Bringingnaturetothefore - Biological Nurturing

1 Thisartic le has two aims:first,to give anhistoricoverview of the nature-nurturedebatein relationto howmo therslearnto br overview will relatehowthe nurture pe rspective cameto dom inateour understandingof the ontogenyof br ea secondai m is to pr oposepro fessionalbreastfeedingcom petenciesin an attempt to integratethe natur e perspectivewithinearlybreastfeedingsuppo rt . Theseare underdevelopmentandwrittenwitha vie w to stimulatingpeer revi ewan d onIn 1955 ,Ma vis Gunther,awell-knownEng lish obstetrician,published alandmarkresearchpaper in which she statedcat egoricallythat modernmothers lacke dbreastfeedinginstincts.

2 Gunther(19 55)the orised that mimicry,not instinct,info rm shomo sapiensan dother primateshow tobreastfeedth efirst baby. She based thisnotionon her clinicalobservations,toge th erwith rep or ts of the inabilityof zoochimpanzees to togeth er,the se su gge st ed that the dep rivationof th evisual breastfeedingexperience in childh oodleads to maternalrejectionof the offspringand omazoologicalperspe ctiv e, mimicryisaprotectiv eresemblanceof one animalspecies (the mimic)to anot her (the model)orto part of the is abi ological strategy,the functionof which isco ncealment,ent rapmentor camouflage(Morris1990).

3 The mimicryinvolvedinbr eastfeedingis better classifiedas whatDes mond Morris(1977),the well-respectedetho logist, terms an absorbedaction or oneacq uired unknowinglyfrom ordingto Morris,there arethr ee other ways in which humanac tions orbeha viours are acquired:taught,discoveredand innatebehavioursareno tlearnt. Inste ad, they are geneticallypre-pr ogrammedor hard-wired,accomplishedwi thout any prior are twoki nds: reflexesand thou gh innatebehavioursarereco gnisedas part of the neonatalrepertoire(for example,sucking,rootingand smiling),there is much controversyco ncerningthe role playedby inbornbeha viours and inst incts in particular inthe adult.

4 This controversyis centralto theong oing, ag e-old nature-nurture debateabout the originsof ex ample,man ysugge st that humanaggressionis pre-pro grammed,part of human nature ,and isthereforeanat ural and unav oidablebeha viouraltrait mandatingfights and war;whereasothers,citing examplesof peacefulsocietieswhere war is unknown,suggestthat ag gressionis culturallydetermined,alearnt response part of nur ture .Brin gi ng nat ure to th efo reSuza nne Co lsonar gu es that it is ti me todra wupbreas tfeed ing competencies inorde rtopro mote the nature persp ectivewit hi nearly breast feed in gsupp ortTABLE1 Mid wif ery br east feedin gcom pet enc ie s aim ,ab bre vi atio ns an d mate rialsThe overallaim is to provideahormone-enhancingenvironment,sup portingthe initiationof exclusivebreastfeeding.

5 BiologicalNurturing:BN Skin-to-skincontact:S2S Hospitalacquiredinfection:HAI Mother-BabyNurturingDiary:ND Oxytocin:OT Mother-BabyNurturingDiary Breast/BottleFeedingReflexAssessment(BRA ) BRA ActionPlan TheLittlePocketBookofBigFeedingFacts TA BL E2 Midwifer ybre astf ee di ng co mpe te nci es sk ill the biologicalnorm (at least) duringthe timeof metabolicadaptation(first three postnataldays). familiarwith BN and reflex theoryin relationto ,detectingany feedingproblemsas soon as an , keepingmothersand differencebetweeninformation-givingand offers informationwith sensitivity, sconfidencein her ability to care for her baby ,ensuringdignityand comfort,supportedby ahands-offpracticeas soon as possibleany deviationfrom the normaland can teachpositioningand attachmentskills if standardof togetherwithkn ownphysiologi calben efi ts associa tedwit hski n-to-skincontact duringthefirst post natal hour.

6 Th eimport ance ofsupp orti ng aho rmone-en hanci ng post na talen vi ronmentconducivetobr ea st fee di ng ini tiat ionmay be an urge ntmi dwife ry prio ri tyCompeting br eas tfeedingargument sGunt her s(1 955)mimi cr ythe ory ab outbre as tfe edin gbeh aviou rs wa sfirm lyanc hor edwi thi nthe n ur tur e sid eof thedeb at e,wh er eshesugge st ed th at cu ltu ralfact or ssu ch as s mall fam ili es, hous ingallow ing pri vacy an dtra dit ion al co nven ti onsof mod est y pr even ted the m ode rn moth erfrom brea stfeedi ngspon tan eou r, biologistssuch as Pryor(1973.)

7 69) continuedto suggestthatmaternalbreastfeedingbehaviou rswere ami xture of nat ure/nurture,whereho rm ones and innat ebehaviours the n ature component providea roughfra me work enablingmothersto initiatebre ast fe eding. However,Gunther smimicrythes ismade more sense and gainedwideacceptance,ov ershadowingthe nature co mponentof the ontogenyofbre ast fe eding. Interestingly,the mimicrytheo ry came with an obvioussolution:justas motherch imps in captivitycould betaughtsucklingskills by male zoo keepers,humanmotherscould acquirethe skillsof breastf eedingthroughactive trainingand years, the Guntherhypothesis,althoughuntested,becam ea f act , reinforcingthe idea that, in theabsenceof abreastfeedingcultureandbecausethey lack instincts, mothersrequiread vice and training(Wells 2006).

8 Today,this maternaldeficiency or instinctualfailure ,in Gunther swords lies at theheart of our currentunderstandingof theonto gen yof bre paper has been widelycite d,pro viding the rationalefor using askills-teac hing approachto nurture perspectivehaspro vided the theoreticalframeworkunderpinningpublic healthinitiativestopromoteand supportbreastfeeding as wellas the professionalobservationsandcompetencies requiredto teach mothersthe me to re -a ssess?Toda y, recent researchfindingssuggestthatthere has been an over-relianceon thisnurt ever-increasingbank of well-designedresearchstudiesdemonstrates that oxyt ocin, one ofthe principalbreastfeedinghormones,is atthe root of all lov erelationships,releasingbeha viouraleffects as well as the well-kno wn contractionand ejec tion effects(P edersen1992).

9 An inve stigat ion exa miningthemechan isms of bio logic al nurtu ring (BN ), aTAB LE 3Ro le an d be haviour (b racketed nu mbe rs li nk to ski ll s lis ted in Table 2)A. Healthadvocate Listensto mothersand encouragesthem to identifytheir feelingsand anxietiesabout breastfeedingand the relatedchangesto themselvesand their lives (2). Gives the motherthe ND, promotingbaby-holdingregardlessof ethnicityandfeedingchoice(1,4,5). Gives abrief explanationof how to use the ND, respondingto questionsthroughpurposefulconversationed ucatingabout culturalexpectationsand the differencebetweencultureand physiology(1,2,4,5).

10 S2S followedby the mother sbody can continueto nourishand nurtureher baby asan integralpart of maternalcomfort,rest and fears about spoilingand needs vs. habits,sharingnurturingdefinitionsand styles while Breastfeedingassessment Washeshands beforeseeingthe motherand in betweenmothers,using this as anopportunityto discussthe importanceof hand-washingand infectionrisks (8). Introducesself and maintainslevel eye contact(2). Asks mother spermissionbeforetouchingor pickingup baby (6). Recogniseswhen it is productiveto touch mother sbreasts,and asks permissiontodo this (6,7).