The first hours of life are important for the initiation, establishment and maintenance of breastfeeding. It has been widely demonstrated. What makes it so important? The first latch creates a lasting impact on the newborn in the way she/he latches onto and suckles at the breast.

As for early initiation, although it has not been explicitly evaluated, evidence suggests that there are positive benefits influencing higher breastfeeding rates at discharge and in its duration. As healthcare professionals, how can we facilitate this first latch after birth? 

The expulsion phase in birth is generally reached when the cervix has fully opened, and the head of the baby is resting on the mother’s pelvic floor. With each contraction, the mother feels the need to push and help the baby to come out. This is an intense stage, where hormones play an important role: oxytocin is stimulating and maintaining the contraction of the uterus. In each contraction, the mother will feel the urge to push, and in each pushing sensation, a large amount of catecholamines will be released to help her push. 

This adrenaline released by the mother will pass into the bloodstream and reach the circulation of the baby through the placenta. In the newborn, after birth, this will cause her/him to remain in a state of active alertness during the first hours of life. This is important, so the first spontaneous and physiological latch can happen.

The first minutes after birth are important for the newborn to adapt to the new situation of life outside of the womb. The most important changes occur in the lung, which must change its function, allowing air exchange by decreasing peripheral alveolar resistances. And in terms of circulation, the closure of the foramen ovale and the occlusion of the ductus arteriosus must occur. There is no hurry, the newborn has one minute to achieve this new milestone and we, as healthcare professionals, must protect this moment: skin-to-skin contact and physiological clamping of the umbilical cord help with this transition of the newborn.

When a newborn baby is placed on its mother’s belly immediately after birth, it will recognize her and feel safe and secure through touch, smell and hearing. It will be able to relax so that it can adapt to the new environment in an optimal state. If we leave the umbilical cord untouched, we will encourage the baby’s blood circulation and so help with the oxygen supply for the duration of the transition. The baby’s energy consumption will be reduced, and this will promote the stabilization of its vital signs (heart rate and respiratory rate) and metabolic parameters, including basal glycemia. 

Once the newborn has completed the transition phase and is already adapted to the new environment, it is ready to start feeding at the breast. By avoiding the separation of mother and baby, the newborn will be allowed to develop primary reflexes (about 20) that can be divided into 9 observable phases described by Widström (A. M. Widström et al, 1987).

These stages are similar in all newborns, regardless of the type of delivery and feeding the mother has chosen, and are encouraged by placing the newborn on top of the mother’s belly in a prone position with the head resting to one side:

1. Crying: immediately after birth, as the lungs expand. Some newborns do not go through the step of crying and simply breathe.
2. Relaxation: relaxation of the body and hands, especially when placed on top of the mother.
3. Awakening: at this stage, the newborn shows small movements of the head and shoulders, opens its eyes and may show mouth activity.. 
4. Activity: The newborn increases movements of the mouth and sucking motions. 
5. Rest: There may be some periods of rest between periods of activity.
6. Crawling: The newborn approaches the mother’s breast while pushing off her feet (the breast crawl).
7. Familiarizing: when reaching the breast, the newborn becomes familiar with the breast by smelling and touching it with the lips, and she will try to latch and suckle. The search reflex is activated and produced by contact with the baby’s cheek, which makes the baby turn her head towards the touched side. The rooting reflex shown by lip movements can be observed when the baby’s lips are stimulated. This latching-on can last about 20 minutes. 
8. Suckling: Continuous suckling at the breast. Usually, this stage is reached around 50 minutes after birth.
9. Sleep: at about 1.5-2 hours after birth, the newborn falls into a restful and physiological sleep that can last for hours.

The stages described by Widström can be affected by medical interventions during labour, such as the use of epidurals, administration of synthetic oxytocin, the instrumentalization of the delivery, maternal complications and others. Hospital practices must be adapted to the mother and baby’s needs by observing the adaptation response of the newborn and the phase in which he/she is, thus enabling normal development and promoting physiology.

As healthcare professionals, it is our mission to protect the mother-baby dyad, to understand why it is important not to interfere in the development of these 9 stages and that routine procedures like the administration of vitamin K, the application of ocular erythromycin, weighing and measuring the baby, etc., can wait. Finally, the environment in the delivery room should be appropriate and bright lighting as well as too much noise in the delivery room should be avoided.