Previous research shows that when a full term newborn is placed skin-to-skin on the mother immediately after birth, the newborn exhibits a pre-programmed biological behavior to approach the breast and start suckling without help[1, 2]. During this first hour when the infant starts seeking the breast, the rooting reflex becomes successively more mature and distinct. During a mature rooting reflex, the mouth is wide open and ready to attach to the breast. At the same time, the tongue is positioned in the bottom of the mouth in order to be below the nipple/areola as the baby attaches to the breast with a forward movement with the head. Interestingly, prior to this rooting-tongue reflex, the baby makes licking movements, which are probably a program aimed at shaping the areola and nipple for easy attachment as well as to transmit taste from the breast to the baby’s mouth. This “familiarization” behavior can take up to 15 minutes before the baby attaches to the breast. During this period, the baby usually massages the breast with the hands, which increases maternal oxytocin levels. This rise in maternal oxytocin is suggested to support milk ejection and maternal bonding.
Typical hospital staff practices that include trying to attach the infant to the breast with a grip around the infant’s neck and a grip around the mother’s breast/nipple (“hands-on latch intervention”) has earlier been suggested to cause an inhibition of the baby’s inborn rooting-tongue reflex. Further, if this practice is too robust and intrusive the baby may scream and show an adverse behavior to the breast, fighting to avoid the breast instead of attaching to the breast to feed. Additionally, our clinical experiences over the years show that this kind of forceful help could be one underlying factor for infants’ latch-on problems. Further, Weimers et al. described mothers’ negative feelings about this practice. Many women have experienced the practice as unexpected when staff used hard-handed touching of the breasts when assisting the infant to attach to the breast. This behavior can cause difficulties for the mother in understanding the infant and also undermine the mother’s self-confidence.
There are even many other labor and postnatal “routines” that are known to negatively affect breastfeeding and directly or indirectly cause breastfeeding problems. Some of these actions are: delayed first suckling[8, 9] often caused by unnecessary separation of mother and infant; supplementary feeds when not given for medical reasons[11, 12] especially if the supplements are given by bottle instead of a cup to infants requiring multiple supplements. Some other medical interventions like caesarean section, epidural and spinal anesthesia are often connected with delayed first suckling, breastfeeding problems and partial breastfeeding[14–17]. Thus infants with latch-on problems during the first months after birth are a common cause of parental and staff stress and may lead to early termination of breastfeeding[18–21].
Older infants with latching-on problems have not been studied previously with respect to the intervention of skin-to-skin contact with the mother. It is our hypothesis that when an older infant with latch-on problems is put skin-to-skin he/she will restore the pre-programmed biological behavior to attach to the breast and start sucking.
Thus, the overall aim of this study was to investigate if placing an older infant with severe latch-on problems skin-to-skin with the mother would positively affect the infants’ ability to latch-on when compared to those infants who did not have skin-to-skin contact but were held clothed in the mother’s arms in a common breastfeeding position.
The specific aims were to conduct a randomized study to compare experimental and control groups as to the following infant and maternal variables:
Infants: 1) Proportion latching-on; 2) Length of time until regular latching-on; and 3) Reaction to the hands-on latch intervention.
Mothers: 1) Assessment on Breastfeeding Emotional Scale; 2) Assessment on Breastfeeding Pain Scale; and 3) Experiences of “hands-on latch intervention”.