Donna Karl's article in the September/October 2004 MCN (29[5]) about using newborn behavioral state organization to facilitate breastfeeding is very important. In my clinical practice, I find that the baby can be forgotten in breastfeeding.

I particularly enjoyed the description of the "closedown"; another reason for closedown is that babies are sometimes injured during birth (headache from vacuum/forceps, sore throats from suctioning, and head scratches from internal leads).

I was a little sad at the author's mention of the need to breastfeed "every 2 hours," which is repeated in the article. Breastfeeding is not a timed or scheduled event; if babies are kept close and mothers are taught to notice feeding cues, newborns tend to feed in a cluster pattern (3-5 feeds in a shorter interval).

It would have been helpful to mention feeding cues a bit more; those lovely signals that babies send when they want to go to breast. Skin-to-skin is a way that babies organize themselves, and often (as mentioned in the case study in the article) will result in a baby either showing feeding cues or self-attaching to the breast.

Kudos to the author for this article!!

Nikki Lee, RN, MS, IBCLC, CCE