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Entries in Laid-Back Breastfeeding (5)

Friday
Mar252011

Biological Nurturing┬« and Late Preterm Babies

Is BN breastfeeding in a laid-back position?  Or is it about babies’ feeding reflexes?  Perhaps it can be a kind of skin-to-skin contact.  Actually, all of these are a part of Biological Nurturing, but there is so much more!

Click to read more ...

Sunday
Nov142010

Doing It Right

Today my guest blogger is one of my favorite people in breastfeeding, Diane Wiessinger, coauthor of the new The Womanly Art of Breastfeeding and author of the seminal article “Watch Your Language,” which forever changed how we think about the “benefits” of breastfeeding.   

I took my young son to a Chinese restaurant for lunch years ago.  I asked our waiter to show us the right way to use chopsticks.  “Well,” he said, scanning a nearby table of Chinese waiters, all busy eating lunch, all with chopsticks, “None of them are doing it right.”

Whether we’re eating, walking, or putting on socks, we don’t have to do it “right”; we just have to do it so it works for us.  So why are there so many rules about breastfeeding?  And why don’t they work very well? 

More than 30 years ago, when my first child was born, there were no rules at all about how to make a baby take the breast (there was no such thing as The Latch).  All anyone knew was that if a baby’s cheek is touched when he’s hungry, he responds by turning his head with a wide, searching mouth.  It was the height of the natural childbirth movement, and many of us who were interested in breastfeeding also had medication-free births, which meant our babies were competent from the start.  Skin-to-skin was unheard of, our babies were kept in central nurseries, often they had a bottle before their first nursing… but most of them latched with little or no difficulty.  It didn’t occur to us that they might not.

Trouble is, we were sore, often for weeks.  So the field of Lactation Consultants began – not to help babies latch, but to figure out what caused the pain.  We LCs looked carefully at each tiny piece and realized that the pain was usually from holding the baby as if for bottle-feeding.  But we broke everything into tiny steps, created rules about how to do each step “right”… and the whole thing worked even less well.  Now we began seeing non-latching babies!  So we added more rules, and more, and mothers’ confidence eroded.

When a baby learns to walk, he’s pretty awkward.  He falls a lot, he wobbles, but no one says, “Oh dear, if you don’t take that baby to a specialist, he’ll never walk right.”  Everyone knows he has the basics built in, and just needs time.  Making him follow a detailed set of rules would probably drive him back to crawling! 

That’s what happened with breastfeeding.  We laid down rules for something that had never had any, and we left mothers feeling incompetent and babies feeling totally confused. 

So try this:   lean back comfortably, your baby’s whole front on you, and let gravity take care of the holding.  Your baby lies there with his cheek against your breast.  If he’s hungry, he turns toward his cheek, and there’s that wonderful nipple right nearby.  You’ve done nothing in particular (in fact, any fumbling that you do probably helps), and he chooses the moment that suits him best.  What a concept! 

Are you doing it right?  Well… if both of you are comfortable and the milk is flowing, what else could possibly matter?  Let the Lactation Consultants save their problem-solving for if you have a problem. 

 

Monday
Oct112010

Some Ins and Outs of Laid-Back Breastfeeding

In an earlier post I explained why it’s time to change the way we teach breastfeeding.  I described research findings indicating that early breastfeeding is easier when mothers lean back with their babies’ weight resting on their body.1  (See my new Blog History category “Laid-Back Breastfeeding” in the right column for a link to all my posts on this subject.)  These laid-back positions not only make breastfeeding less work for mothers, they also make it easier for babies to take the breast deeply, especially during the early weeks.  That’s because in these positions gravity helps rather than hinders babies’ inborn feeding reflexes, which can make a huge difference when babies are at their most uncoordinated. 

After decades of teaching mothers to breastfeed sitting upright or lying on their sides, many have difficulty visualizing this new approach.  One common question I am often asked is whether these positions are practical after a cesarean birth.  The answer is most definitely yes.

A number of adjustments can be made to help a mother customize laid-back breastfeeding (also known as “Biological Nurturing”) to her body type and situation.  As you can see from these line drawings, one adjustment is changing the direction of the baby’s “lie” on her body.  In all laid-back positions, baby lies tummy down on mother, but this can be accomplished in many ways.  The baby can lie vertically below mother’s breast (as on this website’s banner), diagonally below the breasts, across her breasts, at her side, even over her shoulder.  As Suzanne Colson explains in her DVD, “Biological Nurturing: Laid-Back Breastfeeding,” the breast is a circle, and the baby can approach it from any of its 360 degrees, except for positions in which the baby’s body covers mother’s face.  So after a cesarean birth a mother can use many laid-back positions without baby resting on her incision.

Another possible adjustment is the mother’s angle of recline, or how far the mother leans back. In laid-back positions, the mother leans back far enough so that her baby rests comfortably on her body without needing to support her baby with her arms but is upright enough so she and her baby can easily maintain eye contact.   Because most hospital beds are adjustable, finding their best angle of recline is especially easy during the hospital stay.  At home, I suggest mothers imagine the positions they use to watch their favorite television show.  Most of us lean back on a sofa, chair, or bed, using cushions or pillows so we can relax our shoulders, head, and arms.  Colson says the best laid-back breastfeeding positions are those that mothers can easily and comfortably maintain for up to an hour.

When using laid-back breastfeeding, ideally each mother finds her own best variations by trial and error.  In light of these insights, I think the time has come for us to stop naming and teaching specific breastfeeding “holds.”  (After all, no one teaches bottle-feeding mothers how to hold their babies during feedings!)  That way, mothers will no longer waste their time trying to duplicate feeding positions taught in classes or pictured in books that may not be right for them or--even worse--may even make early breastfeeding more difficult. Instead, each mother’s focus will stay exactly where it belongs: on her and her baby.

Reference

1 Colson, S. D., Meek, J. H., & Hawdon, J. M. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development 2008; 84(7):441-449.

 

Tuesday
Sep282010

Changing How We Teach Breastfeeding

We are experiencing a sea change in breastfeeding.  But how quickly can we change our approach?  At a breastfeeding conference last weekend, I summarized breastfeeding teaching strategies since 1980, how our understanding has evolved, and how this affects the way we help mothers. 

In 1980, I was told to breastfeed my first baby by holding him in my arms with his tummy facing the ceiling, which I realize now was a bottle-feeding position.  Over time, these instructions changed.  Instead, we recommended mothers hold their babies “tummy to tummy.” To make latching easier, we suggested breast support using the “C” hold and “U hold.”  We incorporated a variety of techniques for helping babies achieve an asymmetrical—or off-center—latch.  

However, in 2008, U.K. researcher and midwife Suzanne Colson published an article indicating that some of our fundamental assumptions had been wrong.  Not surprisingly, our “latching” or “attachment” instructions had been influenced by what we grew up seeing.  Generations of bottle-feeding had convinced us that mothers needed to sit upright or lie on their sides to breastfeed their babies.  

What changed?  In her research, Colson identified 20 inborn reflexes that help babies breastfeed.  And surprise!  Like baby piglets and other newborn mammals, Colson found that these reflexes work best when our babies feed on their tummies.  It turns out that all those years of teaching upright and side-lying breastfeeding positions may have been wrong-headed.  Although our tried-and-true methods make sense in some situations, rather than using them sparingly, we taught all new mothers to breastfeed this way.  As a result, gravity pulled babies away from their mothers’ bodies and made breastfeeding more challenging.  Colson noted that as “positioning and attachment” techniques became more widely taught in the U.K., more new mothers gave up on breastfeeding early. 

Colson’s research demonstrated that when mothers simply lean back and rest their babies tummy down on their semi-reclined bodies, most of our complicated latching instructions are no longer needed.  In “laid-back” positions, gravity keeps mothers and babies touching and helps rather than hinders breastfeeding. 

Last week I spoke to a mother with a 5-day-old baby who at first had decided to formula feed because her baby wouldn’t take one breast and breastfeeding was just too hard.  But then she felt her milk increase and decided to give it another try.  Her goal was to do some breastfeeding and some formula-feeding.  I told her about laid-back breastfeeding positions and steered her to http://www.biologicalnurturing.com/ to watch Suzanne Colson’s video clips.  When we spoke again yesterday, her 10-day-old baby was now exclusively breastfeeding and she told me how much easier laid-back breastfeeding had been for her. 

After my conference talk, many of my listeners—most of whom work with breastfeeding mothers every day—struggled to accept this new approach.  Clearly much thought and reflection was needed before many could translate this knowledge into practice.  Major paradigm shifts are never easy.  But for the sake of mothers and babies, here’s hoping this one doesn’t take too long! 

For more on laid-back breastfeeding, see my earlier post: http://www.nancymohrbacher.com/blog/2010/7/18/laid-back-breastfeeding.html 

Reference

Colson, S. D., J. H. Meek, et al.  Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev 2008; 84(7): 441-9.

Sunday
Jul182010

Laid-Back Breastfeeding

One reason breastfeeding has gotten the reputation of being so much work is that many mothers use feeding positions that cause muscle strain and require supporting baby’s weight with their arms for long periods. Now there is an alternative. 

In the research she conducted for her PhD thesis, British midwife Suzanne Colson analyzed the effects of gravity on breastfeeding in 93 videotaped feeding sessions of British and French mothers during the first month of life.  After scrutinizing these videos, Colson identified 20 inborn reflexes babies use to get to the breast, latch on, and feed.  These reflexes are triggered best when baby feels light pressure against her chin, torso, hips, legs, and feet.  They can be triggered when a mother breastfeeds sitting up or lying on her side—the breastfeeding positions traditionally taught—but Colson’s research found that in these positions, gravity makes breastfeeding more challenging.

When the study mothers tried to breastfeed sitting up or lying on their sides, gravity pulled their babies’ bodies away, creating gaps between them. Many babies became frustrated and upset when their feeding triggers were missing. One baby of an upright mother began batting at the breast, a reflex Colson refers to as “arm cycling.”  This mother finally gave up, assuming her baby did not want to breastfeed. The pull of gravity caused other babies to arch away and fuss, making attachment difficult. More upright or side-lying mothers found breastfeeding to be a struggle.

When mothers used what Colson calls laid-back breastfeeding (mothers leaning back with all body parts well supported and their babies lying tummy down on their semireclined bodies), the dynamics were very different. Gravity kept their babies’ bodies securely against theirs so no gaps could form and feeding triggers were continuous rather than interrupted. There were far fewer breastfeeding struggles, and the mothers perceived breastfeeding more positively. One reason may be that in laid-back positions, mothers were freed from supporting their babies’ weight with their arms. One of these mothers said, “Breastfeeding is so easy. I wish more of my friends were doing it.”

Colson concluded that human babies, like hamsters and puppies, feed best on their tummies.  From a practical standpoint, breastfeeding in laid-back positions is a lot less work. Thanks to gravity, baby’s chin, torso, legs, and feet automatically stay in contact with mother’s body and mother’s body supports baby’s weight throughout the feeding.

Especially during the early weeks, using laid-back positions reduces the steps mothers need to remember about getting their baby latched on deeply.  Good breastfeeding dynamics occur almost automatically, allowing mothers to focus on their baby instead of what they need to do next.  With gravity helping instead of hindering breastfeeding, the same reflexes (such arm cycling) that can get in the way in other positions actually make it easier for baby to get to the breast and attach deeply. Having at least one hand free also makes it easier for mothers to help their newborn or just to stroke and enjoy her. If desired, variations of laid-back breastfeeding can also be used when mother and baby are out and about.  Mothers can just scoot their hips forward in their chair and lean back.

For more information, see Colson’s website at www.biologicalnurturing.com and see her DVD, “Biological Nursing: Laid-Back Breastfeeding.”

Reference

Colson, S. D., Meek, J. H., & Hawdon, J. M. (2008). Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development, 84(7), 441-449.