THE FIRST HOUR AFTER BIRTH - 9 INSTINCTIVE STAGES

. The First Hour After Birth: A Baby’s 9 Instinctive Stages

Based on the research of Ann-Marie Widstrom, a Swedish researcher on skin-to skin contact between mother and baby. Widstrom described the nine stages that occur in the first hour

or two after birth when a baby is placed immediately skin to skin with his mother.  She believes that if a baby is put skin to skin on the mother’s chest immediately after birth, without a delay for routine procedures, and left their undisturbed  as he goes through the nine developmental stages at his pace, that the likelihood of breastfeeding success is greatly enhanced.

When a baby is in skin to skin contact after birth there are nine observable newborn stages, happening in a specific order, that are innate and instinctive for the baby. Within each of

these stages, there are a variety of actions the baby may demonstrate. The baby may do one, some, or all of these actions.

Stage 1 : The Birth Cry

The first stage is the birth cry. This distinctive cry occurs immediately after birth as the baby’s lungs expand

Stage 2 : Relaxation

The second stage is the relaxation stage. During this stage, the newborn exhibits no mouth movements and the hands are relaxed. This stage usually begins when the birth cry has stopped. The baby is skin to skin with the mother and covered with a warm, dry towel or blanket

Stage 3 : Awakening

The third stage is the awakening stage. During this stage, the newborn exhibits small thrusts of movement in the head and shoulders. This stage usually begins about 3 minutes after

birth. The newborn in the awakening stage may exhibit head movements, open his eyes, show some mouth activity and might move his shoulders.

Stage 4 : Activity

The fourth stage is the activity stage. During this stage, the newborn begins to make increased mouthing and sucking movements as the rooting reflex becomes more obvious.

This stage begins about 8 minutes after birth.

During the activity stage, the newborn could:

Ø    keep eyes open

Ø    look at the breast

Ø    salivate to the point of dampening the mother’s skin

Ø    root by moving his mouth from side to side over the skin by  rubbing the cheek against the mother’s chest

Ø    move his hand to the mouth

Ø    move his hand to the mother’s breast and back to the mouth

Ø    protrude the tongue

Ø    look at his mother

Ø    massage the breast with one or both hands

Ø    exhibit high rooting (rooting that includes lifting part of the baby’s torso from the mother’s chest)

Stage 5 : Rest

At any point, the baby may rest. The baby may have periods of resting between periods of activity throughout the first hour or so after birth

Stage 6 : Crawling

The sixth stage is the crawling stage. The baby approaches the breast during this stage with short periods of action that result in reaching the breast and nipple. This stage usually begins about 35 minutes after birth. The crawling stage does not need to involve “crawling”. It could

 be accomplished through leaping, sliding or crawling and sometimes in conjunction with pushing and rooting.

Stage 7 : Familiarization

The seventh stage is called familiarization. During this stage, the newborn becomes acquainted with the mother by licking the nipple and touching and massaging her breast. This stage usually begins around 45 minutes after birth and could last for 20 minutes or more. During familiarization, the baby may touch the mother’s breast, may mouth on his own hand, lick the mother’s breast, look at the mother, make soliciting sounds to get the mother’s attention, mouth the nipple, lick the nipple, move his hand from his mouth to the mother’s breast, protrude his tongue, look at other people in the room, or massage his mother’s breast.

Stage 8 : Suckling

The eighth stage is suckling. During this stage, the newborn takes the nipple, self attaches and suckles. This early experience of learning to breastfeed usually begins about an hour after birth. If the mother has had analgesia / anaesthesia during labour, it may take more time with skin to akin for the baby to complete the stages and begin suckling.

Stage 9 : Sleep

The final stage is sleep. The baby and sometimes the mother fall into a restful sleep. Babies usually fall asleep about 1 ½ to 2 hours after birth.

Jeanette Crenshaw is doing her doctoral project on the impact of immediate, uninterrupted skin to skin contact on rates of exclusive breast milk feeding at hospital discharge. At the hospital where Jeanette is conducting her project, Dvd’s illustrating the nine instinctive stages were shown to childbirth education classes, doctors and nurses. Babies were placed

immediately on the mother’s chest after most vaginal and caesarean births.  As the mothers and babies were filmed, she heard the staff identifying the nine instinctive stages that the

baby went through. Staff were surprised to see that caesar moms who had uninterrupted contact experienced fewer shakes and fewer episodes of hypothermia.  She is now exploring the influence of uninterrupted skin to skin contact on the rates of exclusive breastfeeding at hospital discharge.

Call to action:

Here is something childbirth educators can do to make a difference! We know how important breastfeeding is to both a baby’s and to a mother’s health and well being. We know that too many mothers, especially ceasar mothers, who plan to exclusively breastfeed their babies are not doing so at the time of hospital discharge. If we teach our students about the nine instinctive stages and advocate at our hospitals for immediate, uninterrupted skin to skin care until the first feeding is accomplished, we can increase the number of mothers exclusively breastfeeding their babies.

Dr Ann-Marie Widstroms research on the 9 instinctive stages: Online published September 14, 2010 in Acta Paediatrica.

She emphasizes the critical importance of NOT forcing the infant to the breast and of allowing the infant to proceed through the nine steps at his own pace.