**7. First hour and breastfeeding**

Breastfeeding has many advantages for the child, mother and the environment. The smooth first hour after birth and mother's skin-to-skin contact to newborn have positive impact on the effectiveness and duration of breastfeeding. Shorter intervals between birth and the start of skin-to-skin care and longer times spent skin-to-skin after birth improved breastfeeding exclusivity and duration. In the first month, woman has to breastfeed as often as the newborn wants or even more. With this the production of milk is assured. Many females are meeting with problem of too small amount of milk. The most frequent reasons are too little ingested liquid and disorderly diet. The problem can also be tiredness, increased amount of stress and rare short passing feeds. Relaxed and satisfied mother, who lives in a pleasant and tranquil environment, will have much better conditions for smooth milk lactation. The production and amount of milk is determining by the law of demand and offer. Birth environment and each health professional in their professional action may be more or less supportive impact on the ability and confidence of women to be born, breastfeeding and care for the baby, and baby's ability to effectively breastfeed. Full breastfeeding can of course be established successfully after a cesarean section also. The beginning of the milk secretion can be delayed after caesarean section, however, there is no rule. It is important to know that a child for successful feeds need to have a search reflexes, reflexes of swallow and sucking reflex which is instinctive. The way of the childbirth does not have influence per this. It is true that the first feed is postponed as a mother is put to sleep during an intervention. Clinical staff has to help her to add a child only after a certain time, when a mother is wake and she is aware of herself and surroundings. There are qualified professionals working in various medical institutions that hold a specific and additional knowledge about lactation and breastfeeding. With breastfeeding, the 'good bacteria' from the mother's body with a calm environment create good conditions for the development and strengthening of the child's immune system. The WHO and UNICEF are recommending three important breastfeeding activities: (1) early breastfeeding and skinto-skin contact with mother just after the birth; (2) exclusive breastfeeding to baby's age of 6 months without other food or liquids and (3) continued breastfeeding to baby's age of 2 years or even more. Meantime, the child can get complementary foods like soft foods and liquids, etc. [45–47]. Early breastfeeding and skin-to-skin contact immediately after birth keep a baby warm and have positive influence on their immune system. Despite that breastmilk is the best food with antibodies for baby's development, it also has effects on mother's ability of continuing exclusive breastfeeding. Mothers who breastfeed also have a (1) early initiation of breastfeeding—place newborns skin-to-skin with their mother immediately after birth, and support mothers to initiate breastfeeding within the baby's first hour of life; (2) exclusive breastfeeding—provide only breastmilk to infants from birth until 6 months of age, with no other food or liquids (including water); (3) continued breastfeeding—breastfeeding until age 2 or longer, in addition to adequate and safe solid, semisolid or soft foods (also called complementary foods) [45–47]. Immediate skin-to-skin contact and starting breastfeeding early keeps a baby warm, builds his or her immune system, promotes bonding, boosts a mother's milk supply and increases the chances that she will be able to continue exclusive breastfeeding. Breastmilk is more than just food for babies—it is also a potent medicine for disease prevention that is tailored to the needs of each child. The 'first milk'—or colostrum—is rich in antibodies to protect babies from disease and death, lower risk of developing breast and ovarian cancers. Breastfeeding can also delay mother's ovulation [13, 47].

health. This is especially important considering immune-mediated diseases. For example, children born via C-section are significantly more likely to develop allergic rhinitis, asthma,

Besides mode of delivery, breastfeeding also provides a route of maternal microbial transmission. Breast milk was considered sterile at first, but in colostrum collected aseptically already

To ensure the best maternal transmission of beneficial microbes, Reed [41] has made follow-

• Baby should be naked on mothers chest immediately following birth for at least an hour

• Avoid bathing baby for at least 24 h after birth [42]. Use own linen from home for baby if

The complex symbiosis between humans and microbes is important for our health, and breastfeeding benefits the health and well-being of infants. Maternal transmission is also a key factor in shaping the structure of the microbiome in animal species over evolutionary time, since microbes that promote host fitness, especially in females, will simultaneously increase their odds of being transferred to the next generation; therefore, it is essential to create optimal

Breastfeeding has many advantages for the child, mother and the environment. The smooth first hour after birth and mother's skin-to-skin contact to newborn have positive impact on the effectiveness and duration of breastfeeding. Shorter intervals between birth and the start of skin-to-skin care and longer times spent skin-to-skin after birth improved breastfeeding exclusivity and duration. In the first month, woman has to breastfeed as often as the newborn wants or even more. With this the production of milk is assured. Many females are meeting with problem of too small amount of milk. The most frequent reasons are too little ingested liquid and disorderly diet. The problem can also be tiredness, increased amount of stress and rare short passing feeds. Relaxed and satisfied mother, who lives in a pleasant and tranquil environment, will have much better conditions for smooth milk lactation. The production and amount of milk is determining by the law of demand and offer. Birth environment and each health professional in their professional action may be more or less supportive impact on the ability and confidence of women to be born, breastfeeding and care for the baby, and baby's

celiac disease, type 1 diabetes and inflammatory bowel disease [40].

• Exclusively breastfeeding. If not, probiotics should be considered.

• Probiotics may also be beneficial for babies suffering from colic.

• Avoid unnecessary antibiotics for the baby [43, 44].

harbors hundreds of bacterial species [39].

and a lot in following frost days.

• Minimize the handling of baby.

conditions to achieve the transmission.

**7. First hour and breastfeeding**

ing suggestions:

18 Selected Topics in Neonatal Care

in hospital.

One of the important factor that contributes to good establishment of breastfeeding is adding of the newborn to the mother's chest as soon as possible after birth, advisably to first half an hour or at least in hour after childbirth. If mother needs an advice or help during this time, it is very important that she gets it. First of feeds is introducing the first food and the first immunization to a child which further encourages the production of colostrum. Baby's sucking reflex is expressed the most during the first hour after a birth. It is awaken during skin-to-skin contact and care. If the mother is breastfeeding the newborn immediately after birth, the hormonal balance during pregnancy is established for a long time, which very favorable impacts on mother's overall health being. In addition, under the influence of the hormone oxytocin, which is secreted, while a newborn stimulates mother's nipples, the uterus intensively cramps and quickly returns to its original size. And this reduces the likelihood of severe bleeding after childbirth. Oxytocin, which increases significantly during skin-to-skin care, promotes newborn attachment, reduces maternal and newborn stress and helps the newborn transition to postnatal life. With breastfeeding in first hour, the child also has a stable heart rhythm without bradycardia. The possibility of apnea is reduced by 75%, since the depth of each breath becomes more stable [9, 13, 48].

and method of birth, have uninterrupted skin-to-skin care beginning immediately after birth,

Neonatal Care in the First Hour of Life http://dx.doi.org/10.5772/intechopen.69600 21

There is still a lot of unnecessary interventions in the first hour after birth in many maternity hospitals. Routine procedures are being carried out starting from early cord clamping to vitamin K injection, eye prophylaxis antibiotic ointment, navel prophylaxis, foot and hand printing, weighing, measurements and bathing and others. All health-care providers should know that immediate skin-to-skin contact is the best way for a newborn and mother to bond. Healthy newborns should be placed in 'skin-to-skin' contact with the mother until the first round of breastfeeding is established. Skin-to-skin care means placing dried, unclothed newborns on their mother's bare chest, with warmed light blankets or towels covering the newborn's back. Women who have a planned or unplanned C-section would not be in the ideal position for intimate bonding right away. Baby could be taken to a warming table for a quick assessment first. Authors [18] claim that there is no reason why stable mothers should not have the experience of skin-to-skin contact after cesarean births, to collect the same short- and long-term benefits of it. Even from psychological point of view, it helps them mourn the loss

The first hour should be focused on baby's first breastfeed and mother-baby and family bonding. The manner in which a new baby is welcomed into the world during the first hours after

[1] Coad J, Dunstall M. The transition to neonatal life. In: Anatomy and Physiology for Midwives. 3rd ed. Edinburgh: Churchill Livingstone, Elsevier; 2011. pp. 379-403

[2] Novak B. Adaptations to extrauterine life—respiration and cardiac functions. In: Stables D, Rankin J, editors. Physiology in Childbearing with Anatomy and Related Sciences.

[3] Crenshaw JT. Healthy birth practice #6: Keep mother and baby together—it's best for mother, baby, and breastfeeding. The Journal of Perinatal Education. 2014;**23**(4):212-219

[4] Ludington-Hoe SM, Lewis T, Cong X, Anderson L, Morgan K, Reese S. Breast and infant temperatures with twins during shared kangaroo care. Journal of Obstetric, Gynecologic

Teja Škodič Zakšek\*, Anita Jug Došler, Ana Polona Mivšek and Petra Petročnik

Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia

lasting for at least an hour.

of a normal vaginal birth.

**Author details**

**References**

birth may have short- and long-term consequences.

\*Address all correspondence to: teja.zaksek@zf.uni-lj.si

3rd ed. London: Elsevier; 2010. pp. 641-656

& Neonatal Nursing. 2006;**35**:223-231

Colonization by mother's bacteria and first lactation colostrum, which creates an optimal intestinal flora, is an optimal protection of the child immunity from possible allergies which might otherwise can be developed later in child life. Breastmilk is more than just food—it is also a potent medicine. It protects the child against disease, regulates the child's immune system and helps child to digest the food [47]. This process helps to program the healthy development of the infant's gut microbiome for life. There is evidence, for example, that breastmilk can help to counteract an infant's genetic predisposition for obesity and other chronic diseases. So the first hour after birth is a critical period with irreversible consequences from the point of bacteriological view [12, 48]. More on that can be found in impacts on infant microbiome assembly chapter.

Mother's breasts are natural thermoregulator to maintain the body temperature of a child. They regulate the temperature of a child. If the child is cold, the breast temperature increases, or if the child is warm, the breast temperature falls. Mother's breasts are also natural thermoregulator for child's respiratory and heart rates [8, 10, 48].

An undisturbed first hour with skin-to-skin also reduces the risk of hypoglycemia (see chapter about metabolic adaptation). Newborn babies can produce glucose from their body stores of energy until they are breastfeeding well and are more likely to do so when they remain skin-to-skin with their mothers. Breastfeeding extended period of natural immunity against mumps, measles and polio. Colostrum has a laxative effect and helps to facilitate the elimination of the first child's stool. It is extremely easy to digest and does not cause constipation. The child has also less troubling with abdominal cramps. As long as the child is breastfed, it is protected against many infections, because breast milk receipt of child antibodies that protect against diseases that can overcome its mother. The child is also protected against ear infections, diarrhea, gastrointestinal infections and diseases of the respiratory tract. For breastfed infant, it is less likely to be diagnosed with meningitis and childhood diabetes. An active intake (compared with passive swallowing bottle) promotes the proper development of the jaw, the mouth muscles and cheek bones, resulting in a very favorable impact on the development of children's speech.
