Caring for your new baby: A modern evidence-based approach on why your baby is your guide Dr Nicole Gale MBBS (Hons), FRACGP, IBCLC
Newborns are magical and somewhat mysterious creatures. Seemingly so delicate, parents are in awe of the little person they now hold in their arms, and perhaps wonder who will become and how they will navigate this. Many parents feel a heavy responsibility, knowing that they are captain of the ship of growth and development for their baby and feel as if it is their task alone to navigate this, or perhaps be told how to do so.
What most new parents don’t realise is the extent to which their new baby is born ready and willing to vocalise their needs, to participate and to help guide the process of this growing.
The systemic constructs around new families within western health structures can not only disempower parents, but also vastly underestimate the abilities of the new baby themselves. Medical intervention can be life-saving, and comprehensive support is essential to hold the rebirth of a new parental identity both physically and emotionally. However, what is pivotal to thriving with your new baby is in fact deep trust and reverence for their cues and interactions.
To understand why so many parents and health professionals have a distrust of women’s bodies and babies, it is essential to understand how as a society infant care has evolved. There are many schools of thought both philosophical and religious around the developing new baby. Nature versus nurture is an oft discussed dilemma in the question of what makes us who we become. A new soul to be guided, transition to the world through birth and beyond is one of the most profound journeys your baby will go on in their lifetime. They do not travel this road ill equipped, though in recent decades approaches to their care have assumed this is the case.
Much of our current western cultural care of babies and children derives from approaches fostered by behavioural psychologists during the 20th century. Applying research primarily undertaken on animals around what influences behaviour (think Pavlov’s dogs), similar principles were incorporated into infant health and were then promoted as the gold standard. At the time, there was a general distrust in intuitive and traditional responses around birth and postpartum. Births became increasingly medicalised, mothers disconnected from their involvement and consent, and breastfeeding poorly trusted with a not-so coincidental increase in the distribution and uptake of infant formula. What resulted was the widespread and devastating loss of eons of intergenerational knowledge and respect of the physiological and biological norms of the postpartum period and breastfeeding. We are still suffering this loss today and reclamation will likely take generations. Many Women feel this and intuitively seek support, whilst not really being able to verbalise what is lacking or what this would look like if done well.
The view was that babies were born needing to be moulded. To be taught to communicate, eat, sleep and grow. Taking a step back, the absurdity of this in the context of the survival of our species becomes apparent. Babies do not need to be taught to eat or sleep. If they did, our species would not have survived.
With an increasing evidence-based approach that is research informed, more knowledge around normal infant communication, feeding and sleep is being recognised within the health profession. As a parent, while this may not align with how you thought your new baby would behave, understanding what is normal is however pivotal for your wellbeing.
A complete summary of all the marvellous capabilities of newborns is beyond this scope. However here are four things that might help you begin to understand your new baby and how they can work with you.
Newborn babies have innate reflexes to facilitate breastfeeding and maternal recovery from birth
If not born premature or medically unwell, babies go through predictable phases of rest and alertness before moving towards the breast and initiating suckling. Called the ‘breast crawl’, the baby will practice a sequence of movements from the first trimester in utero, mastering each one prior to entering the world, that can finally be displayed in the dance after birth. This phenomenon can also be recreated in the early days and weeks after birth but requires a hands-off experience and can take up to 90 minutes to occur.
When a baby is born, due to the length of the umbilical cord and the birth of the placenta having not yet occurred, they will be placed on a mother’s chest/ abdomen. A rush of love occurs with the release of hormone oxytocin which sharpens bonding and imprinting for both mother and baby, whilst simultaneously facilitating contraction of the uterus. A stepping reflex of the baby helps propel them towards the breast, as well as massaging the uterus to assist in it reducing in size and minimising blood loss. Bobbing, nuzzling and licking the breasts and nipples causes the nipple to become erect for deep latching. Arms and hands at either side of the breast are not designed to get in the way but massage the breast to start the flow of milk.
Babies utilise these reflexes with each early feed. Skin to skin and/or pressure on their chest and abdomen when they lie against a mother’s reclined body, activates their feeding reflexes. If hungry, they will help find their way to the nipple. If allowed time and support, most babies will latch to the breast well. A “baby led” latch is usually deeper, more comfortable and has better transfer of milk than one where the baby is forced to the breast. The minute coordination required is completed more successfully by the baby than anything we can recreate as adults. Babies will latch if they are able to. If they are not able, something is “tricky” and they deserve professional assistance. Most babies with adequate support, are able to complete this.
Babies can regulate their appetite and growth
Babies are well equipped to communicate their cues around food and a generally settled baby with good wet and dirty nappies is likely to be gaining well. Babies will start with early hunger cues that include rousing from sleep, turning their heads and mouthing and progress to late hunger cues like crying. Babies will want to feed regularly – from 8-12+ times/ 24 hours in a newborn. Their stomachs are small, feed volumes are small and this is biologically normal. If in doubt, offer your baby a feed. Conversely, if they seem to be too sleepy (and are well) and pushing away or refusing, they may not be hungry and it is ok to respect their boundaries.
Babies do not need to be taught to sleep
New babies can regulate their sleep intake. There is no such thing as “bad sleep” related to duration or location with all sleep being equally restorative. Infant sleep is very different to adult sleep. It is entirely normal for your baby to want to sleep on or with you and to do so in short bursts. Biologically most babies will not sleep alone for hours on end in a cot and will need you to be responsive in relation to night settling for years after birth.
The ability to “self soothe” is a trait that takes decades to refine (and some adults may say a lifetime) and babies are temperamentally and genetically either able to do it (“self soothers”) or not. This cannot be taught. Just as some adults are more independent and others require more affection and reassurance, babies are similar with sleep.
Sleep needs varies significantly between individuals and specified amounts of sleep for infants per 24 hours, for their age, have no basis in research or evidence of increased wellbeing. Strict sleep routines relate to the historical behaviouralist ideas and whilst some families may find these helpful, they are not the biological norm and most babies won’t naturally follow this pattern. These babies will still grow normally and thrive.
Many babies will find their own loose and flexible pattern by 3-4 months of age
Routine might be a loaded term, but many babies will find their own pattern of feeding and sleeping that whilst might fluctuate, will become somewhat more predictable over time. It is however normal for babies to deviate from this when they have a big developmental upgrade. From an evolutionary perspective, most humans statistically were a “subsequent” and not “first” child and so had to be flexible in their eating and sleeping whilst their carers assisted others and undertook domestic and work duties.
What becomes apparent is that a newborn is human and just as we all vary vastly as individuals, so too do our babies. One size does not fit all. If your new baby is as human and individual as the rest of us, THEY ultimately are your guide to settling into your new family life and dynamic. Nature has vast intelligence. What we learn in the early days in parenting our children, translates at every stage of their childhood. The sooner we learn to trust in our children’s ability to communicate their needs and when they are ready for something, even as early as the first few hours and days after birth, the smoother, more respectful, and more joyous our experiences as a family. Our beloved little humans are truly awe inspiring.
Dr Nicole Gale is a specialist Family Physician/ General Practitioner and an International Board Certified Lactation Consultant (IBCLC) who works exclusively in maternal and infant health, practicing Breastfeeding Medicine in Melbourne, Australia. She supports families through complex postpartum, breastfeeding, growth, settling, mental health and medical concerns. She has undertaken additional training in Newborn Behaviour Observation, Neuroprotective Developmental Care and is a board member of the non-profit Breastfeeding Medicine Network of Australia / New Zealand, providing education and mentoring of health professionals. She is currently opening ‘Juno – Maternal, Infant and Women’s Specialists’, a holistic clinic for mothers, infants and women and can be found at @drnicolegale and www.drnicolegale.com.