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    <meta name="author" content="Denise Fisher" />
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      <h1 id="top">4.3 Postnatal interventions</h1>
      <div class="section" id="Separation_of_mother_and_newborn"><h2>Separation of mother and newborn</h2>
    <div>
      <p>
		From an evolutionary perspective skin-to-skin care is the norm. Routine separation of the newborn from its mother soon after birth is unique to the 20th Century. At the risk of laboring the point, separating the mother and baby after birthing for any reason, other than medical emergency, is NOT applying best practice care. All indicators of infant well-being and successful extrauterine adaptation are stabilized better and faster when the newborn is in skin-to-skin contact with its mother from immediately after birth for the first few hours, or at least until after the first breastfeed.
	</p>
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    <div class="section" id="Effect_on_newborn"><h3>Effect on newborn</h3>
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            <p>A researcher in behavioral neuroscience described the innate behaviors of the newborn that occur when the infant remains with his mother immediately following birth. <br />When mother and infant are separated the infant exhibits firstly distress cries, followed by what is described as "protest-despair" behavior.<sup><a href="#note1">1</a></sup> </p>
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        </div><div class="column" style="width: 60%">
          <div class="captionBox"><img width="396" height="266" src="images/newborn_weigh_trudy.jpg" alt="Note the protest response being exhibited by this newborn." /><p>Note the protest response being exhibited by this newborn. <br />Photo &copy;  T.Young, RM</p></div>
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            <p> Separation distress cries have been documented in newborns. Separated newborns make 10 times more crying signals than babies in skin-to-skin care, and their cries have a completely different character.<sup><a href="#note2">2</a>,</sup><sup><a href="#note3">3</a></sup> During the "protest" response there is intense activity seeking the mother, followed by "despair" behavior which sees the baby withdraw with decreased heart rate and temperature, mediated by a massive rise in stress hormones.<sup><a href="#note4">4</a></sup> </p>
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        </div><div class="column" style="width: 60%">
          <div class="captionBox"><img width="394" height="428" src="images/newborn_swaddled.jpg" alt="What stage is this newborn exhibiting?" /><p>What stage is this newborn exhibiting? <br />Photo &copy;  D.Fisher, IBCLC</p></div>
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    <div class="section" id="Effect_on_oxytocin"><h3>Effect on oxytocin</h3>
      <div>
        <p>Oxytocin levels are highest around the time of birthing. Oxytocin cannot cross from the peripheral circulation into the brain; therefore it is only naturally occurring oxytocin released by the posterior pituitary gland that will have an effect on the mother's temperament, ie. not oxytocin administered to the mother. </p>
        <p></p>
        <p class="listTitle">Oxytocin causes<sup><a href="#note5">5</a>,</sup><sup><a href="#note6">6</a></sup></p>
        <ul>
          <li>increased uterine contraction limiting postpartum blood loss,</li>
          <li>the temperature of the mother's breast to rise, providing warmth for the infant,</li>
          <li>an anti-stress effect, reducing maternal blood pressure and cortisol levels and releasing gastrointestinal hormones,</li>
          <li>a state of calmness and social responsiveness,</li>
          <li>bonding with their infant, and enhanced maternal behaviors,</li>
          <li>milk ejection; important at this time prior to it becoming conditioned by the suckling stimulus.</li>
        </ul>
        <p>During the time the infant in skin-to-skin contact after birthing is making massage-like movements on the mother's chest and breasts the maternal serum oxytocin levels rise.<sup><a href="#note7">7</a></sup> The infant begins these hand movements soon after birth and continues until he self-attaches and suckles. </p>
        <p> The work of Michel Odent is well recognized by those involved in obstetrics. Odent's studies of the effects of oxytocin and other hormones of birthing are worthwhile following. In 2001 he wrote: </p>
        <p> </p>
      </div>
      <blockquote>
        <div>The age of cesarean sections on request, epidurals and drips of oxytocin is a turning point in the history of childbirth. Until recently women could not give birth without releasing a complex cocktail of 'love hormones'. Today, in many countries, most women have babies without releasing these specific hormones. The questions must be raised in terms of civilization. This turning point occurs at the very time when several scientific disciplines suggest that the way human beings are born has long-term consequences, particularly in terms of sociability, aggressiveness or, in other words, 'capacity to love'. <sup><a href="#note8">8</a></sup></div>
      <p class="cite">Odent, 2001</p></blockquote>
      <div>
        <p>
			With this in mind, the importance of skin-to-skin contact for mothers and babies who experience an assisted birthing appears to be even more important.
		</p>
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      <table class="callout"><thead><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_01.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background: repeat-x url(design/callout_02.png);"><img src="design/callout_02.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_03.png" width="10" height="10" alt="" /></td></tr></thead><tfoot><tr class="decoRow"><td class="topleft" style="width: 10px"><img src="design/callout_07.png" width="10" height="10" alt="" /></td><td class="topcenter" style="background-image: url(design/callout_08.png);"><img src="design/callout_08.png" width="59" height="10" alt="" /></td><td class="topright" style="width: 10px"><img src="design/callout_09.png" width="10" height="10" alt="" /></td></tr></tfoot><tbody><tr><td class="middleleft" style="background: repeat-y url(design/callout_04.png);"><img src="design/callout_04.png" width="10" height="80" alt="" /></td><td class="body"><a href="http://www.health-e-learning.com/resources/articles/34-falling-in-love" target="_blank"><img src="design/article.png" class="icon" alt="" /></a><h3><a href="http://www.health-e-learning.com/resources/articles/34-falling-in-love" target="_blank">Falling in Love</a></h3>
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          <p>Click on the icon on the left and read the article.</p>
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    <div class="section" id="Effect_on_breastfeeding"><h3>Effect on breastfeeding</h3>
      <div>
        <p> Learning is a dimension of behavior and physiology, and the human neonate has evolved to learn how to suckle when in skin-to-skin contact.<sup><a href="#note1">1</a></sup> </p>
        <p> Most babies (27 out of 34) who were separated from their mothers after 19 minutes for routine weighing procedures and then returned for feeding either refused to suckle, or demonstrated superficial nipple sucking techniques. The difference between two groups (one group remained in skin-to-skin contact) in ability to attach to the breast and suckle correctly for effective milk removal was significant (p&gt;0.001).<sup><a href="#note9">9</a></sup></p>
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      <div class="section" id="Washing_mother_or_newborn"><h2>Washing mother or newborn</h2>
    <div>
      <p> Washing the mother and/or baby is also to be discouraged. Infants localize the nipple by smell and have a heightened response to odor cues in the first few hours after birth. When one of the mother's breasts is washed after birthing 22 out of 30 infants preferentially self-attached to the unwashed breast.<sup><a href="#note10">10</a></sup> </p>
    </div>
    <blockquote>
      <div>
        <p> Breast odours from the mother exert a pheromone-like effect at the newborn's first attempt to locate the nipple. Newborns are generally responsive to breast odours produced by lactating women. 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.<sup><a href="#note11">11</a></sup> </p>
      </div>
    <p class="cite">Winberg, 1998</p></blockquote>
  </div>
      <div class="section" id="Suctioning_of_the_newborn"><h2>Suctioning of the newborn</h2>
    <div>
      <p> Oral aversion as an outcome of routine oropharyngeal or gastric suctioning or intubation is often cited by clinicians as a cause of breastfeeding difficulty, but little research is available to confirm this. <br /></p>
      <p>Fortunately routine oral and gastric suctioning is no longer recommended, it's effects proving to be harmful to more than just the infant's ability to suck.<sup><a href="#note12">12</a></sup> <br />Routine gastric suctioning, involving the passage of a tube into the neonate's stomach and aspiration of the contents has been linked to a delay in infant pre-feeding behaviours<sup><a href="#note13">13</a></sup> and an increased prevalence of functional intestinal disorders in later life.<sup><a href="#note14">14</a></sup><br /></p>
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              <h3>Workbook Activity 4.4</h3>
              <p>Complete Activity 4.4 in your workbook.</p>
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            <td class="body"><img src="design/group.png" class="icon" alt="" /><h3>Group Activity</h3>
    <div>
      <p>Form a small group to firstly compare your lists of the benefits of keeping mothers and babies together in skin-to-skin contact, then list all the interruptions to this by birthing room staff or others.</p>
      <p>Together, look at each interruption separately and develop strategies for change to prevent these separations. </p>
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      <div class="section" id="What_should_I_remember_"><h2>What should I remember?</h2>
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      <div>
        <ul>
          <li>where the normal place to care for a newborn is from immediately after birth and for several hours following</li>
          <li>the behavioural state and physiological response of the infant who is wrapped up and separated from his/her mother</li>
          <li>the baby's role in causing an oxytocin response in the mother and the effect this has on her</li>
          <li>how separation of mother and baby, even for a short time, affects his/her ability to breastfeed<br /></li>
        </ul>
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      <div class="section" id="Self-test_quiz"><h2>Self-test quiz</h2>
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      <div></div><div class="activity" id="activity_i">
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	new MCQ('What is the hormone that is released in the mother as the newborn infant makes hand movements and begins to move towards the breast?', [{text:'Prolactin',feedback:'No, not this one.',score:0},{text:'Oxytocin',feedback:'Yes that\'s correct. Take a moment to read over some of the many effects of oxytocin again.',score:1},{text:'Progesterone',feedback:'No, not this hormone.',score:0},{text:'Beta endorphin',feedback:'No, not this one.',score:0}]),
	new MCQ('When the practices of a birthing unit are based on best-practice principles where will the newborn infant be cared for immediately following birth?', [{text:'Taken immediately to the resuscitation area until cardiorespiratory stability achieved.',feedback:'It is not necessary to separate mother and baby for this - it occurs more quickly in skin-to-skin contact.',score:0},{text:'To the end of the birthing bed until dried, resuscitated and wrapped warmly.',feedback:'No. This reflects poor practices.',score:0},{text:'Placed in skin-to-skin contact on mother\'s chest.',feedback:'Yes, that\'s correct.',score:1},{text:'Handed to the father to hold until medical procedures, such as delivering the placenta, have been completed.',feedback:'No. The correct place for baby will see a big surge of oxytocin which helps to deliver the placenta - this is not the place.',score:0}]),
	new MCQ('When a newborn baby is separated from its mother it exhibits firstly distress cries, followed by what type of behavior?', [{text:'Quiet, alert state',feedback:'They do appear quiet, but not because they are happily alert.',score:0},{text:'Seeking the breast prior to latching.',feedback:'That would be difficult - they\'re separated.',score:0},{text:'A deep sleep.',feedback:'Part of the response could look like this.',score:0},{text:'Protest-despair behavior.',feedback:'Correct. There is a big biochemical change that is occurring in the separated infant.',score:1}]),
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      <div class="section" id="Assessment_Quiz"><h2>Assessment Quiz</h2>
    <div>
      <p>
		When you are happy that you've understood all the information in this topic you will be ready to complete the Module 4 Assessment. To do this, go to the course opening page, scroll down to the Assessment section and choose Module 4.
	</p>
    </div>
  </div>
      <div id="footnotes">
        <h3>Notes</h3>
        <ol>
          <li id="note1"><a href="references.html#albe94" title="See full details">#</a> Alberts JR (1994) Learning as adaptation of the infant.</li>
          <li id="note2"><a href="references.html#mich96" title="See full details">#</a> Michelsson K et al. (1996) Crying in separated and non-separated newborns: sound spectrographic analysis</li>
          <li id="note3"><a href="references.html#chri95" title="See full details">#</a> Christensson K et al. (1995) Separation distress call in the human neonate in the absence of maternal body contact</li>
          <li id="note4"><a href="references.html#berg03" title="See full details">#</a> Bergman N (2003) Humans and Kangaroos: A Biological Perspective</li>
          <li id="note5"><a href="references.html#matt01" title="See full details">#</a> Mattos-Graner RO et al. (2001) Relation of oral yeast infection in Brazilian infants and use of a pacifier</li>
          <li id="note6"><a href="references.html#uvna98" title="See full details">#</a> Uvnas-Moberg K (1998) Oxytocin may mediate the benefits of positive social interactions and emotions</li>
          <li id="note7"><a href="references.html#matt01a" title="See full details">#</a> Matthiesen AS et al. (2001) Postpartum maternal oxytocin release by newborns: Effect of infant hand massage and sucking</li>
          <li id="note8"><a href="references.html#oden01" title="See full details">#</a> Odent M (2001) New reasons and new ways to study birth physiology</li>
          <li id="note9"><a href="references.html#righ90" title="See full details">#</a> Righard L et al. (1990) Effect of delivery room routines on success of first breast-feed</li>
          <li id="note10"><a href="references.html#vare94" title="See full details">#</a> Varendi H et al. (1994) Does the newborn baby find the nipple by smell?</li>
          <li id="note11"><a href="references.html#winb98" title="See full details">#</a> Winberg J et al. (1998) Olfaction and human neonatal behaviour: clinical implications</li>
          <li id="note12"><a href="references.html#clif10" title="See full details">#</a> Clifford M et al. (2010) Neonatal resuscitation.</li>
          <li id="note13"><a href="references.html#wids87" title="See full details">#</a> Widstrom AM et al. (1987) Gastric suction in healthy newborn infants. Effects on circulation and developing feeding behaviour</li>
          <li id="note14"><a href="references.html#anan04" title="See full details">#</a> Anand KJ et al. (2004) Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life</li>
        </ol>
      </div>
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      <h1>Breastfeeding Essentials</h1>
      <ol>
        <li>1.0 <a href="topic_1-0.html">Why Breastfeeding is Important</a><ol><li>1.1 <a href="topic_1-1.html">Biochemistry</a></li><li>1.2 <a href="topic_1-2.html">Immunology</a></li><li>1.3 <a href="topic_1-3.html">Relative risks</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Communication Skills</a><ol><li>2.1 <a href="topic_2-1.html">Non-verbal</a></li><li>2.2 <a href="topic_2-2.html">Listening skills</a></li><li>2.3 <a href="topic_2-3.html">Building confidence</a></li><li>2.4 <a href="topic_2-4.html">An example</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Pregnancy Care</a><ol><li>3.1 <a href="topic_3-1.html">The feeding decision</a></li><li>3.2 <a href="topic_3-2.html">The barriers</a></li><li>3.3 <a href="topic_3-3.html">Physical preparation</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">The Birth Experience</a><ol><li>4.1 <a href="topic_4-1.html">The first hours</a></li><li>4.2 <a href="topic_4-2.html">Labor interventions</a></li><li class="current">4.3 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_4-3.html">Postnatal interventions</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Breastfeeding the Baby</a><ol><li>5.1 <a href="topic_5-1.html">Positioning Principles</a></li><li>5.2 <a href="topic_5-2.html">Breastmilk transfer</a></li><li>5.3 <a href="topic_5-3.html">Assessing breastfeeding</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">A time to learn</a><ol><li>6.1 <a href="topic_6-1.html">Practical skills</a></li><li>6.2 <a href="topic_6-2.html">Breastfeeding messages</a></li><li>6.3 <a href="topic_6-3.html">Normal growth</a></li><li>6.4 <a href="topic_6-4.html">Sleep</a></li><li>6.5 <a href="topic_6-5.html">Psychological support</a></li><li>6.6 <a href="topic_6-6.html">Discharge planning</a></li></ol></li>
        <li>7.0 <a href="topic_7-0.html">Infant Challenges</a><ol><li>7.1 <a href="topic_7-1.html">Late preterm infant; Non-latching</a></li><li>7.2 <a href="topic_7-2.html">Hypoglycemia; Jaundice</a></li><li>7.3 <a href="topic_7-3.html">Supplementation</a></li><li>7.4 <a href="topic_7-4.html">Crying baby</a></li><li>7.5 <a href="topic_7-5.html">Inadequate weight gain</a><ol><li>7.5.1 <a href="topic_7-5-1.html">Feeding-line device at the breast</a></li><li>7.5.2 <a href="topic_7-5-2.html">Cup feeding</a></li><li>7.5.3 <a href="topic_7-5-3.html">Finger Feeding</a></li><li>7.5.4 <a href="topic_7-5-4.html">Bottle feeding</a></li></ol></li></ol></li>
        <li>8.0 <a href="topic_8-0.html">Maternal Challenges</a><ol><li>8.1 <a href="topic_8-1.html">Engorgement</a></li><li>8.2 <a href="topic_8-2.html">Nipple Pain</a></li><li>8.3 <a href="topic_8-3.html">Breast Problems</a></li><li>8.4 <a href="topic_8-4.html">Insufficient breastmilk</a></li><li>8.5 <a href="topic_8-5.html">Medical, Surgical Issues</a></li></ol></li>
        <li>9.0 <a href="topic_9-0.html">Promotion, Protection and Support</a><ol><li>9.1 <a href="topic_9-1.html">The International Code of Marketing of Breastmilk Substitutes</a></li><li>9.2 <a href="topic_9-2.html">The Baby Friendly Initiative</a></li><li>9.3 <a href="topic_9-3.html">Young Child Feeding</a></li><li>9.4 <a href="topic_9-4.html">Local initiatives</a></li><li>9.5 <a href="topic_9-5.html">Infant feeding in emergencies</a></li></ol></li>
        <li>10.0 <a href="topic_10-0.html">Closing session</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
        <li class="appendix"> <a href="contents.html">Course contents</a></li>
        <li class="appendix"> <a href="full.html">Print version</a></li>
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