This is the continuation of Stohm's story ... which started on page "A premie's journey".

This second part is about breastfeeding and the underlying behaviour, a third part shows  Stohm going home.

The breastfeeding photos were taken on the 14th January 2002. Stohm weighs 1400g, and is growing well in the stepdown nursery. Mother Sharleen is back at work, and so has not been breastfeeding, but she does bring expresed breast milk.


Stohm29 awake and alert   

Sharleen has just come in, and Stohm is awake and alert - see how the eyes focus on the camera coming within range.

STATE ORGANISATION   is important to understand in order to understand newborn breastfeeding. State organisation is about the level of awakeness of the baby.  Baby will spend most of its time asleep, and sleep can be deep, or quiet, or light.  As the state organisation of the baby rises, it goes through being drowsy, being awake and quiet, and "awake and alert".  Crying is a higher level of state org-anisation, and "hard crying" is the highest.
 To breastfeed .... the newborn must be calm, and in "awake and alert".

 Stohm30 ignoring camera   Stohm31 eye contact at breast  

 Stohm needs her own time. All the senses of a newborn are important, but at this stage, smell is perhaps the most important. Therefore, we leave the breast close to Stohms face, without rushing in.

After two or three minutes of looking around aimlessly, Stohm makes definite eye-contact with mother, which she maintains for some time.

   Stohm33 hand breast mouth  Stohm32 hand mouth splay  

 Still maintaining eye contact, Stohm makes typical and classical "hand to mouth movements", and puts her thumb in her mouth. These movements are part of the "routine" - the newborns hands should be free and not restrained.
 This same movement is done in the uterus

 Stohm45 ultrasound  

 This is an ultrasound picture, which shows a fetus in the uterus, making exactly the same movement Stohm is making.

"Very early during gestation the fetus practices rooting, finger sucking, and swallowing" (Prechtl and de Vries)


 Stohm34 hand breast tongue curl  Stohm35 mouth gape  

 After the hand to mouth movement, Stohm was still for almost two minutes, before again making hand movements, and then she opened her mouth and pushed her tongue out, notice how curled it is - "practising" to fit under the nipple. A minute later she opened her mouth wide, but only for a split second!

 Stohm36 smelling milk  Stohm37 lunges to breast  

 The previous pictures were taken over a period of about fifteen minutes. At the point when Stohm opened her mouth so wide, I asked Sharleen to express just one drop of milk.
   The following pictures were taken over the space of one minute. As Sharleen brought the drop of milk towards Stohm, Stohm opened her mouth, smacked her tongue, lunged forward, and grabbed the nipple with her mouth. (Darker picture, flash charger too slow!)
 Notice determined look!

 Stohm38 hand back and latch  Stohm39 full latch  

 Stohm then makes a few suckling movements - "chewing" movements of the jaw. With that, notice the areola getting smaller as it is fully taken into the mouth, accomplishing a good latch. The lips aren't as perfectly "flanged" wide open as could be, but the chin is close to the breast. Notice hands are free.

 Stohm41 relaxes latch  Stohm40 dozing off  

  Stohm only actively suckled for about 30 seconds, with a few second pauses, then she tired. Note that more areola is visible. Note also the eye contact which was maintained for the major part of the early suckling.
 Stohm is still very small and weak, and is being fed through the nasogastric tube. But she has shown a range of "pre-breastfeeding" behaviours, and has shown that she can put all those behaviours together. As she has more opportunity to do this, she will be able to breastfeed more and more.

 Stohm42 eye contact  

  It was difficult to say how much milk Stohm took in this episode, but for Sharleen the important thing was that she could understand what Stohm was doing, and why.
 Sharleen was encouraged not to do anything at this stage. Stohm looked like falling asleep, but lay with the nipple in her mouth without suckling or swallowing. She then seemed to wake up slightly, making renewed eye contact, before slowly releasing her grasp.

 Stohm44 dozing in SSC  Stohm44 sleeping in SSC  

 Sharleen then picked up Stohm and placed her back in the skin-to-skin position, between her breasts. Within a minute, Stohm had settled down for a good sleep.



 Story continues: see Stohm going home


 Comment: breastfeeding is a NEUROBEHAVIOUR ... meaning it is wired into the baby's mammalian brain. But the behaviour needs the right conditions, the right time and the right sensory stimulations.      
All of these are provided in mother's skin-to-skin contact.
Premature babies have this behaviour.