INTRODUCTION:

Breast feeding is a “by default” activity- it is expected to come naturally and be the easiest and most intuitive thing in the world, and it is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breast feed, provided they have accurate information, and the support of their family, the health care system and society at large. Promotion of early initiation of breastfeeding has great potential, because there is an increasing risk of neonatal mortality with increasing delay in initiation of breastfeeding from one hour to 7 days. Late initiation (after day 1) was associated with 2.4 fold increase of neonatal mortality (Kathwinkel, 2000). According to a survey worldwide 23.4 % of newborns were given breast milk in the first hour of birth (NFHS – III, 2000) and 22 % of neonatal mortality can be prevented if breastfeeding initiated within an hour of birth irrespective of whether they are exclusively breastfed later or not (WABA, 2007).

Benefits of early initiation of breastfeeding are widely known and practice is generally encouraged, no specific method for starting such breastfeeding is recommended.

Breast crawl is the evidence based and easiest method to initiate breast feeding within half an hour; it can be defined as every newborn when placed on the mother’s abdomen soon after birth has the ability to find their mother’s breast on their own and decides when to take the first breastfeed. The breast crawl was originally described in 1987 by Swedish midwife Ann Marie Widstrom and her team from Karolinska Institute, Sweden. It was known for years but not practiced as its potential was not so far recognized and explored.

Unless there are no complications with delivery, best time to start breastfeeding is within 20-30 minutes of the birth (WHO, 2007) when newborns were in alertive stage, alertness gradually decreased until 150 minutes after birth, when they fall asleep. If initiation is not attempted soon after birth, a vital period of alertness will be lost and the newborn will start to sleep, hence the first breastfeeding may be delayed for several hours (Widstrom, 1987). Most of the newborns complete breast crawl in about 30-60 minute (Gangal, 2008). Newborns had the ability to complete breast crawl successfully with spontaneous attachment as it was their instinctive. (Widstrom, et al., 1987)

Revised Baby Friendly Hospital Initiative Global Criteria (2006) stated a new interpretation to help mothers to initiate breastfeeding within half an hour of birth. It recommended that ‘place the newborns in skin to skin contact with their mothers, immediately following birth for at least an hour and encourage mothers to recognize their newborn’s readiness to breastfeed, offering help if needed’. This procedure is same as breast crawl in which the newborn placed on mother’s abdomen soon after delivery and uninterrupted skin to skin contact will be maintain until the completion of first breast feeding.

In the past, most caretakers believed that the newborn needs help to begin breastfeeding. Hence, immediately after birth the newborn was given to the mother with its lips placed near or on the mother’s nipple. Even gently forcing a crying newborn to the mother’s breast might cause the newborn to instinctively place their tongue on their palate and at the next feed they may repeat the same reaction leading to preventable breastfeeding problems (Widstrom and Paulsson, 1993). Contrary to the belief that a newborn is not able to do anything on their own, breast crawl demonstrates the process of initiating breastfeeding exclusively on newborn’s own ability and the method is associated with a variety of sensory, central, motor and neuro endocrine components.

The biggest advantage of breast crawl method is that, it ensures better mother - newborn bonding, helps to keep the newborn warm and facilitate early initiation of breast feeding (Gangal, 2007). Early initiation and frequent feeding had positive influence on longer duration of breastfeeding (Salariya, et al., 1978). When the newborn is placed on the mother’s abdomen, the pleasing touch releases endogenous opioids in the mother which reduces the pain perception (Weller and Feldman, 2003). Breast crawl helps in uterine contraction, enhances expulsion of the placenta, reduces maternal blood loss and prevents anemia. It seems to distract mothers from discomfort during perineal repair (Roller, 2003).

Birth practices like bathing, anthropometric assessment, injection of vitamin K and application of eye ointment can affect initiation of breastfeeding. Hence, all these routine practices should be delayed for at least one hour. Breast crawl is novel, easy, readily available, evidence based and cost effective miraculous method to initiate breastfeeding. It does not require elaborate preparations or instructions and can be performed in all birth settings and units.

METHODOLOGY:

Research design

Quasi experimental one group post tests only design was adopted for this study.

Sampling

Purposive sampling technique was adopted to select the participants and a total number of 22 participants were selected and included in the study.

Research materials

1. Obstetrical data

2. APGAR Score for assessment of the newborn.

3. Modified LATCH Breastfeeding Assessment tool. (Jensen, et al., 1994)

Tool consists of criteria for newborn includes ability to crawl, latch, sucking, audible swallowing, and length of time before latch on. Criteria for mother includes type of nipple, condition of breast and nipple, ability to hold the newborn, pain (episiotomy suturing pain, after pain, leg pain).

Intervention

Step 1: Soon after delivery, oronasal suctioning was done with bulb sucker. Umbilical cord clamped and cut by the midwife who conducted delivery.

Step 2: After cried and started breathing well, the newborn was thoroughly dried with a soft cotton cloth except the hands.

Step 3: Newborn was shown to the mother and kept close to her cheek.

Step 4: After that the newborn was placed in prone between the mother’s breasts, so that the newborn’s nose in the midline of the mother’s chest and eyes at the level of the nipples.

Step 5: The newborn and the mother covered together with a cloth, care taken to prevent the newborn from falling.

Step 6: Mother’s head was raised with a pillow to facilitate mother newborn visual contact. Encouraged the mother to talk with her newborn.

Step 7: In order not to remove the odour, mother’s breast was not washed/wiped before feeding.

Step 8: Skin to skin contact was continued until completion of the first breast feed.

Data collection

The procedure of breast crawl method was explained to the mothers at first interview and oral consent was obtained from mothers. The investigator was present during the time of labour for all the participants and directly observed the procedure. Soon after delivery oronasal suctioning was done with the bulb sucker, newborns were received in soft cotton cloth and dried except hands. APGAR score was assessed and newborns were shown to their mothers. After that, newborns were kept in breast crawl position and mothers were asked to hold the newborns. Uninterrupted skin to skin contact was maintained until the completion of breast crawl. The events are directly observed and scoring was given accordingly.

Data analysis

Descriptive statistical analysis was used to find out the results.

RESULTS AND DISCUSSION:

In this study, among 22 participants, 18 % of newborns were placed in breast crawl position at 3-5 minutes, 50 % of them were placed in 6-8 minutes interval, 23 % are placed at 9-11 minutes and remaining 9 % of them are placed at 12-14 minutes from the time of birth the time of initiation of breast crawl was varying from 3 – 14 minutes, there was no difference found in completion of breast crawl from newborns that were placed in 3 minutes and were placed in 14 minutes in breast crawl position. The newborn may take 15 to 20 minutes of rest after exhaustative movements; they started to make crawling movements towards the breast about 20 minutes after birth (Righard and Alade 1990). When the newborns placed on mother’s chest immediately after birth, 15 minutes of comparative in activity was observed (Widstrom et al., 1987).

Table 1 Time Distribution of Breast Crawl (N= 22)

Time (in minutes)	Number of newborns	Percentage (%)
Time at breast crawl position Initiated
3-5	4	18
6-8	11	50
9-11	5	23
12-14	2	9
Time taken by the newborn for latching
11-20	6	28
21-30	8	36
31-40	4	18
41-50	2	9

Table 2 Distribution of Newborns Based on Score of Modified Latch Breastfeeding Assessment Tool (N= 22)

Total score	Number of newborns	percentage (%)
0-3	2	9
4-6	5	23
7-10	15	68
Total	22	100

64 % of newborns have started to latch within 30 minutes, 27 % have taken 30-50 minutes for latching, and 9 % of newborns did not achieve the latch, after an hour of breast crawl initiation. It reveals that most of the newborns have ability to initiate breastfeeding within 30 minutes by their own. Average time taken by the newborns to achieve the latch was 27 minutes. In the similar way, Righard and Alade (1990) found that, newborns started to make crawling movements towards the breast about 20 minutes after birth and most of the newborns were suckled at the breast by 50 minutes. Newborns’ need average of 30 minutes for latch after started to make movements

The finding shows that 41 % of newborns completed breast crawl in 41-60 minutes of duration, 50 % of newborns completed breast crawl in 61-80 minutes of duration and 9 % of newborns took around 81-100 minutes duration, and they are not able to latch or initiate breastfeeding through breast crawl, as they were not able to crawl and latch. At 55+ minutes the newborns spontaneously found the nipple and started to suckle (Widstrom et al., 1987) newborns successfully complete the breast crawl in about 30-60 minutes (Gangal, 2008)

The result reveals that most of the newborns (68%) were actively initiated breastfeeding through breast crawl by their own. 23 % of them needed assistance to initiate breastfeeding through breast crawl. Only 9 % of them were not able to initiate breastfeeding through breast crawl. Hence, the hypothesis “Breast crawl will enhance the ability of newborn to initiate breastfeeding” is accepted.

FINDINGS:

1. Term newborns had the ability to complete the breast crawl successfully.

2. There was no difference in the performance of breast crawl in male and female newborns.

3. Most of the newborns kept in breast crawl position within 10 minutes from the time of birth. There was no difference in the time of initiation of breast crawl and time taken by the newborn to latch.

4. 64 % of the newborns latched within 30 minutes from the time of initiation of breast crawl.

5. 91 % of newborns completed breast crawl within 80 minutes duration.

6. The mothers satisfied and agreed that breast crawl is the best method to initiate breastfeeding. Most of the mothers expressed that they were excited, felt sleepy, reduce of pain, and increased bonding with their newborns.

CONCLUSION:

Good health begins with breast milk; there is no substitute for it. WHO, UNICEFF, WABA and all other government agencies are strongly recommended that breastfeeding should be initiated in the first hour of birth. The study was undertaken to assess the ability of newborn to initiate breastfeeding through breast crawl method. In this particular setting most of the newborns completed breast crawl successfully. Hence, breast crawl is the best method for early initiation of breastfeeding.

REFERENCES:

1. Gangal, P. (2007). Breast crawl: Initiation of breastfeeding by breast crawl. Retrieved June 05, 2009, from http://www.breastcrawl.org

2. Kathwinkel, (2000). Early initiation of breastfeeding reduces neonatal mortality. Retrieved April 4, 2009, from http://fex.ennonline.net/28/neonatal.aspx

3. National family health survey (NFHS-3) (2007). Retrieved April 4, 2009, from http://www.nfhsindia.org/

4. Righard, L., and Alade, M. (1990). Effect of delivery room routines on success of first breast feed. Lancet, 336, 1102-1107.

5. Roller, C. G. (2003). Getting to Know You : Mother’s Experiences of Kangaroo Care. Journal of Obstetric Gynaecologic and Neonatal Nursing, 2, 210-215.

6. Salariya, E. M., Easton, P. M., and Cater, J. I. (1978). Duration of breastfeeding after early initiation and frequent feeding. Lancent, 2, 1141-1143.

7. Jensen, D., Wallace, S., and Kelsay, P. (1994). LATCH: A breastfeeding charting system and documentation tool. Journal of Obstetric Gynaecologic and Neonatal Nursing, 23, 27-32

8. WHO, (2007). Breastfeeding the 1 Hour-save 250,000 babies. Nightingale Nursing Times, 3, 9-11.

9. World Alliance for Breastfeeding Action (2007) Nightingale Nursing Times, 1, 21-23.

10. Widstrom, A. M., Ransjo-Arvidson, A. B., and Christensson, K. (1987). Gastric suction in healthy newborn infants: Effects on circulation and developing feeding behaviour. Acta Paediatrica Scandinavica, 76, 566-572.

11. Widstrom, A., and Thingstrom- Paulsson, J. (1993). The position of the tongue during rooting reflexes elicited in newborn infants before first suckle. Acta paediatrica Scandinavica, 82, 281-283.

Received on 04.10.2013 Modified on 22.11.2013

Int. J. Adv. Nur. Management 2(1):Jan. - Mar., 2014; Page 12-14