how to hold your baby or to get both of you working together.  They are logical steps.  They are what is known as left brain thinking.  They might look like a sensible approach when we are pregnant, but when you are in the early days of breastfeeding, awash with hormonal changes and trying to adjust to motherhood working out how to get each step to turn into a latched baby sometimes isn't so easy.  What mums actually describe is that their baby is hitting her, or pushing her away, or shaking his head.  Mums say things like, "he shakes his head to say No".  This can lead to a feeling of rejection in a new mum and many stop breastfeeding without ever really having a chance to experience it.

Left brain vs Right brain 

www.freepik.com/free-photos-vectors


Breastfeeding doesn't really work as a set of instructions.  Learning to breastfeed is more like learning to ride a bike.  You could set out instructions which might mention something like this:  Stand with each leg on either side of the frame, hold the handlebars straight, move one peddle to an almost vertical position, push this peddle down, maintain balance by turning the handlebars, push off this peddle to reach a sitting position, place the other foot on the free peddle, maintain balance by moving your body.
Again, it describes what happens, but it certainly doesn't teach you how to do it.  You can't learn how to maintain your balance on a bike unless you try it.  We feel it in our body.  It is experiential learning.  It is right brained learning.

In normal circumstances, when a baby is born, both mum and baby are in a biological state where they are primed to breastfeed.    Left to their own devices a set of behaviours happen.  As we discussed in the last blog, if placed on mums body, a baby will crawl to the breast and latch on.  These instinctive behaviours don't just happen in baby.  Studies have shown that mums also participate and through stroking their baby, they seem to trigger exactly the right reflexes to latch at just the right time. It is a intricate and beautiful dance.

The reason that breastfeeding more easily when the baby is tummy down on mum's semi reclined body is because babies are designed to be "tummy feeders".  We are mammals, and just like kittens or puppies, babies are designed to lie on their tummy to latch and breastfeed.  In that position your baby is stable.  He can crawl to your breast. He can use his hands on either side of your breast and push against you in order to lift his head and see where your nipple is.  Lifting his head also means that his head are nicely tilted back so he can get a wide gape and a deep latch.  That means he can get milk more easily and it is more comfortable for you.  You and your baby are in sync, reacting to each other's subconscious, instinctive cues and breastfeeding naturally follows.  It is right brain instinctive behaviour, but it is easily over-ridden by our logic and analysis.

If we over think breastfeeding and follow the instruction manual of latching, the reflexes work differently.  A very common position we see in breastfeeding booklets is cradle hold - mum is sitting upright, holding her baby on his side.  Her baby may still try to follow his instinctive reflexes, but now he is in an unstable position.  His hands that are trying to push against the breast to tilt his head back now seem to be in the way.  Mums try to move them, to tuck them away, and baby moves them back.  The head movement that is ideal to move into the right position to self latch now seems to be bobbing around and unable to latch.  Without support to let mum know that this is actually perfect breastfeeding initiation if she just leans back a little into more of a relaxed slouch on the sofa position, she is left feeling that her baby doesn't want to feed.

 Laid-back breastfeeding - image from Babycentre.co.uk

In a slightly reclined position breastfeeding becomes easier.  It doesn't mean that you always need to feed in this position, but it can help to use those reflexes in the early days.  Once we understand how it feels we can experiment, we can try riding with one hand, no hands, doing a wheelie.  It becomes easier to feed in any position.

Experiential learning also comes through observation.  In the same way that your great grandmother learned breastfeeding from her family circle, you can learn it from watching other mums.  Going to your nearest breastfeeding support group when you are pregnant can be invaluable.  It's amazing how much you can learn from watching other mums and their babies.  See how babies move.  See how they use their hands, understand how they bob and move their heads to latch.  If you can't get to a group, watch the videos at the bottom of the page.  They can't replicate what you learn in person, but they give a good overview.  Sometimes the difference between a struggle to breastfeed and an easy comfortable latch is just in understanding our baby's behaviour.  Babies know how to breastfeed.  So do we - sometimes we just need to get our left brain thinking out of the way.  Relax.  Lean back. Hold your baby on your body and allow both of you to feel your way.



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