domingo, 22 de agosto de 2010

The Normal Newborn and Why Breastmilk is Not Just Food

What is a normal, term human infant supposed to do?
First of all, a human baby is supposed to be born vaginally. Yes, I know that doesn't always happen, but we're just going to talk ideal, normal for now. We are supposed to be born vaginally because we need good bacteria. Human babies are sterile, without bacteria, at birth. It's no accident that we are born near the anus, an area that has lots of bacteria, most of which are good and necessary for normal gut health and development of the immune system. And the bacteria that are there are mom's bacteria, bacteria that she can provide antibodies against if the bacteria there aren't nice.
Then the baby is born and is supposed to go to mom. Right to her chest. The chest, right in between the breasts is the natural habitat of the newborn baby. (Fun fact: our cardiac output, how much blood we circulate in a given minute, is distributed to places that are important. Lots goes to the kidney every minute, like 10% or so, and 20% goes to your brain. In a new mom, 23% goes to her chest- more than her brain. The body thinks that place is important!)
That chest area gives heat. The baby has been using mom's body for temperature regulation for ages. Why would they stop? With all that blood flow, it's going to be warm. The baby can use mom to get warm. When I was in my residency, we would put a cold baby "under the warmer" which meant a heater thingy next to mom. Now, as I have matured, if a baby is "under the warmer," the kid is under mom. I wouldn't like that. I like the kids on top of mom, snuggled.
Now we have a brand new baby on the warmer. That child is not hungry. Bringing a hungry baby into the world is a bad plan. And really, if they were hungry, can you please explain to me why my kids sucked the life force out of me in those last few weeks of pregnancy? They better have been getting food, or well, that would have been annoying and painful for nothing.
Every species has instinctual behaviors that allow the little ones to grow up to be big ones and keep the species going. Our kids are born into the world needing protection. Protection from disease and from predators. Yes, predators. Our kids don't know they've been born into a loving family in the 21st century- for all they know it's the 2nd century and they are in a cave surrounded by tigers. Our instinctive behaviors as baby humans need to help us stay protected. Babies get both disease protection and tiger protection from being on mom's chest. Presumably, we gave the baby some good bacteria when they arrived through the birth canal. That's the first step in disease protection. The next step is getting colostrum.
A newborn baby on mom's chest will pick their head up, lick their hands, maybe nuzzle mom, lick their hands and start to slide towards the breast. The kids have a preference for contrasts between light and dark, and for circles over other shapes. Think about that...there's a dark circle not too far away.
Mom's sweat smells like amniotic fluid, and that smell is on the child's hands (because there's been no bath yet!) and the baby uses that taste on their hand to follow mom's smell. The secretions coming from the glands on the areola (that dark circle) smell familiar too and help the baby get to the breast to get the colostrum which is going to feed the good bacteria and keep them protected from infection. The kids can attach by themselves. Watch for yourself! And if you just need colostrum to feed bacteria and not yourself, well, there doesn't have to be much. And there isn't because the kids aren't hungry and because Breastmilk is not food!
We're talking normal babies. Breastfeeding is normal. It's what babies are hardwired to do. 2009 or 209, the kids would all do the same thing: try to find the breast. Breastfeeding isn't special sauce, a leg up or a magic potion. It's not "best. " It's normal. Just normal. Designed for the needs of a vulnerable human infant. And nothing else designed to replace it is normal.
Colostrum also activates things in the baby's gut that then goes on to make the thymus grow. The thymus is part of the immune system. Growing your thymus is important. Breastmilk= big thymus, good immune system. Colostrum also has a bunch of something called Secretory Immunoglobulin A (SIgA). SIgA is made in the first few days of life and is infection protection specifically from mom. Cells in mom's gut watch what's coming through and if there's an infectious cell, a special cell in mom's gut called a plasma cell heads to the breast and helps the breast make SIgA in the milk to protect the baby. If mom and baby are together, like on mom's chest, then the baby is protected from what the two of them may be exposed to. Babies should be with mom.
And the tigers. What about them? Define "tiger" however you want. But if you are baby with no skills in self-protection, staying with mom, having a grasp reflex, and a startle reflex that helps you grab onto your mom, especially if she's hairy, makes sense. Babies know the difference between a bassinette and a human chest. When infants are separated from their mothers, they have a "despair- withdrawal" response. The despair part comes when they alone, separated. The kids are vocally expressing their desire not to be tiger food. When they are picked up, they stop crying. They are protected, warm and safe. If that despair cry is not answered, they withdraw. They get cold, have massive amounts of stress hormones released, drop their heart rate and get quiet. That's not a "good baby". That's one who, well, is beyond despair. Normal babies want to be held, all the time.
And when do tigers hunt? At night. It makes no sense at all for our kids to sleep at night. They may be eaten. There's nothing really all that great about kids sleeping through the night. They should wake up and find their body guard. Daytime, well, not so many threats. They sleep better during the day. (Think about our response to our tigers-- sleep problems are a huge part of stress, depression, anxiety).
I go on and on about sleep on this site, so maybe I'll gloss over it here. But everybody sleeps with their kids- whether they choose to or not and whether they admit to it or not. It's silly of us as healthcare providers to say "don't sleep with your baby" because we all do it. Sometimes accidentally. Sometimes intentionally. The kids are snuggly, it feels right and you are tired.
So, normal babies breastfeed, stay at the breast, want to be held and sleep better when they are with their parents. Seems normal to me. But there is a difference between a normal baby and one that isn't. Safe sleep means that we are sober, in bed and not a couch or a recliner, breastfeeding, not smoking...being normal. If the circumstances are not normal, then sleeping with the baby is not safe.
That chest -to -chest contact is also brain development. Our kids had as many brain cells as they were ever going to have at 28 weeks of gestation. It's a jungle of waiting-to-be-connected cells. What we do as humans is create too much and then get rid of what we aren't using. We have like 8 nipples, a tail and webbed hands in the womb. If all goes well, we don't have those at birth. Create too much- get rid of what you aren't using. So, as you are snuggling, your child is hooking up happy brain cells and hopefully getting rid of the "eeeek" brain cells. Breastfeeding, skin-to-skin, is brain wiring. Not food.
Why go on and on about this? Because more and more mothers are choosing to breastfeed. But most women don't believe that the body that created that beautiful baby is capable of feeding that same child and we are supplementing more and more with infant formulas designed to be food. Why don't we trust our bodies post-partum? I don't know. But I hear over and over that the formula is because "I am just not satisfying him." Of course you are. Babies don't need to "eat" all the time- they need to be with you all the time- that's the ultimate satisfaction.
A baby at the breast is getting their immune system developed, activating their thymus, staying warm, feeling safe from predators, having normal sleep patterns and wiring their brain, and (oh by the way) getting some food in the process. They are not "hungry" --they are obeying instinct. The instinct that allows us to survive and make more of us.

Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM

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