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This is aided by the physiological state of each: the mother's high oxytocin levels and newborn infant's extremely high catecholamine levels. This process is suggested to contribute to an early coordination of infant's five senses: sight, hearing, touch, taste and smell, as well as movement 17 , In animal studies, for example, if an ewe is separated from her lamb soon after birth, she will reject the lamb when they later are reunited.

Interestingly, it has been shown that simulating a birth through the birth channel at reunion of mother and lamb enhances oxytocin release in the mother ewe, resulting in her acceptance of her lamb. This illustrates that natural oxytocin facilitates the bonding between the ewe and the lamb during the first hour after birth In the human mother, a surge of oxytocin is released in the mother's blood vessels during the first hour after birth to contract the uterus, facilitate placental discharge and to decrease blood loss 6.

Oxytocin released to the blood stream in this situation is likely to be paralleled by an intense firing of parvocellular oxytocin neurons in the brains, as Theodosis has shown in animal experiments 20 , causing an increased maternal sensitivity for the young. The mother is attracted to the infant's smell, facilitating a chemical communication between the two 22 , This highlights the importance of a new mother's access to her newborn infant's bare head to smell her baby.

This is an example of the early symbiotic biological relationship between the dyad 24 , The newborn infant has high levels of catecholamine immediately after a normal, vaginal birth These are highest closest to the time of birth, especially for the first thirty minutes. Catecholamines strengthen memory and learning.

In addition, the closer to birth, the more oxygenated haemoglobin was observed over the olfactory cortex This increased sensitivity for the odour of breastmilk, especially soon after the birth, indicates a physiologically based early sensitive period in the newborn infant. This reaction matches the mother's biologically based enhancements of the breast odour through the increase of the surface of the areola and Montgomery gland secretions during the corresponding time Thus, the increased early sensitivity for the odour of breastmilk, in the presence of high levels of catecholamine which strengthens this memory, is indication of a physiologically based early sensitive period in the newborn infant.

It has been our experience that parents are captivated by the newborn infant's instinctive behaviours and respond positively when they learn about the 9 stages and can identify the newborn infant's actions Parents should also have an understanding about the importance of monitoring the newborn infant's position, breathing and safety. Providing the parents with a pamphlet or tear sheet or having a poster of the 9 instinctive stages somewhere in the birthing suite has been found to be helpful for the parents to follow the baby throughout the stages and recognise their newborn infant's ability.

This also gives a clear role to the companion and provides both motivation to remain with the mother and newborn infant, and an additional opportunity for the baby's safety. Parents thereby have this additional knowledge and can prioritise focus on the newborn infant rather than distractive actions such as phone calls 43 , 44 , posting on the Internet, talking to friends or family in the room, which are behaviours that are best postponed until after this unique time.

Staff have the opportunity to protect this important, small window of time for the parents to follow their newborn infant's behavioural development. This includes ensuring that the mother's clothing has been arranged so it will be easy to remove and will allow access to the mother's chest immediately after the birth, being aware of any intravenous lines in relation to the sleeves of the mother's gown, etc.

Hospital protocol should be reviewed to ensure it reflects best practice. This first stage is characterised by the initial birth cry, when the lungs expand for the first time as the newborn infant transitions to breathing, and other survival instincts Fig. These behaviours could include the moro reflex, grimacing, coughing, lifting the full body from the mother's torso, abruptly opening the eyes and tension in the body.

The baby's motions during the birth cry stage emanates from the drive to survive. During this extremely alert period, the newborn infant is able to make defensive movements with the hands to protect their airway, for example against a suction catheter or bulb. Used with permission. The initial birth cry, and the subsequent crying during the first minutes after the birth, has the effect of expectorating the airways of the amniotic fluid In addition, extremely high catecholamine levels at birth help in absorbing liquid from the airways Research has shown that suctioning may disrupt the inborn sequential behaviours of the newborn infant While transitioning the baby to the mother's chest, it is important to avoid compressing the baby's thorax, which could hamper breathing.

Clinical practice should include gentle hands to hold the newborn infant in the drainage position tilted with the head lower than the torso and the head slightly to the side immediately after the birth, allowing the fluid to flow freely from the mouth and nose. If possible, the baby should be in a lengthwise position on the mother's body, with the head on the mother's chest, and above her breasts.

Positioning the baby's mouth close to the mother's nipple would put the focus on immediate breastfeeding, which the newborn infant is not ready to do now. Standard practice includes drying the baby's head and body with a clean, dry cloth to help maintain body temperature. The baby's face should initially be turned to the side, which facilitates free airways and monitoring of the baby's breathing. During a caesarean surgery, the newborn infant might be positioned horizontally above the drape instead of vertically.

In this case, the newborn infant is placed across the mother's breasts. In addition, there was a possible positive effect in infant's health and development 55 , Deferred cord clamping is in line with recommendations from the World Health Organization Clinical practice shows that the umbilical cord should be left long, not clamped close to the newborn infant's belly, so that the newborn infant is not disturbed by the clamp, since clamps, and hard clamps especially, can be uncomfortable in a prone position.

It can also cause a cry of discomfort. In addition, the nine stages offer an opportunity for staff to discuss the progress of the newborn infant and to ensure continued observation by the parents or attendants. The focus on following the newborn infant's progress through the nine instinctive stages results in a close examination of the baby by the mother's companion s and staff throughout the vulnerable first two hours. This may help to illuminate the capabilities and limitations of a specific baby, and thereby increase the safety during this important time.

The safety of the newborn infant and mother is always the highest priority Table 2. We have seen that when an unmedicated mother receives her newborn infant into her arms immediately after birth, she grasps the baby with confidence. When the mother has the newborn infant immediately after birth on her naked chest, it has a profound impact on her. We have noticed that this simple act of the staff handing over the newborn infant to the mother supports early parental confidence.

If the mother has received analgesics during labour, special care must be taken to watch for free airways. For example, pethidine can cross the placenta and affect the newborn infant's breastfeeding behaviour negatively 33 and may specifically hamper the newborn infant's ability to lift the head 38 as well as infant's temperature and crying Fentanyl given in the epidural space passes rapidly into maternal blood.

Fentanyl has been measured in the newborn infant's urine for at least 24 hours postpartum During the relaxation stage Fig. Clinical experience shows it is not possible to elicit a rooting reflex during the relaxation stage. The baby's sensory system seems to be depressed. From an evolutionary perspective, this silent and motionless period may be a way to hide from predators during a vulnerable time When lying quietly on the mother's chest, the baby can hear the mother's heartbeat. It is suggested that the pressure on the head through the birth canal is the cause of extremely high catecholamine level after birth, a level 20 times higher than that of a resting adult This high catecholamine concentration might partly be the cause of the higher pain threshold in the baby close to birth 64 and be a mirror of nature's way to relieve pain in the baby when passing through the birth canal.

Consequently, the baby's temporarily impaired sensation at birth causes the relaxation stage — the baby has decreased sensitivity to the surroundings. We have noticed that staff members exhibit concerns about the newborn infant's silent and relaxed state during this time. This stems from a lack of understanding of the baby's stage, often resulting in rubbing or massaging the newborn infant in a disruptive and vigorous manner, repositioning or lifting the baby from the mother.

If, during the relaxation stage, the newborn infant is disturbed by the actions of the staff, the baby will react with crying, grimacing and protective reflexes. If separated from their mother, babies exhibit a distinct separation distress call. This separation distress vocalisation in mammalian species that stops at reunion may be nature's way of keeping newborn infants warm with maternal body temperature.

The baby's call at separation is thus a survival mechanism 65 , Mammalian species, including human mothers, react to these separation distress calls and intuitively attempt to retrieve the newborn infant. In hospital settings, where the mother has limited control over her environment, we have noticed her straining to look at the infant who has been taken away and asking others about the state of the infant.

The awakening stage Fig. The baby makes small motions. Small movements of the head, face and shoulders gently ripple down through the arms to the fingers. The baby makes small mouth movements. They will gradually open their eyes during this stage, blinking repeatedly until the eyes are stable and focused Fig. During the activity stage Fig. The limbs move with greater determination; the baby may root and lift the head from the mother's chest.

Rooting also becomes more obvious during this stage The successive protrusion of the tongue continues throughout this stage. At the beginning of this stage, the newborn infant may have only moved the tongue within the mouth. During the activity stage, the baby will bring the tongue to the edge of the lips, then protrude beyond the lips, then protrude repeatedly beyond the lips These tongue exercises, which may pave the way for later tongue behaviours, specifically suckling, can be affected by medications, such as pethidine During pregnancy, the nipple has become more pigmented 68 and is easy for the newborn infant to discover Fig.

The Montgomery glands also become more pronounced Fig. The scent of areolar secretions has been linked to behavioural responses, such as head turning 69 and directional crawling in newborn infants This release of the breast odour by the Montgomery glands is known to help the newborn infant find the nipple 17 , 27 , This stimulates rooting and crawling movements in the newborn infant to reach the nipple.

The connection between the taste of amniotic fluid and the scent of the breast from the Montgomery glands highlights a biological survival mechanism — a pathway of flavour with lifelong consequences. The infant has learned to recognise the mother's voice during intrauterine life The infant's learning and memory skills are quite sophisticated; the foetus can learn to recognise a vowel from the surrounding language and is some days after birth able to discriminate this vowel from a vowel from a foreign language After the newborn infant has located the nipple by sight, the mother's voice will attract the baby's attention to her face.

The complex experiences of the newborn infant during the first hour encompass more than simply a journey to the breast; the opportunity for eye contact emphasises the importance of parents and staff valuing instinctive behaviour during this time, and the avoidance of interruptions.

The resting stage Fig. A baby may stop or start during any of the stages to rest, and then continue with that same stage, or move on to the next 12 , The baby could be lying still sucking on fingers or just gazing at the nipple.

The eyes may be open or closed. It is important to value the resting stage and not worry that the baby is done and has not been successful with the process of the first hour. It is vital to allow the newborn infant to take these pauses throughout the first hour or so without being interrupted or separated, remembering that this stage is naturally interspersed throughout other stages. This could be applicable to the newborn infant's rest during the first hour as well Separation causes a critical break of the stages If the newborn infant is separated from the mother, even if the infant is returned, the newborn infant might need to begin again at the first stage — crying and relaxing before beginning to progress through the stages again, which might take some time.

The likelihood increases that the newborn infant may not be able to go through all the stages before needing to sleep, compromising the possibility to suckle, Stage 8. The crawling stage Fig. Sometimes this process is so subtle that parents and staff are surprised to notice that the baby has made its way over to the breast.

Other times, the baby may make strong and overt motions, collecting the attention of everyone in the room. During this process, it is important to protect the newborn infant's effort to reach the breast, with the intention not to lift or turn the baby's body. Placing a towel or pillow under the mother's arms is important during this stage, since the newborn infant will be travelling over to one side of the chest and therefore in many settings close to the edge of the bed This support can help the newborn infant to reach the nipple without becoming exhausted by unnecessary sliding in the wrong direction.

It is also important for parents to be aware of the travelling process, since they may try to reorient the baby back to the middle of the chest, to keep the newborn infant from the edges of the bed. Support under the mother's arms may also allow the nipple to remain in an area easy for the baby to find and grasp. A mother might use her own palm to arrange the breast as well. A baby needs to use the feet to achieve crawling, and sometimes the feet are in a less than ideal position.

They may be off the side of the mother's body or pushing in the air. In those cases, it may be helpful if the mother puts her hand under the newborn infant's foot to give the baby something to push against in order to move towards the breast.

To reach the breast, it must be possible for the baby to manoeuvre into an appropriate position. When approaching the breast the newborn infant performs specific soliciting calls to mother — a short clinging call that usually results in a gentle response from the mother.

The frequency of these sounds increases as the newborn infant gets closer to the mother's nipple The odours from the mother's breast are likely to be inducing this response. Parents respond to the newborn infant's soliciting During the familiarization stage Fig. This period could last 20 minutes or more. The newborn infant massages the breast, which increases the mother's oxytocin levels 35 and shapes the nipple by licking.

During this stage, it is evident that the baby is smelling and tasting, and previous actions become more vigorous and more coordinated. Therefore, it is important not to interfere or introduce odours from unfamiliar hands.

The baby continues with tongue activity during this stage, now more overtly related to eventual breastfeeding, by licking above and below the nipple. The baby may make noises with the mouth and lips, like smacking sounds, during this stage. The breast and nipple are shaped by the massaging and licking actions of the newborn infant. The newborn infant is preparing the tongue, breast and nipple for the moment of attachment and suckling.

The actions of the tongue inform the staff of the newborn infant's coordination of the tongue with the rooting reflex, and the ability to move the tongue to the bottom of the mouth, curved and thin. This learning is vital as the newborn infant initiates the suckling process.

It is also common for the baby to attach, suck once or twice, and then disengage. The newborn infant will be conducting a normal step of the familiarization Stage, but it may look to staff like the newborn infant is unable to attach. The baby must thus be allowed to do these moves to adjust into an instinctive position. This is conducive to the newborn infant's chin making an initial contact with the mother's breast as the baby endeavours to catch the nipple.

In a study of babies who had later been diagnosed with significant latch problems, the majority of mothers reported that the newborn infant had been forced to latch to his mother's breast. According to the mothers, the babies screamed, acted in a panicky way, exhibited avoidance behaviours and had other strong reactions against the forceful treatment This could happen even weeks after birth if not possible earlier This is a promising way to calmly solve breastfeeding problems, especially since a new study shows that breastfeeding is associated with decreased childhood maltreatment The newborn infant attaches to the nipple during this stage and successfully breastfeeds Fig.

It is interesting to note that the hands, which have been so busy, often stop moving once suckling begins 35 ; the eyes, which have been looking at the breast, the mother and the room, often become focused after attaching. The newborn infant does not need help to adjust the latch. Thus, this reduces the risk of supplementation. However, there is increasing evidence concerning the negative consequences of certain medications such as fentanyl and oxytocin, on success with breastfeeding Parents and staff must take into account the consequences when considering amount, timing and choice of specific labour medications.

Towards the end of suckling, about an hour and a half after birth, the newborn infant becomes drowsy and falls asleep Fig. The oxytocin, released in both mother and infant by suckling, triggers the release of gastrointestinal GI hormones, including cholecystokinin CCK and gastrin.

The high level of CCK in both mother and newborn infant will cause a relaxing and satisfying postprandial sleep The GI activity will also improve maternal and infant nutritional absorption. If separation occurs, hand expression of milk within the first hour after birth enhances milk production One reason for this is that the initial stages of a birth cry, relaxation and awakening are associated with the situation and hormonal status unique to the time immediately after birth.

Later after birth, the baby has more control over his body and movements. Understanding the stages, and the breastfeeding behaviours of the newborn infant, is indeed, reassuring to the parents, even in the postpartum ward. The background to SUPC is multifactorial. However, one of the common causes of the collapse seems to be respiratory distress 44 , 93 , 94 , The possibility of labour medications affecting the newborn infant adversely is not highlighted in the Sudden Unexpected Postnatal Collapse SUPC literature.

The microbial colonisation of the infant begins before birth and continues through the birth canal. This is one of the reasons the newborn infant should not be washed during this time. As the hour progresses, the first tastes of colostrum will provide vital sustenance to the infant's developing gut microbiota, which has been implicated in the expression of genes Interestingly, Moffitt et al. From the beginning, biological processes during the first hour after birth ensure survival of the mother and infant.

This sensitive period has an emotional consequence on the mother's understanding of the newborn infant, enhancing bonding. Humans are resilient, and there are opportunities to bond and breastfeed even when the experience immediately after the birth is less than optimal. For example, even days and months after the birth, the infant will exhibit these same instinctive breastfeeding behaviours, with the potential to overcome early breastfeeding problems. But this sensitive period immediately after birth must be recognised and valued, both by parents and staff, to provide the opportunity for this unique experience.

It is vital not to interrupt these natural behaviours, as they form nature's basis for attachment, and support the mother's confidence in her infant's inborn capability. A sensitive period of the newborn infant coincides with mother's sensitive period during the first hour after birth.

Hospital guidelines must support and enhance this important time. Acta Paediatrica Oslo, Norway : Acta Paediatr. Published online Mar Author information Article notes Copyright and License information Disclaimer. Eva Nissen, Email: es. Corresponding author. This article has been cited by other articles in PMC. Conclusion The first hour after birth is a sensitive period for both the infant and the mother.

Key notes. The framework of the newborn infant's 9 stages creates an opportunity to understand the biological and physiological situation for the dyad, and clinical implications of practice during this sensitive time. Table 1 Shows the nine stages. Stages Behaviours 1. Birth cry Intense cry just after birth, transition to breathing air. Relaxation stage Infant rests. No activity of mouth, head, arms, legs or body. Awakening stage Infant begins to show signs of activity.

Small movements of limbs and shoulders. Active stage Infant moves limbs and head, more determined movements. Suckling stage Infant has taken nipple in mouth and commences suckling. Sleeping stage Infant closes eyes and falls asleep. Learn More. Using innovative imaging and machine learning solutions, coupled with robust data-driven analysis, we create unique, actionable insights from raw energy data.

These insights can reduce risks and enable a more detailed understanding of natural resource investments. Dive deeper into TGS insights. Search by data type, technology, or region using the below the search bar. Explore now. TGS is meeting the current and future data demands of the energy industry. Our decades of energy data expertise positions us to provide valuable insights and solutions for the energy transition, enhancing the growth of more sustainable and renewable energy systems.

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