INTRODUCTION:

A baby is born with many instinctive abilities which enable the newborn to perform the ‘Breast Crawl’. With the innate abilities the infant come into life like programmed computer chip with the set of instructions. It appears that young humans, like other baby mammals, know how to find their mother’s breast (Klaus and Kennel, 2001). Breast Crawl is associated with a variety of sensory, central, motor and neuro-endocrine components, all directly or indirectly helping the baby to move and facilitate survival in the new world. The Breast Crawl was originally described in 1987 by Dr. Ann-Marie Widstrom, Dr. Anna-Berit Ransjo-Arvidson, Dr. Kyllike Christensson, Ms. Ann-Sofi Matthiesen, Dr.Jan Winberg and Dr. Kerstin Uvnas-Moberg from Karolina Institute (Sweden).

DEFINITION:

Every newborn, when placed on her mother's abdomen, soon after birth, has the ability to find her mother's breast all on her own and to decide when to take the first breastfeed. This is called the 'Breast Crawl'.

NEWBORN CAPABILITIES FOR PERFORMING BREAST CRAWL

The innate ability of newborn enhances the performance of breast crawl. They are: A. Sensory Inputs, B. Central Component and C. Motor Outputs.

A. The Sensory Inputs: The mother is the source of an array of olfactory, visual, auditory and tactile stimulation that the infant may perceive and respond to when placed on her bare chest. The sensory inputs of the newborn: olfactory, visual, taste, auditory and touch. Smell, vision and taste all help the newborn to detect and find the breast. Auditory inputs and touch makes the baby to be comfortable and help to create a suitable environment.

The olfactory (smell) sense is the most important input for the newborn. The amniotic fluid contains some substance similar to a certain secretion of the breast, albeit not the milk. The baby uses the taste and smell of amniotic fluid on its hands to make a connection with a certain lipid substance on the nipple related to the amniotic fluid (Klaus and Kennel, 2001). Besides secreting milk and colostrum, the nipple and areola are dense in glands that perhaps secrete attractive odours. A baby prefers their mother's unwashed breast, soon after birth (Varendi et al, 1994). And washing could reduce or eliminate such odours. In 1998 Wineberg and Porter stated that about 1-2% of the human genome is allocated to production of receptors for the olfactory epithelium - a hint as to the possible importance of this chemical sense. Breast odours from the mother exert a pheromone-like effect at the newborn's first attempt to locate the nipple. Olfactory recognition may be implicated in the early stages of the mother-infant attachment process, when the newborns learn to recognize their own mother's unique odour signature - a process possibly facilitated by the high nor epinephrine release and the arousal of the Locus Coeruleus at birth. The visual abilities of the newborn are stated by Illingworth (1987) after reviewing a number of studies stated following: Within minutes after birth, the infant follows a face like pattern more than other patterns of similar brightness, it will look at a black on white drawing of a face longer than three black dots on a white background, turns their heads and eyes towards a moving stimulus and greater response to a proper picture of a face than to a scrambled one. Perhaps that is the main reason why the areola is hyperpigmented. Newborns can recognize their mother's face (Bushnell et al, 1989) and can follow it for a short distance (Brazelton and Cramer, 1990).

The newborn is much more interested in the mother's face, especially her eyes, even though the nipple is right next to their lips. If newborn kept in-between the mother's breasts, it usually begins with a time of rest and quiet alertness during which she rarely cries and often appears to take pleasure in looking at her mother's face. There is a beautiful interlocking of gazes, at this early time, with the mother's interest in the infant's eyes and the baby's ability to interact and to look eye to eye. Visual interaction during the first few hours may significantly reduce the incidence of abandonment later among babies who were given early contact with suckling and who were rooming-in. This may be partly due to the special interest that mother's have, shortly after birth, in hoping that their infant will look at them and to the infant's ability to interact during the prolonged period of their quiet alert state in the first hour of life (Klaus and Kennel, 2001).A taste ability of newborn explains part of the interest in suckling the hands and fingers. The baby uses the taste and smell of amniotic fluid on its hands to make a connection with a certain lipid substance on the nipple related to the amniotic fluid (Klaus and Kennel, 2001).

The auditory sense of the newborn recognizes the mother's voice as most intense acoustic signal in the amniotic environment itself. Both the newborn and the fetus show heart rate decelerations in response to speech sounds. Newborn infants prefer the sound of the maternal voice and also suckle for longer when they hear it (De Casper and Fifer, 1980; Fifer and Moon, 1994). They can discriminate the language heard in utero from another language (Mehler et al, 1988). Thus, the mother's voice is a naturally occurring and salient stimulus during a critical time period in which there is significant development in several psychobiological systems.

Given these abilities of the newborn, the breast crawl offers the best chance for auditory stimulation with the natural voice of the mother, which the newborn is accustomed to in utero. However, it is also important to encourage mothers to initiate conversations with the baby in the antenatal period and to continue conversing in the early tender moments soon after birth. This may not only comfort the baby but also may have a bearing on development. Thus, the Breast Crawl provides continuity in auditory stimulation and development during transition from intrauterine to extrauterine life.

The tactile stimulation provides benefits for the mother and baby. The skin-to-skin contact: Helps in maintaining body temperature, Facilitates metabolic adaptations especially sugar levels and acid-base balance, Results in less crying (Christensson et al, 1992, 1995), Facilitates bonding (Widström et al, 1990), Causes oxytocin release in the mother, and Improves immediate and long term breastfeeding success: (Righard and Alade, 1990; WHO, 1998; DeChateau and Wiberg, 1977).

B. Central Component: After birth, the healthy newborn often undergoes a quiet alert phase, which has been referred to as the first phase of reactivity. When placed skin to skin on a mother's chest shortly after birth, the infant often becomes quiet and starts exploring its environment (D'Harlingue and Durand, 2001). Infants separated from their mothers cry excessively. This confirms that the newborn's brain is optimally ready to integrate various sensory inputs and other components of the Breast Crawl soon after birth. If initiation is not attempted soon after birth, a vital period of alertness will be lost – the newborn will go off to sleep and the first breastfeed may be delayed for several hours. This delay leads to baby losing out the benefits of early initiation.

C. Motor Outputs: The newborn motor outputs discussed here are: Orofacial, Lower limbs, Upper limbs, Salivation and Neuro-Endocrine component.

Orofacial: Around 30-40 minutes after birth, the newborn begins making mouthing movements, sometimes with lip smacking. Suckling of hands and fingers is commonly seen. After attaching successfully, newborns continued to suckle for 20 minutes (Righard and Alade, 1990).

Lower limbs: The Stepping Reflex helps the newborn to push against her mother's abdomen to propel her towards the breast. Pressure from the infant's feet on the abdomen may also help to expel placenta and reduce uterine bleeding (Klaus and Kennel, 2001).

Upper limbs: The ability to move its hand in a reaching motion enables the baby to claim the nipple. This helps to stimulate, elongate and protract the nipple (Klaus and Kennel, 2001) and facilitates attachment. When the baby massages the breast and subsequently suckles, a large oxytocin surge is induced from the mother's pituitary gland into her bloodstream. This also helps in the manufacture of prolactin.

Muscular strength in the neck, shoulders and arms helps newborns to bob their heads and do small "push ups" to inch forward and side to side. The efforts to reach the breast are interspersed with short periods of rest. Sometimes babies change direction in midstream.

Salivation: Salivation occurs in anticipation that the food is in close proximity.

Neuro-Endocrine component: It is known that oxytocin (the love hormone) is released in the mother's blood by the posterior pituitary gland. This oxytocin is in fact produced by the hypothalamic neurons and reaches the posterior pituitary gland through their axons. It is responsible for the letdown of milk and contraction of the uterus. In humans, there is a blood brain barrier for oxytocin, and only small amounts reach the brain via the blood stream.

The lesser known fact is that de novo oxytocin synthesis occurs in both the infant's and mother's brain when breastfeeding occurs. The stimuli for this release are touch on the mother's nipple and the inside of the infant's mouth. This oxytocin, acting on multiple oxytocin receptors in the brain (Klaus and Kennel, 2001) plays the following roles:

· Stimulation of the vagal motor nucleus, releasing 19 different gastrointestinal hormones including insulin, cholecystokinin and gastrin (Tafari and Ross, 1973). Five of these 19 hormones stimulate growth of the baby's and mother's villi and increase the surface area and the absorption of calories with each feeding (Uvnas-Moberg, 1989).

· Important for the initiation of maternal behaviour and for the facilitation of bonding between the mother and the baby (Klaus and Kennel, 2001).

· In mothers it results in slight sleepiness, euphoria, increased pain threshold and feeling of increased love for the infant. It appears that, during breastfeeding, elevated blood levels of oxytocin are associated with increased brain levels; women who exhibit the highest plasma oxytocin are the sleepiest (Klaus and Kennel, 2001).

ADVANTAGES OF BREAST CRWAL: The breast crawl helps Newborn, Mother and combine For Both.

A. FOR NEWBORN / BABY: Breast crawl helps in Warmth, Comfort, Metabolic Adaptation, Quality of attachment and Enhancing the breastfeeding by eliciting Innate abilities of newborn.

Warmth: Mother is an important heat source for the newborn, even it can be described as “Natural Warmer”. The natural body to body (skin-to-skin) contact may have been part of a genetic programme for maternal behaviour, which is worthwhile protecting. This natural body to body (skin-to-skin) contact will help to reduce the incidence of neonatal hypothermia which is an important factor for increasing the newborn morbidity and mortality. Skin-to-Skin contact stabilizes newborn breathing, heart rate, prevent heat loss in newborn, stabilizes the blood sugar level, helps in the flow of colostrum after birth, increases the newborn breastfeeding performance and learning to feed, and improves the suckling reflexes for correct attachment.

Comfort: The transition from life in the womb to existence outside the uterus is made easy by the various sensory inputs in the Breast Crawl position. In this position, the infant can experience sensations somewhat similar to that felt during the last several weeks of intra-uterine life. It is likely that each of these features – the crawling ability of the infant, the decreased crying when close to the mother, and the warming capabilities of the mother's chest-are adaptive features that have evolved to help preserve the infant's life (Klaus and Kennel, 2001).

Metabolic adaptation: Breast Crawl position helps in keeping higher blood sugar levels and more rapid recovery from transient acidosis at birth (Christensson et al, 1992).

Quality of attachment: Breast Crawl position maintains uninterrupted skin-to-skin contact helps for initiation of the early suckling pattern which is prognostic value and success of breastfeeding (Righard and Alade, 1990).

The innate abilities of newborn: Breast milk is a food for newborns and infants up to 6months and they are gifted with some innate abilities to drink or have breast milk; these are known as newborn feeding abilities. If nurses know about newborn feeding abilities they can / will implement the initiation of breastfeeding as early as possible on the delivery table and they can spend as little as 10 minutes to help each mother to discover some of their newborn innate abilities. Breastfeeding is one of the most effective ways to ensure child health and survival. A lack of exclusive breastfeeding during the first six months of life contributes to over a million avoidable child deaths each year.

The facts of newborn feeding abilities are;

· A normal full term infant is born with instinctive reflex ability to breast feed effectively.

· Newborn will develop predictable coordinated feeding behaviors within minutes of birth.

· Newborns can instinctively find the nipple without help and correctly attach to the breast.

· Newborns will be guided to the nipple by their sense of smell.

B. FOR THE MOTHER:

· Breast crawling of baby initiates massage of the breast and subsequent suckling induce a large oxytocin surge into her bloodstream.

· Close emotional interaction coupled with cutaneous, visual and auditory stimuli from the baby during the breast crawl also help oxytocin release. It helps in uterine contraction, expulsion of placenta and closing off many blood vessels in the uterus, so reducing blood loss and preventing anemia.

· Pressure of the infant's feet on the abdomen may also assist in expelling the placenta. (Klaus and Kennel, 2001).

· With the baby in breast crawl position, the blood level of oxytocin soon after delivery is elevated significantly compared with that postpartum (Nissen et al, 1995).

C. ADVANTAGES FOR BOTH:

· It enhances the bonding.

· Skin to skin attachment and gazing eye to eye, helps to learn each other on many different planes.

· Mother, is uniquely open, emotionally, to respond to her baby and to begin the new relationship.

· Suckling enhances the closeness and new bond between mother and baby.

The hindering factor for the breast crawl would be using of analgesics to the mother during labour.

The activities to be and not to be performed to enhance the breast crawling are:

For the Mother

· Use drugs for labour analgesia judiciously.

· Do not wash / wipe breast before feeding.

· Raise mother's head on a pillow to facilitate mother-baby visual contact.

· do not move mother out of labour room until completion of the first breastfeed.

For the Baby

· a baby who has cried well does not need oro-nasal suction.

· Dry the baby thoroughly except for the hands.

· do not pass orogastric / nasogastric tube or do gastric suction as a routine.

· The baby and the mother should be covered together with a cloth, so that they keep warm while continuing with skin-to-skin contact.

· Delay the injection of vitamin K, weighing, routine measuring and dressing (wrapping) till after the first breastfeed.

· Baby bath is best delayed to beyond 24 hours.

· Continue the first skin-to-skin contact till completion of the first breastfeed.

REFERENCES:

1. DeCasper AJ. and Fifer WP. Of human bonding: newborns prefer their mother's voices. Science. 208; (1980): 1174-6.

2. D'Harlingue AE and Durand DJ. Recognition, Stabilization, and transport of the high risk newborn in 'Care of the high-risk neonate. W. B. Saunder's Company. 2001; 5^th ed: pp 65-99.

3. Illingworth RS. Abilities and reflexes of the newborn in the development of the infant and young child: Normal and abnormal, ELBS. 1987; 9^th ed: 60-82.

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5. WHO. Evidence for the ten steps to successful breastfeeding. 1998.

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14. Nissen E, Lilja G and Widstrom AM. Elevation of oxytocin levels in early postpartum women. Acta Obstetrics and Gynecology Scandinavia. 74; 1995: 530.

15. Righard L and Alade MO. Effect of delivery room routines on success of first breastfeed. Lancet. 336 (8723); 1990: 1105-7.

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17. Uvnas-Moberg K. The gastrointestinal tract in growth and reproduction. Scientific American. 261; 1989: 78–83.

18. Varendi H, Porter RH and Winberg J. Does the newborn baby find the nipple by smell? Lancet. 344 (8928); 1994:989-90.

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Received on 27.01.2012 Modified on 28.02.2012

Asian J. Nur. Edu. & Research 2(1): Jan.-March 2012; Page 21-24