Sharleen has just come in, and Stohm is awake and alert – see how the eyes focus on the camera coming within range.

STATE ORGANISATION is important to understand in order to understand newborn breastfeeding. State organisation is about the level of awakeness of the baby. Baby will spend most of its time asleep, and sleep can be deep, or quiet, or light. As the state organisation of the baby rises, it goes through being drowsy, being awake and quiet, and “awake and alert”. Crying is a higher level of state organisation, and “hard crying” is the highest.

CRYING IS ALWAYS BAD
To breastfeed, the newborn must be calm, and in “awake and alert”.

Stohm needs her own time. All the senses of a newborn are important, but at this stage, smell is perhaps the most important. Therefore, we leave the breast close to Stohms face, without rushing in.

After two or three minutes of looking around aimlessly, Stohm makes definite eye-contact with mother, which she maintains for some time.

Still maintaining eye contact, Stohm makes typical and classical “hand to mouth movements”, and puts her thumb in her mouth. These movements are part of the “routine” – the newborns hands should be free and not restrained.

This same movement is done in the uterus.

This is an ultrasound picture, which shows a fetus in the uterus, making exactly the same movement Stohm is making.

“Very early during gestation the fetus practices rooting, finger sucking, and swallowing” (Prechtl and de Vries).

The previous pictures were taken over a period of about fifteen minutes. At the point when Stohm opened her mouth so wide, I asked Sharleen to express just one drop of milk.

The following pictures were taken over the space of one minute. As Sharleen brought the drop of milk towards Stohm, Stohm opened her mouth, smacked her tongue, lunged forward, and grabbed the nipple with her mouth. (Darker picture, flash charger too slow!)Notice determined look!

Stohm only actively suckled for about 30 seconds, with a few second pauses, then she tired. Note that more areola is visible. Note also the eye contact which was maintained for the major part of the early suckling.

Stohm is still very small and weak, and is being fed through the nasogastric tube. But she has shown a range of “pre-breastfeeding” behaviours, and has shown that she can put all those behaviours together. As she has more opportunity to do this, she will be able to breastfeed more and more.

It was difficult to say how much milk Stohm took in this episode, but for Sharleen the important thing was that she could understand what Stohm was doing, and why.

Sharleen was encouraged not to do anything at this stage. Stohm looked like falling asleep, but lay with the nipple in her mouth without suckling or swallowing. She then seemed to wake up slightly, making renewed eye contact, before slowly releasing her grasp.

Sharleen then picked up Stohm and placed her back in the skin-to-skin position, between her breasts. Within a minute, Stohm had settled down for a good sleep.