Kelly Durbin, Austin, Texas, USA
Every month, La Leche League meetings attract mothers who are struggling with some aspect of breastfeeding. Some need minor adjustments to their latch techniques while others might need to explore alternative positions. Some parents seek LLL support when there has been a disruption of breastfeeding or feeding at the breast has not yet taken place. For these situations, it can be helpful to suggest a total reboot of the whole process, so that babies are better able to access their innate feeding behaviors. There is no doubt that skin-to-skin (also called kangaroo care) is a gentle way of providing sensory input in the right environment to stimulate a baby’s inborn knowledge of the feeding process. Kangaroo care in a low-stress situation often works wonders for babies who seem disorganized at the breast. But some infants need a more complete restart from the beginning, as if to go through the birth process again. In these situations co-bathing can be a useful technique for starting over.
In the most simplistic view, co-bathing is a mother-baby bathing experience. But when the bath is used for the purpose of restarting breastfeeding, this technique is referred to as “re-birthing” because it can be utilized to re-create the feel of being born. In this way, babies get the sensory input that is needed to better access innate feeding reflexes. Nikki Lee, RN, IBCLC (International Board Certified Lactation Consultant) and author of Complementary & Alternative Medicine in Breastfeeding Therapy, states that co-bathing is a therapeutic means of rehabilitating the process of breastfeeding (Lee, 2011). For many babies who have experienced a difficult birth or problematic initial feeding experience, infants who are newly adopted, or babies who are adjusting after a frenotomy (division of a tongue-tie) or other procedure, co-bathing can be a gentle, low-pressure way of connecting with their mother in a warm, nurturing environment.
There are several important elements to co-bathing. Always caution parents to practice safe co-bathing. Begin by collecting any necessary supplies–several dry bath towels, a hand towel, plastic cup—and have a second adult available for handling the baby. Keep the bath water warm but not hot, about 37°C / 99°F. Adjust the water level so that the breasts can be above the water line when the mother is reclined.
Basic steps for co-bathing
- Before placing the baby in the bathtub, be sure that the mother is seated safely in the water.
- A partner or other adult can bring the baby to the tub.
- Place the baby in the water, lying on their back, fully supported by the mother’s arms. Be sure the baby’s full face is out of the water.
- Relax in this position for a while, allowing the baby to enjoy the warm water and the peaceful, nurturing environment.
- After relaxing a while, the mother will sit back into a reclined position, bringing the baby out of the water and onto the chest between the breasts, skin-to-skin in a tummy-down position on mother’s chest
- Because the baby’s upper body will be out of the water, place a hand towel over the baby’s back and use a plastic cup to pour warm water over the baby and the towel. This will help keep the baby warm while in the skin-to-skin position. Pour water over the baby’s back frequently to keep the towel warm.
- Allow the baby to rest skin-to-skin for a while. In this position; many babies will be prompted to begin seeking the breast, and to use innate feeding behaviors to find the nipple, to latch and begin feeding—even if the baby has never latched before.
- Be realistic about expectations. This environment re-creates the feel of emerging from the womb and can activate a baby’s feeding reflexes, even if they are beyond the newborn stage, however, feeding at the breast is not a guarantee in this situation.
- When the bath is over, the mother hands the baby to another adult before getting out of the bath.
- Safety precautions: Pay close attention to the water temperature and the air temperature while co-bathing to keep the baby sufficiently warm while in the bath. Note that cooler air temperatures will cool the bath water quickly. Co-bathing with the assistance of another adult ensures the infant can always be handed safely to a second adult who can quickly dry the baby and keep them warm.
Since part of the goal with co-bathing is to initiate feeding at the breast, be sure to encourage parents to be aware of the baby’s appetite before getting in the bath. They can aim to have the baby in the bath during a time when baby is not extremely hungry, nor at a time when they have just been fed. Aim for something in between in order to maximize the chances of bathing while the baby is happy and is likely to be interested in feeding. If the baby does not latch during the bathing experience, the baby can be placed skin-to-skin after the bath for more low-pressure feeding opportunities.
Co-bathing is an interesting combination of peaceful hydrotherapy and skin-to-skin that can help many babies access their mammalian feeding skills. If this technique is successful for helping a baby find the breast and initiate feeding, it may be wise to spend as much time in the skin-to-skin position in the day or two after the bath experience. This provides the baby with several more positive opportunities to practice new feeding skills.
Lee, N. (2011). Complementary and Alternative Medicine in Breastfeeding Therapy.
Kelly Durbin has been a Leader for about ten years in the United States with experience leading meetings in five different states across the country. She, her husband and their two daughters now live in Austin, Texas, USA.