“Birth no more constitutes the beginning of the life of the individual than it does the end of gestation. Birth represents a complex and highly important series of functional changes which serve to prepare the newborn for the passage across the bridge between gestation within the womb and gestation continued out of the womb.” (Montagu, 1986, 57)
Welcome to The Fourth Trimester
Baby-led attachment
Nature designed a perfect system: keep the baby within reach of the breast day and night. Create subtle feeding cues easily noted by their mother long before the desperate crying which will alert predators. Allow the mother to quickly move the baby to the breast from their position on her chest. When baby falls asleep at the breast, continue to keep them close. In the learning days, lean in to staying close. Contact naps lead naturally into baby-led attachment. Nappy changing can nearly always wait until a break between breasts or even longer. Aim to move baby from chest to breast with minimal delay in the early days.
Circadian Rhythm and the Newborn Human
In the womb, your baby shares your natural body clock. It takes at least 3 months for infants to develop their own circadian rhythm.
It is normal and natural then for your baby to have no discernible day/night pattern to feeding and sleeping. They lack the hormonal control to establish one. And it is not something they can be taught, no matter how much parents try and self-styled "sleep trainers" promise. What is more likely to occur is various techniques and programs are tried until one "magically" works coincidentally as the natural development stage is reached and circadian rhythm begins to function. Most babies naturally begin sleeping longer stretches at night around 3 months.
Breast storage and the Magic Number
Breastfeeding works by supply and demand: take milk out, make more milk. Leave milk in, make less milk. This feedback loop between baby and breasts works around the clock, reliably keeping production running.
But there is another factor at play which you might not be aware of. It explains why breastfeeding frequency can vary so much between mothers.
Fast-paced postnatal period
The reality is most new mothers are up and about, attending appointments with nurses, lactation consultants, breastfeeding clinics, doctors, physiotherapists and other professionals who used to come to your bedside. There is shopping to be done (smaller onesies after all!), older kids to get to school and meals to prepare. The village network of support has evolved to videos shared on social media and face time when you get a minute.
Feed frequently to make milk
There are times when it's just not worth moving the boob away from the baby. Periods of increased breastfeeding signal to the breast to increase production because the infant has some big stuff going on. You literally need to go with the flow.
You can invest a lot of thinking into the Why of the increased feeding but looking at it as a problem to be solved is considering it from entirely the wrong perspective. Because you are actually observing a problem being solved.
Keep Me Close
Imagine being yanked out of your warm and cosy bed on a cold morning, without notice or explanation.
This must be how we all feel in that extraordinary moment we call birth. Confused, overwhelmed and shocked.
Keeping babies close in these early days helps them acclimatise to this strange world of sensory overload. Newborns seek contact and avoid isolation. Your baby cannot explain that the nursery you prepared with such love is an alien space. They cannot tell you that lying on their back in a bassinet is sending panic signals to their brain.
Don't put up with pain
It breaks my heart when I meet someone who has put up with painful #breastfeeding for weeks or months because someone told them that it's normal to hurt.
Tenderness in the first day or so is typical, as nipples experience something new. But - the great big but - pain is your body's way of communicating that something is wrong.
The most common reason for nipple pain is the baby is not taking a good mouthful of breast tissue. Improving attachment will stop further damage and allow rapid healing.
Why the Weight Can Wait
here is no medical reason that weighing a newborn needs to be one of the first things to happen after birth. In fact, there are good reasons to delay the process.
An undisturbed first hour is important for establishing breastfeeding and should only be interrupted for urgent medical care of mother or child. That hour should be considered a minimum period of time and parents should be supported to continue as long as they wish. Where the mother is unable to safely hold her child, her partner should be the only other person to do so for as long as possible, ideally skin-to-skin. All tests and assessments can be done while in this position.
Colostrum: right from the start
Colostrum is the very first milk your body produces, typically beginning around 16 weeks gestation. While some mothers can express a few drops early on, and others find their breasts leaking in pregnancy, some might only notice a little dried costrum on their nipple and many see none at all before their baby is born: all normal variations and not indicators of milk production or breastfeeding capability.
Making a Plan for The 4th Trimester
The time to plan for your 4th trimester is while you are still in the 3rd. There are options you might like to consider for both your birth plan and breastfeeding plan which can help things go more smoothly during the first 12 weeks of the postnatal period.
While things beyond your control will happen during your labour, delivery and hospital stay, researching and discussing options well before your baby arrives means you can approach obstacles knowing you have made informed decisions.
The Magical Hour
Birth interventions and the medicalisation of natural childbirth last century masked something incredible which had almost been lost in western midwifery memory: babies are born hard-wired to seek the breast and attach with minimal assistance.
The hints were there in the reflexes observed and assessed at birth: the stepping movement of the feet, the rooting reflex, the grasping reflex. Babies delivered onto the belly of their mother can crawl and move their body to the breasts, identify the nipple area, lift and move into position and latch on.
Why we are surprised by this, when we observe similar behaviour in other mammals shows how distanced we are from our biological normal.