But is the assumption water births do not affect breastfeeding correct? I've always been a big advocate, but I'm now not convinced things are that cut and dry. I know this will probably raise eyebrows for a lot of people, but I now think there is a very real possibility that water births can contribute to problems.
As many lactation supporters will know, when a healthy baby is born naturally without exposure to medication, when placed on mums chest they will crawl to the breast, root, self attach and begin breastfeeding. All their instincts are primed for this immediately after birth, which is why UNICEF and the World Health Organisation strongly recommend skin to skin and initiating breastfeeding within half an hour.
As long as there are no underlying issues such as tongue tie or palate abnormalities - this group by far has the highest rate of early lactation success, and it's far less common to find mums in this position suffering from problems such as sore nipples, latching issues, breast refusal and so on.
But I'm not sure this is the case for water births; as the "breast crawl" becomes more well known, mothers are starting to mention it - and I'm finding more are stating their baby simply didn't do it. In fact now when I'm supporting a mum who describes a normal unmedicated delivery followed by problems initiating feeding, my next question is "was it in water?".
How could water cause a problem?
As mentioned above, the primary instinct for a newborn is to locate the breast and feed - but how does it do that? We know that during pregnancy the nipples and areola darken and enlarge, because we know newborns with immature vision, see the contrast between dark and light most easily; but infants do not rely solely on sight, in fact it may actually play quite a small role in terms of initially locating the breast.
The infant's senses are stimulated by the sounds and feel of the mother's body and more importantly in this case, scent - as you can see in the clip above, baby is constantly smelling and tasting.
Mum's sweat and the amniotic fluid on baby, both play a very significant part in the breast crawl and newborn breastfeeding (and many sources also link this with bonding, but one for another blog post I think!). Mum's sweat smells the same as amniotic fluid, which is still present on baby's hands - so he uses this taste to guide him to the breast, which is also conveniently located close to the armpit. As the breast is actually an enlarged and modified sweat gland, this means the odour is strongest in the area baby needs to reach.
A 1994 study examining whether the infant found the nipple by smell states:
One breast of each participating mother was washed immediately after delivery. The newborn infant was placed prone between the breasts. Of 30 infants, 22 spontaneously selected the unwashed breast. We concluded that the infants responded to olfactory differences between the washed and unwashed breasts.I don't have access to the full study to find out what the other 8 did, but they may not have crawled anywhere or become disorientated due to analgesics, perhaps separated from mum too - which as seen in the clip above can also influence co-ordination. I think this also clearly highlights why babies should not be removed, wiped and wrapped in a towel before being given to mum!
Lancet. 1994 Oct 8;344(8928):989-90
A 1997 study entitled "Unique salience of maternal breast odors for newborn infants" found:
Human infants are particularly responsive to olfactory cues emanating from their mother's nipple/areola region. Beginning within minutes after birth, maternal breast odors elicit preferential head orientation by neonates and help guide them to the nipple. Such odors also influence babies' general motor activity and arousal, which may contribute further to successful nipple localization and sucking. To some extent, the chemical profile of breast secretions overlaps with that of amniotic fluid. Therefore, early postnatal attraction to odors associated with the nipple/areola reflect prenatal exposure and familiarizationThere's more...
I also found a small study from 2001 that specifically explored crawling behaviour based solely on scent:
Breast odour as the only maternal stimulus elicits crawling towards the odour source -This study investigated the influence of breast odours per se on orientated physical movement of neonates. In total, 22 babies were observed during two trials on a warming bed. In one trial, a pad carrying the mother's breast odour was placed 17 cm in front of the baby's nose; in the other trial a clean pad was used. More babies moved towards and reached the breast pad than the clean pad. Conclusion: Natural breast odours unsupported by other maternal stimuli therefore appear to be sufficient to attract and guide neonates to the odour source.Birthing in water strips the process of these vital odours and tastes for baby - given the above it seem to me it at least explains why some babies born in water don't crawl. I cannot locate any research examining breastfeeding success rates following a water birth, but I would be fascinated to see any if it exists.
Heat: In the same way heat can help period pains, it can also help in labour. Wheatgerm bags (or alternative filled bags) may be safer than hot water bottles if you are moving about lots and perhaps applying pressure with them. The link also contains details of how to make your own.