Search for tag: "breastfeeding"

Newborns do a lot of strange movements and behaviors that quite often scare parents. What are normal newborn reflexes, and when should parents worry?

The first one most parents know and call the startle reflex. It's technically called the Moro reflex. Parents often tell me it's when their baby gets scared, but that's not really the reason. Babies don't get scared as newborns. It's due to their nervous system response to a sudden change in sensory stimulation.

And it's a good thing, actually. In fact, it's able to be seen on ultrasounds when a mom is only 16 weeks pregnant, and a baby's own cry can even stimulate it. It lasts until babies are about 2 to 3 months old.

So when should you worry? Well, if you had a difficult labor and there was concern that your baby might have had some oxygen deprivation, then an exaggerated Moro reflex could be concerned for something called hypoxic-ischemic encephalopathy. Basically, the brain is hurt by having the oxygen supply cut down.

Neurologists can help evaluate and treat this, and the good news is it's picked up really closely after birth. And if there's any concern, your baby will be in the intensive care unit really quickly for a full evaluation. If your baby is otherwise in the normal newborn nursery and goes home, there's a good chance this is not what your baby has.

Another normal reflex is the suck or rooting reflex. And that's just what it sounds like. It's basically what helps the baby learn to find a food source and eat. This reflex doesn't start until about 32 weeks of pregnancy, which is why preemies have such a hard time learning how to eat. This reflex is fully developed at about 36 weeks.

Now, when parents see this, they automatically think their baby is hungry and often that's true. It could be that it's just the reflex and they suck on their fingers and hands as a self-soothing behavior. I see a lot of parents trying to force their babies to eat and then the babies get over-full and throw up.

Then there's the tonic neck reflex. We call it the fencing reflex because they have one arm outstretched and one bent and they're about to say, "En garde!" Some parents worry that there is a problem because both arms aren't in the same position or both arms aren't being used the same way at the same time. But this is normal, and it can last until they're about 7 months old.

Finally, this isn't a reflex, but it's something parents ask me about all the time at the newborn checkups. It's called periodic breathing. Babies do this weird thing where they look like they're breathing really fast, then they can hold their breath for up to 10 seconds, and then they take a big breath in and then they're back to normal breathing. And it can happen when they're sleeping or when they're awake. And it usually lasts until they're about 6 months old.

Babies' lungs are still developing and their brains are still trying to figure out how to send messages to the lungs to remind them to breathe. Basically, they are still trying to figure out this whole breathing thing and breathing patterns. And it looks scary, but it's normal.

So when should you worry about your baby's breathing? If they're consistently breathing more than 60 times a minute, if they're having retractions where it looks like their stomach muscles are sucking in under their ribs, if they are making grunting noises with each breath, or if they hold their breath for more than 20 seconds and turn blue, those are not periodic breathing, and that needs to be evaluated right away to see if your newborn's oxygen is low. Depending on how severe the symptoms are, the best place for your newborn to be evaluated for breathing issues may be the emergency room.

One last thing. What about those eyes? Well, babies have very little control over their eye movements right away. That's why they always look at you cross-eyed. They're trying to figure out how to control their eye movements and learn to focus on things.

Also, it's not uncommon for a baby to roll their eyes when they're sleeping or when they're almost asleep, like when they're going to sleep or trying to wake up. But this should not be the norm. If they are not rolling their eyes but doing more of a rhythmic back and forth, something called nystagmus, that is absolutely not normal.

If your baby rolls their eyes often, that is not normal. If your baby's eyes roll and your little one also has stiffness in their arms or legs or has shaking that doesn't look like the startle reflex, that could be a seizure and that's an immediate trip to your local children's emergency room.

Many things can cause seizures in a new baby, including low blood sugar, low calcium levels, metabolic diseases, or brain abnormalities, in addition to epilepsy and high fevers. Your child will probably be admitted to the hospital and see a neurologist for tests to determine why they are having these weird movements and possible seizures.

So while a lot of these normal behaviors look concerning, they are often just part of your baby adjusting to being in the outside world. If your baby has any of the not-so-normal behaviors I talked about, please have them see their pediatrician right away or go to your closest pediatric emergency room.

It's been an issue for several weeks now, parents scrambling to try and find baby formula amid the shortage. So what are you supposed to do? You have a hungry baby who needs to eat.

Like many women, I was unable to completely provide enough breast milk to feed my boys. Trust me. It wasn't for lack of trying to increase my supply with supplements, medications, pumping, working with my OB and five lactation consultants. And we learned, for me, I have a medical condition that just won't allow me to make as much as my kids needed, so I had to supplement. And I find this is often the case for many of my patients' mothers.

Often, some women just choose not to breastfeed, and they want to just give formula. And that's okay too. Most important is for the baby to be fed and loved.

So what exactly happened to cause this formula shortage? The manufacturer of Similac products, Abbott Nutrition, recalled powdered formula brands due to bacterial contamination in some of their batches. This, combined with supply chain issues, triggered a nationwide formula shortage.

For families that were affected, this has triggered a lot of questions about what to do. The easiest thing that parents can do is to just switch to a different infant formula. I know that sounds scary, but many store brands and other brands, like Enfamil and Gerber, have formulas that are equivalent to Similac.

Most babies do just fine on a cow's milk-based formula, and there are a ton of variations for whatever your babies might need — gentle formulas, formulas for soft bowel movements, formulas for breast milk supplementation, formulas with extra ingredients to help with digestion and brain development. There are so many options out there.

I often recommend generic or store brand formulas because they're cheaper, but they still have the same nutritional quality as the brand names. We used generic versions of gentle formulas for both of our boys and found they actually tolerated them better than the brand names.

What if your baby is on a special formula, like for milk protein allergy or prematurity? The good news is these formulas really aren't affected by the shortage as much. Your pediatrician can help figure out what is best for your baby in those situations. There are milk banks where women who have excess breast milk donate their milk, and that's a great source for babies who are preemies. Neonatal intensive care units often work with milk banks to get milk for preemies. The milk is strictly screened and totally safe.

What about mixing infant formula differently to make it last longer? This is a big fat no. Adding extra water to make diluted formula is bad. I've seen it happen more than once, where parents do this and it has actually landed their babies in the intensive care unit. What happens is that too much water upsets the balance of salts in their body because the babies' kidneys can't process that much water. That causes the babies' sodium levels to drop to the point that the babies have seizures, and it could be fatal.

Babies will not get the correct amount of nutrients if the formulas are diluted. That is why we have specific instructions on how to properly mix formulas.

What about all of those homemade baby formula mix recipes? Those aren't a good idea either. While, in the past, people made their own baby formula, that was before we had a really good handle on the specific nutritional needs of infants. And those homemade baby formulas don't provide the right concentration of nutrients that we now know babies need. Some babies have even been hospitalized after being given homemade formulas.

Finally, what if your baby is close to turning 1? Can you start milk early? Well, it depends on how early. Babies actually need the nutrition that is in formula until they're 12 months old. I would say that if they're within two weeks of turning 1, you can start transitioning to whole milk. Transitioning before that puts them at risk of iron deficiency anemia because milk has no iron in it. Also, once they start drinking milk, they need to limit their consumption to 16 to 24 ounces per day, or they could develop iron deficiency anemia as toddlers.

Parents often ask what milk kids can have if they don't want to give their kids cow's milk. Luckily, there are a lot of alternatives. Soy and pea milk are the most similar to whole milk in terms of nutrition. They can also have oat milk or nut milks, like almond or cashew milk. Plant-based milks are good for calcium and vitamin D, but they may not have the best nutrition when it comes to protein, fat, and calories, things toddlers need from ages 1 to 2, as their brains are still developing. And other milks, like goat's milk, can cause pernicious anemia due to vitamin deficiencies.

The good news is there are reports that the formula shortage should start to improve in a few months once the factories get the okay from the Food and Drug Administration to resume production. Until then, hopefully, parents are able to find alternatives.

One question I get a lot is, "What formula should I give my baby?" There are so many choices out there, regular or sensitive, one for spit-ups, one for soft stools, brand or generic. My answer always is there is no one formula I recommend. Some babies do just fine on milk-based. Some need a sensitive version or one that is more for babies with reflux. Only very few needs soy based or special formulas for premature babies, or babies who truly are allergic to milk protein. For many babies, generic formulas are just as good as brand name formulas. It may take some trial and error, but the one your baby takes best and seems to not upset their stomach is the one to stick with.

Speaking of infant formulas, some parents worry that their baby will be bored with formula. Babies really don't get bored of having the same thing over and over like we do. Also, formula and breast milk have the best nutrition that your baby needs when they are brand new. A baby's digestive system isn't set up for a lot of variety at birth, or even at two or three months old. Currently, the guidelines are for starting fruits and vegetables and grains at about four months old if your baby's ready. A baby will need to continue to have breast milk or formula until 12 months of age.

What about toddler formula? In most cases, once your child turns one, they can have whole milk and they don't need special formulas. For toddlers who are very limited in their diets, talk to your child's pediatrician to see if they would benefit from one of the toddler formulas.

Next, I get asked a lot, what sippy cup should I give my child? Whichever one they will drink out of. It took seven different sippy cups until we found one that my older son liked that didn't spill all over the place.

Finally, what do I do if my child really only wants to eat candy and cookies and soda and junk food? Two things. One, your child doesn't do the grocery shopping. If you buy those things, of course, your child will want to eat them and not the things that are more healthy. Your child should know that those are special foods for treats and not a main course item. Second, if you eat healthy, your children are more likely to eat healthy. Kids from little on wan to do everything their parents do. So show them by example. Unless we're having something really unusual, my husband and I aren't short-order cooks for our boys. Whatever we made, that's what we serve them. And now they eat, or at least will try, a huge variety of foods. They like fruits, vegetables, foods from other countries. And yes, they still get cookies and candy and soda. But those foods are not the mainstay of their diets and those are treats.

If you have feeding concerns about your child, go ahead and ask your pediatrician. Chances are we've heard your concern before and are able to help.

As COVID concerns increase, so do the questions parents have about keeping their children safe.

One question I've gotten several times is, "Can I still breastfeed my baby during COVID-19?" Moms are often anxious anyway about their babies, and a lot of what is in the news is increasing everyone's anxiety right now. I've had several moms ask me if they can transfer their anxiety to their babies by breastfeeding. The good news is no. Actually, continuing to breastfeed their babies will help their anxiety, and it's a great bonding experience for both mom and baby. Also, by breastfeeding, they are still getting their babies all the good immune system boosters found in breast milk.

A lot of new moms also find that breastfeeding isn't as easy as they make it look in the movies. I know it was a struggle for both of my boys. I had five lactation specialists working with me, and it just wasn't happening. I needed to supplement with both, but I felt so bad. The bottom line is keep breastfeeding as much as you can. Pump and give him a bottle if you have to. That's what I ended up doing, and I still had to supplement. And if you need help, there are many resources available. Talk to your pediatrician about what is best for you and your baby.

For something that is as common, normal, and naturally engineered as breastfeeding, most first-time moms are a little nervous.

Okay. Here are some dos and don'ts about breastfeeding for new moms. If you've done this before, it's usually like riding a bicycle. You don't forget. If you're not a first-time mom and your breastfeeding didn't work out so well for you last time, it doesn't mean in all cases that you won't be able to be a happy, successful breastfeeding mom this time.

So here we go. Do plan to breastfeed. The vast majority of women are biologically equipped to do it. There are very few women who physically cannot or are recommended not to breastfeed. The default decision these days, not in our mothers' days, is to breastfeed.

Don't beat yourself up if you cannot or choose not to breastfeed. For many women who are the main source or the only source of income for a family, they must go back to work immediately. Family leave only assures that your job will be there if you take a certain amount of time off. It doesn't guarantee that you'll get paid, at least not in the U.S. If there are medical reasons that you cannot breastfeed or you live near a big city, it is possible that you can access donated breast milk from a breast milk bank.

Do talk to a knowledgeable medical professional about any medications you may be taking after your pregnancy. Do not expect that all doctors and nurses know all of the science behind medications and breastfeeding. And many automatically default to, "Just don't breastfeed if you're taking that medication."

The Centers for Disease Control, cdc.gov, has a section on breastfeeding with a section on medications. The National Institutes of Health and the U.S. Library of Medicine has a website called LactMed that has a site with specifics on different medications and interactions with breastfeeding. You or your healthcare provider can plug in the name of the medication and find out the facts. It's updated monthly.

The InfantRisk Center at Texas Tech University Health Sciences website has done lots of good information, and a link to MommyMeds, a mobile app for meds and breastfeeding.

Don't just get information from your friends and family about drugs and breastfeeding because they probably don't know.

Do get some helpful advice from the lactation specialist in the hospital where you delivered. Most hospitals have nurses who are specially trained to help new moms get comfortable with breastfeeding, how to help the baby latch on to the nipple, how to troubleshoot if you're having difficulty for the first couple of days.

But remember, most women who have an uncomplicated vaginal delivery go home in 24 to 48 hours, and that's before their milk comes in. For new moms, that can be a little scary if they're planning to exclusively breastfeed because the milk hasn't come in yet. It may take even longer after a cesarean section. Lactation specialists know this and can give you a contact number and a handout on what to expect while you're waiting for the milk to come in.

Don't freak out when your milk comes in. It often comes in like a train and the breasts can be very distended and uncomfortable. Think of this as an insurance policy that nature has put in place in case you had twins. You may make more at the beginning than your newborn can use. If the breast is too tense for the baby to latch on, hand express some milk or use a breast pump. This is a great time to pump out the extra after the baby is full and put it in the freezer.

Do keep very well hydrated. Water is a good source. Milk, if you drink it, has all the calories and protein and calcium that you need for breastfeeding if you drink three glasses a day.

Don't expect to do it all. The first several weeks of nursing and recovering from delivery is tiresome. If you're breastfeeding, you'll be nursing every couple of hours. You will be sleepless. Think ahead about what your friends and family can do for you and have a list all ready so that when people say, "What can I do for you?" you can look at your list because you're going to be too tired to think of a new list. So you've got your list and you can tell them what's on your list.

Do think carefully about drinking alcohol and smoking marijuana. The amount of alcohol in your blood after a drink is transferred to the breast milk and is equal in your blood and your breast milk. Babies' livers don't metabolize alcohol very well, so their alcohol stays up longer. That doesn't mean that one glass of wine or one beer will knock your baby out. But remember, if you're making breast milk, you're doing it while you're drinking and alcohol will be in your breast milk for hours after you drink.

THC, the active ingredient in marijuana, and there are many but this is the one that gets you high, is excreted in breast milk and we don't know what it does to the developing brain.

Don't, just don't smoke cigarettes while you're breastfeeding. Just don't smoke cigarettes. If you gave it up because you knew it was bad for pregnancy, it's bad for your newborn.

Do get your vaccinations, especially influenza and measles and Tdap. If they find that you aren't immune during your pregnancy, the only vaccinations that are contraindicated in breastfeeding are smallpox and yellow fever. And most of you aren't going to be looking out to get those. You can check with the CDC's website on vaccination and breastfeeding.

Don't ignore your partner. Breastfeeding creates a highly intimate relationship with you and your baby. If you have some milk frozen and you use a bottle sometimes for breast milk or formula, let your partner in on it if they're willing and interested. It creates a good backup for you and your baby and lets them become close to the baby in their lives.

Do try to be flexible. A newborn and breastfeeding don't always fit into your pre-baby life. At the end of the day, if you have to stop breastfeeding, there are good alternatives and you are not a failure or a bad mother.

Don't quit breastfeeding because you get sick, unless you are too sick to breastfeed. If you have to stop because of some temporary medications to treat your illness, keep pumping. You can discard the milk, but keep the breast used to producing so you can go back to breastfeeding when you're better. If you stop breastfeeding or pumping for some days, it can be difficult to get the mechanism going again.

This is just a very short list of things women might wonder about. There's lots of information from the American Academy of Pediatrics and the CDC on other topics. If you're having trouble, get help from your local lactation specialist. You can do it. Thanks for joining us on The Scope.

Dr. Jones: Getting let down. Getting let-down. The first is a psychological consequence and the second is about breastfeeding. How are they connected? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: There's a world of data that suggest for newborns "Breast is Best." That puts a lot of pressure on new moms to be successful breastfeeders. In the days before formula, a newborn's life depended on a mom's ability to provide breast milk, and a mom's health might already be precarious after what might have been a dangerous delivery. For this reason, many cultures have a time after delivery, several weeks or a month, to allow moms to heal and breastfeed.

Okay. That's all good. But after that in the US of A many moms have to go to work. That means if moms are still going to provide breast milk, that breast pumping pump at work becomes a reality. Now, to provide breast milk, a mom has to be at least moderately well-nourished and well-hydrated. But almost all American moms can accomplish that in the workplace. Then, there's the problem of let-down.

To make milk, moms need to be in reasonable health. They have to be breastfeeding, meaning they have to suckle. When the infant suckles, their nerves on the chest wall and the nipple feed information back to the brain to release the hormone prolactin from the pituitary gland. This hormone helps the breast make milk. But the milk just doesn't come out in a continuous dribble. It's made in the far parts of the breast called the alveoli and collected in tubes or ducts in the breast waiting for, you got it, let-down.

When the infant suckles, nerve fibers in the nipple cause the posterior pituitary to release oxytocin, which stimulates myoepithelial cells. These are little muscular cells to squeeze milk from the milk producing part of the breast called the alveoli so it can drain into the lactiferous ducts and then squeezes the milk down the pipeline to the nipple. It takes less than a minute from the time when the infant begin suckling -- the latent period -- until the milk is secreted -- the let-down. But what happens if the baby isn't there?

You're in your office or you're in the ladies restroom with your breast pump or if you're lucky you have a private room with a lock and an electric outlet and an electric breast pump and a rocking chair. Nice, but you still have to get let-down. Many experienced breastfeeding moms know that just the sound of their baby giving a hungry cry can begin let-down and that could be embarrassing if the baby isn't close and you start to leak through your clothes. However, for new moms, pumping at work let-down can be difficult to get started.

If let-down is a neuroendocrine reflex from the brain, many things can get in the way of timely let-down. Anxiety, pain, embarrassment, stress, stimulants like caffeine and nicotine, too much alcohol gets in a way but a little bit of alcohol might be relaxing, but not in the workplace. Acute fear or anxiety can suppress let-down. The fight or flight mechanism inhibits let-down, as it should if you're running away from tigers or something else.

Many years ago, when I was a young obstetrician back at work shortly after the birth of our son and pumping when I could find the time, my residents gave me as a joke, I think, a pager duct taped to a breast pump. Now, there isn't anything less conducive to let-down in my world than my beeper going off and a disaster happening to some poor laboring woman on labor and delivery. What a let-down.

So what's a new mom at work to do? Some suggestions include bringing a picture of your baby to look at when you're pumping. Bring something like a little t-shirt that smells like your baby with you. Try to get your head in a calm space before you put the breast pump to work. Deep breathing, focused visualization of having your baby at your breast and instead of that pump can be useful. Turning up the vacuum on the breast pump or just pumping harder with the hand pump won't do. The problem is let-down, not suction.

In an effort to increase the success at milk production and future breastfeeding for moms of very premature infants, some research has been illuminating. You can imagine that having a very sick newborn that you've never been able to nurse because they're too little and you're sitting in a pumping room next to the intensive care nursery might not be conducive to let-down.

A paper published in advances in neonatal care took 162 mothers of premature babies who were trying to provide breast milk for their babies and divided them into four groups. One group had standard instructions in a breast pumping room. The other group was taught guided imagery, imagining their babies and imagining themselves in a safe, warm, quite place with their newborns. Another group was given soothing music. And the fourth was given imagery and soothing music.

Women who were taught guided imagery or given soothing music had more output of milk. And the women who had music and guided imagery together has the most milk of all. Now, this wasn't just a little difference. Moms who had the interventions had two to three times more milk than moms who didn't. Mothers who had interventions to decrease stress also had more milk fat, had richer milk in the first days of the study.

So what else is out there? Last year the annual Make the Breast Pump, Not Suck Hackathon -- isn't that a great meeting -- awarded the Technology Frontiers Award to group that were testing out virtual let-down by transforming pumping rooms at work and in public places into a nursery decorated with pictures and videos and sounds of their babies by using a virtual reality headset.

So what do you do? For a new mom committed to breastfeeding and is returning to the workplace or needs to travel away from their baby, what do you do? Practice using your pump at home in your baby's room before you take it to a strange place. Get your head in the right place. This can take time and practice before you're rushing into a pumping place or a bathroom in the airport or your workplace. Get some soothing music and, yes, there are YouTube videos with music and guided imagery and meditation that you can use. You can just power it up on your phone, put in your headphones.

But use these first with your baby so the association can be stronger. Stay well-hydrated. And if you're struggling, get a coach through your hospital nurse lactation specialist or a La Leche League. This is hard, but you can do it. Don't get let down.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

One question I get a lot from new parents, is that they can't get their baby to burp. Is this a big deal or not? Is it just an old wives tale that not burping your baby will cause stomach problems? That's today's topic on The Scope. I’m Dr. Cindy Gellner.

Dr. Gellner: Parents often get very worried when their child won't burp, like it's going to cause their baby's stomach to get upset or bloat. I promise you, your baby won't explode, and gas eventually does make it out of the GI system. If not out the top end, then it comes out the bottom end. Older children and adults don't get burped after they eat and we're usually okay.

People have been burping babies for hundreds, maybe thousands of years. Does that make it right? We finally have the ability to study this, and guess what? Someone actually did the study in 2014.

The researchers studied two things with relation to burping, colic symptoms and spit-up. Both of these are harmless, but as a mother of boys that did a lot of spitting up, and one with really bad colic I can understand why it's such a big deal for parents.

The scientists had half the parents burp their babies and the other half not burp. All the parents kept records for three months on their babies' colic and spitting up symptoms. What they found was that there was no difference between the groups with regards to colic symptoms. What this means, is that babies will be equally fussy, or not fussy, whether you burp them or not. The babies in the burping group also spit up twice as much as the un-burped babies. You'd think the opposite, huh?

So, if you try to burp your baby and nothing happens, no need to worry. If you don't burp your baby ever, no need to worry. If your baby is spitting up or has colic, burping may not make those any better, or may make it worse. And remember, your pediatrician is the best resource for any concerns you may have about your baby's digestive system.

updated: June 7, 2021
originally published: May 1, 2017

Interviewer: The importance of skin-to-skin contact for mom and baby. You'll learn more about that next, on The Scope.

Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.
You know, it seems like mothers are always looking for ways to ensure their baby is happy, and more importantly healthy. One of the simplest things you can do is also one of the best, it's simple skin-to-skin contact which doesn't necessarily always happen the way that it should.

We're talking beyond breastfeeding, by the way. Elizabeth Smith is a board certified lactation consultant at the University of Utah healthcare. Skin-to-skin contact with mom and baby sounds pretty basic, but for some reason we're talking about it so it must not be happening, why is that?

Elizabeth: It is happening but it's not always happening for every baby and every mom. And the reason that I want to talk about this is because for years, for about 10 years we've been really encouraging the skin-to-skin contact. We've been encouraging it because it helps so much with breastfeeding, and helps to get that relationship off to a good start. But what we fail or where we forget is that the moms who are not able to breastfeed and babies who are unable to breastfeed don't get that benefit all the time and it's so important for all of them to get it.

Interviewer: Okay so if a mother is chosen or is unable to breastfeed, that skin-to-skin contact needs to still happen. Where it's naturally happening if a woman is breastfeeding.

Elizabeth: Yeah, it's an automatic that if mom says she's breastfeeding we're going to get the baby skin-to-skin so that they can start that whole process and have it happen. But sometimes we forget if mom is not choosing to or if there is a medical reason why she's not, we forget that that is so important, and maybe even more critical for those babies.

Interviewer: Let me jump in and say if you have chosen to breastfeed you should continue to listen because there's still some good advice here as far as skin-to-skin contact, when it should start happening, how long, that sort of thing.

Elizabeth: Yeah absolutely.

Interviewer: Let's talk about the benefits for baby, and there's a lot of great research that supports what you're about to tell us.

Elizabeth: Yeah, the research is continuing to come out. It's daily that I get information about a new study that's been done, showing the benefits.
So what we know is that if a baby is put skin-to-skin on mom's chest right after birth, as soon as possible, then mom and baby are both going to have an oxytocin response. And so that oxytocin is going to help mom to calm and it's going to help baby to calm, which helps the transition for baby to being from inside the womb to breathing air. It's going to help with that, and then mom is also going to have some better benefits for the rest of the laboring process, as the placenta comes out, it's going to help with that.
So those are good benefits, and then baby will maintain a better body temperature, typically have glucose, respiration, heart rate, and all of those things that are so critical in the immediate after-birth period.

Interviewer: Okay so these numbers sound great that they've got better temperature, better glucose, but I mean does it really make a difference in the health of the baby?

Elizabeth: It does make a difference in the health of the baby long-term, but the other area that often times has not been studied as much, or doesn't get emphasized, is the colonization of the gut. And so by taking that baby and putting him or her on mom's chest, then what happens is an immediate colonization so that the flora of the gut is healthy, versus if we put that baby in a sterile environment or an unfamiliar environment, where it's going to change that flora.
And as we look at inflammation being as the cause of most disease, what we're finding is that if we can have that flora be good in the very beginning and that colonization happen, then we're going to have a long-term health benefit for that baby because of a decrease of inflammation through-out their life span.

Interviewer: So it's good for the baby, it's also good for the mom or are there other mom benefits?

Elizabeth: The biggest mom benefits are the calming of mom, the oxytocin released, the prolactin that gets released into her system. All of those things are going to definitely benefit mom.
Involution of the uterus so that it clamps down quicker and better. So involution is that the uterus does need to, it needs to get smaller after growing to the size of a baby, it now needs to go down to the size of a grapefruit in about five minutes. The oxytocin is really going to benefit her.

Interviewer: That's really crazy how skin-to-skin contact can invoke such a physical reaction, deep inside the mother.

Elizabeth: It's the hormones, they really work so well to have all of these biological responses happen. Interviewer: How soon should skin-to-skin contact happen? You had mentioned like, as soon as after-birth as possible, what does that even mean? Like as soon as it comes out, bam?

Elizabeth: That's what it means, we want the baby to go to mom's belly or chest as soon as possible. The cord length can determine where that baby is placed initially, and then should be brought up to the chest, because that's where you get the highest response. Mom has, her chest will actually get hot to heat that baby because of that oxytocin response.
So you want that to happen immediately. We also know that there are some times when a baby may not be medically stable, or mom may not be medically stable, and they might have to have separation. So in those instances, the baby should be brought to mom as soon as both, one or the other whoever, as soon as they're both medically stable and can be put in that skin-to-skin.
Now if mom is the one that is medically unstable, baby could be placed on dad, or an alternate care-giver so that that skin-to-skin contact can also have a benefit. I want to note to that, it's not quite as good as it is with mom, but it is still a benefit. Male care-givers can heat a baby, but they don't cool off the way a mom does, and so we can actually over-heat a baby by putting them on dad, so we want to just be careful, watching out for temperatures.

Interviewer: So even before the umbilical cord is cut, there needs to be skin-to-skin contact, how long does that go on then?

Elizabeth: So the skin-to-skin contact, we want it to happen for at least the first hour, up to two hours if possible in labor and delivery, and that should be uninterrupted skin-to-skin contact. So if grandmas, or aunts, or other people are coming into the delivery room, it really should be that mom is the one who is doing that skin-to-skin contact and we wait . . .

Interviewer: Yeah . . .

Elizabeth: . . . to pass baby around. Baby is going to go into a deep sleep after they get that initial rush from being born, and that's a good time for other people to be holding, and oohing and ah-ing over the baby.

Interviewer: Does that contact then need to continue even beyond this point?

Elizabeth: It absolutely should continue. Babies should skin-to-skin several to numerous times daily over the first few days and weeks of life. And then it also can be a good calming and soothing technique that parents can use even up to several months of life.

Interviewer: Is this happening in hospitals right now? I guess, I mean, I've never been in a delivery room, so I don't know.

Elizabeth: It is the standard of care in most hospitals, some do better than others, and as the research evolves it does happen frequently, but there are times that it does get neglected and sometimes when mom says she's not choosing to breastfeed, that gets overlooked, and it shouldn't. We still need to make sure that those babies are getting placed skin-to-skin with mom.

Interviewer: Okay. What can a mother do to ensure that things go smoothly during the delivery, I mean after the delivery to make sure that this does happen in the hospital? Because I mean you wouldn't know if your hospital is doing or not.

Elizabeth: The biggest thing to do is ask, and the majority of the time in Salt Lake, you're going to find that hospitals will say, "Yes we do that as a standard of care", but even with that yes as the answer, mom should still make sure that when she goes in for delivery that she lets the nurses and the care-givers know that that is important to her. Also her support person should be aware of that, so that as soon as the baby is born if baby isn't put right next to mom, that the care-giver can step in and say, "Oh, we want to have the baby on mom's chest," so that it does happen.

Interviewer: Trying to give our listeners some perspective here. Out of all the things that are going on before and during and after delivery, how crucial is it that this is one of the things that does happen?

Elizabeth: I think it's really one of the most important things that happens, and if the baby is put skin-to-skin with mom, then the transition is going to go better, baby is going to have that better adaptation, and it actually is a benefit to the care staff, because if they are not having to be as observant of a baby, taking that baby to a warmer and having to watch what's going on, then they can do everything else that they need to do post-delivery a little bit easier.
We've even had comments from nurses who have said this since we started doing that as our standard of care, that they have found that it is easier for everyone involved.

Interviewer: Any final thoughts, anything I forgot to ask? Or anything you feel compelled to say?

Elizabeth: I just want to say that this is the best thing for moms and babies, and that we need to make sure that it's a priority.

Announcer: Thescoperadio.com is University of Health Science's radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.