INTRODUCTION:

A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate (from Latin, neonatus, newborn) refers to an infant in the first 28 days of life (from birth up to 4 weeks after birth, less than a month old). For newborn breast milk is the only food which is good, easy for digestion and won’t cause any problem to their sterile stomach.

God has made only the breast milk as a food for newborns and infants up to 6months. Newborns are gifted with some innate abilities to drink or have breast milk; these are known as newborn feeding abilities. If nurses and nursing students know about the newborn innate feeding abilities they can/will implement the 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.

UNICEF, WHO and WABA (World Alliance for Breastfeeding Action) along with the scientific community strongly recommend initiating breast feeding within a half-hour of birth. Evidence shows that early initiation of breast feeding can prevent 22% of all deaths among babies below one month in developing countries. 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', was first described in 1987 at the Karolinska Institute in Sweden (Widstrom et al, 1987)¹⁵.

The facts of newborn feeding abilities are;

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

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

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

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

A normal full term infant is born with instinctive reflex ability to breast feed effectively and newborn will develop predictable, coordinated feeding behaviors within minutes of birth: Newborn has organized feeding behavior which develops in a predictable way during the first hours of life, initially expressed only as spontaneous sucking and rooting movements, soon followed by hand-to-mouth activity together with more intense sucking and rooting activity, and culminating in sucking of the breast. A baby is born with many instinctive abilities which enable her to perform the breast crawl. With these innate programmes, the infant seems to come into life carrying a small 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)¹⁰.

Newborns can instinctively find the nipple without help and correctly attach to the breast and newborns will be guided to the nipple by their sense of smell: The 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 her survival in the new world. Babies completing the breast crawl with spontaneous attachment is instinctive and almost a very few requiring assistance.

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)¹⁰. Horizontal motion is achieved by using small pushups and lowering one arm first in the direction they wish to go. 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)¹⁰ 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 production 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. Salivation occurs in anticipation that the food is in close proximity. The promotion of early initiation of breastfeeding has great potential: 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding were started within the first hour after birth (Edmond et al, 2006)⁸.

Newborn’s smell, vision and taste sensory inputs help to detect and find the breast. Auditory inputs and touch make her comfortable and help to create a suitable environment. Babies preferred their mother's unwashed breast, soon after birth. (Varendi et al, 1994)¹³.

Besides secreting colostrum and milk, the nipple and areola are dense in glands that perhaps secrete attractive odours. 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 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)¹⁰. 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.

Newborn has organized visual perception which is an unlearned capacity. Newborns can recognize their mother's face (Bushnell et al, 1989)² and can follow it for a short distance (Brazelton and Cramer, 1990)¹. Visual interaction during the first few hours may explain the significantly reduced incidence of abandonment later among babies who were given early contact with suckling and who were put in 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)¹⁰.

Amniotic fluid on the infant's hands probably 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)¹⁰. Newborn infants prefer the sound of the maternal voice and also suckle for longer when they hear it (DeCasper and Fifer, 1980⁵; Fifer and Moon, 1994⁹). They can discriminate the language heard in utero from another language (Mehler et al, 1988)¹¹. 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. The rhythmic sound of the mother's heart-beat can also have a calming influence on the baby.

The supportive factor which enhances the newborn breast feeding ability is skin-to-skin contact.

Skin-to-skin contact is between the baby front and the mother’s chest. The more skin-to-skin is the better.

1. Skin-to-skin contact is important to help stabilize newborn breathing.

2. A newborn’s heart rate is stabilized by skin-to-skin contact.

3. Skin-to-skin contact is important to prevent heat loss in newborn babies

4. A newborn’s blood sugar levels are stabilized by skin-to skin contact.

5. Skin-to-skin contact helps the flow of colostrum after birth.

6. Uninterrupted skin-to-skin contact immediately after birth helps in newborn’s breastfeeding performance.

7. Hours of continuous skin-to-skin contact helps a newborn baby learn to feed.

8. Interrupting skin-to-skin contact within 15-20 minutes of birth seriously disturbs the suckling reflexes for correct attachment.

Skin to skin touch provides heat and variety of other tactile inputs. It offers benefits at many levels: Helps maintain temperature (Christensson et al, 1992)³, Facilitates metabolic adaptations especially sugar levels and acid-base balance (Christensson et al, 1992)³, Results in less crying (Christensson et al, 1992³; Christensson et al, 1995⁴), Facilitates bonding (Widstrom et al, 1990)¹⁶, Causes oxytocin release in the mother, Improves immediate and long term breastfeeding success: (Righard and Alade, 1990¹²; WHO, 1998¹⁴; DeChateau and Wiberg, 1977⁶).

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)⁷. Infants separated from their mothers cry excessively.

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. 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)¹².

Skin-to-skin contact is important to help stabilize newborn breathing, heart rate, prevent heat loss, and maintain blood sugar levels, helps in flow of colostrum, important for newborn learning and breastfeeding performance and intimacy between mother and baby: For the baby, mother is the reliable source of heat and breast crawl position helps to maintain body temperature. The natural body to body contact may have been part of a genetic programme for maternal behaviour, which is worthwhile protecting. Incidence of morbidity and mortality due to neonatal hypothermia can be reduced. 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)¹⁰. Breast Crawl position keeps blood sugar levels higher for 90 minute and more rapid recovery from transient acidosis at birth, as compared to babies separated and kept in a cot next to the mother (Christensson et al, 1992)³.

CONCLUSION:

The newborn has much inborn abilities to drink first breast milk from mother. But we think that health professionals or any significant person from the family only should train the baby to take feed. The author believes that after reading this article the health care professionals especially nurses and student nurses will spend some time to initiate the breast feeding by putting the newborn on the mother for breast crawl and its benefits are more.

REFERENCES:

1. Brazelton BT, Cramer B. The earliest relationship. Journal of American Psychoanalytic Association. 41; 1993: 281-284.

2. Bushnell et al. Neonatal Recognition of the mother's face. British Journal of Developmental Psychology. 7; 1989: 3-15.

3. Christensson et al. Temperature, metabolic adaptation and crying in healthy newborns cared for skin-to-skin, or in cot. Acta Paediatrica Scandinavica. 8; 1992: 488–503.

4. Christensson et al. Separation distress call in the human neonate in the absence of maternal body contact. Acta Paediatrica. 84; 1995: 468–473.

5. DeCasper AJ, Fifer WP. Of human bonding: Newborns prefer their mother's voices. Science, 208; 1980: 1174-6.

6. DeChateau P, Wiberg B. Long term effect on mother-infant behaviour of extra contact during the first hour postpartum. Acta Paediatrica. 66; 1977: 145-151.

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

8. Edmond KM et al. Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics. 117; 2006: 380-386.

9. Fifer WP, Moon CM. The role of mother’s voice in the organization of brain functions in the newborn. Acta Paediatrica Supplement. 397; 1994: 86-93.

10. Klaus MH, Kennel JH. Care of the parents in 'Care of the high-risk neonate', W. B. Saunder's Company.2001. 5th ed: pp.195-222.

11. Mehler et al. A precursor of language acquisition in young infants. Cognition. 29; 1998: 143-178.

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

13. Varendi et al. Does the newborn baby find the nipple by smell?. Lancet. 344 (8928); 1994: 989-90.

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

15. Widstrom et al. Gastric suction in healthy newborn infants: effects on circulation and developing feeding behaviour. Acta Paediatrica Scandinavica. 76; 1987: 566-572.

16. Widstrom et al. Short-term effects of early suckling and touch of the nipple on maternal behaviour. Early Human Development. 21(3); 1990: 153-63.

Received on 10.05.2013 Modified on 25.05.2013

Asian J. Nur. Edu. and Research 3(3): July-Sept., 2013; Page 196-198