Specialist Nurse in Maternal Health and Obstetrics
HPA Magazine 9
There are currently quite a few European Maternity Units and Hospitals that could be designated as “Baby-Friendly”. Achieving this status is part of a long process of accreditation that institutions are submitted to, subjecting their professionals and respective clinical practices to a rigorous and detailed scrutiny.
The status of “Baby-Friendly Hospital” is based on the compliance with 10 recommendations issued by the World Health Organisation (WHO) and understood to facilitate/promote the success of maternal breastfeeding. Without going into too much detail, these Ten Recommendations aim to optimise the practices by the health team that constantly and exclusively promotes breastfeeding without obstacles and constraints; professionals who are informed and trained in the promotion and counselling of maternal breastfeeding, through the adoption of accommodation for nursing mothers, support and constant maternal encouragement, among other factors.
The 4th Recommendation of this set specifically emphasises that in order to achieve success in breastfeeding, it is necessary to guarantee conditions so that the adaption to the breast happens or is initiated up to 1 hour after birth. It specifies the following: the baby should be placed in skin-to-skin contact with the mother immediately after birth, for at least an hour, encouraging her to recognise when her baby is ready to feed, offering support and help when necessary.
It is therefore essential that the health professionals in Maternity Wards are made aware to encourage this practice and integrate it with the care given immediately after childbirth, to the mother and the new-born. They are the ones who can stimulate and facilitate the skin-to-skin contact, even delaying other non-proprietary tasks, in order to respect the adaptive physiological mechanisms of the baby in the first hour of its life and those that follow.
The period of gestation, the 38 to 40 weeks that constitute pregnancy until term, allow the pregnant mother to develop positive feelings and emotional bonding with the baby, as well as a progressively closer identification with the child. In this way, making skin-to-skin contact viable after childbirth, immediately after delivery, we allow important and multiple mechanisms that are sensory, behavioural, cognitive and hormonal to be stimulated. The adaption to the breast at this stage constitutes a fundamental task, not only in the process of bonding (giving continuity to the identification that occurred during the pregnancy between the mother and the baby), but also in the processes of development of the suction/swallowing reflexes and breast stimulation.
It is indispensable to make time available, in a quiet, supportive and comfortable ambience in the delivery room, so that there is skin-to-skin contact to take advantage of its benefits, leaving the administration of vitamin K, cleaning the eyes, weighing or observation by the Paediatrician until later. Naturally, this can only happen with the mother’s agreement, and when the strength and good health of both are established and guaranteed. Otherwise, the priorities are to stabilise and help them. Premature and Caesarean births are regarded as a factor that often impedes early contact.
“Skin-to-skin contact calms the baby, helps stabilise the heartbeats and respiratory pattern, reducing crying and stress, and also promotes thermoregulation.”
“The skin is the largest organ in the human body and therefore receives various types of sensory stimuli, and skin-to-skin contact can promote organic adaptive alterations in the mother and baby in the first hours of life.”
IN THE HPA MATERNITY UNIT…
Excluding exceptional situations, such as maternal or neonatal instability, or by the express will of the mother not to do so, skin-to-skin contact and adaption to the breast in the first hour of life are standard practice, developed immediately in the delivery room and, in Caesarean birth, during recovery.