EverythingOldIsNewAgain
DianeWiessinger,MS,IBCLC,LLLLeader
[email protected]
Firstofallwhat’snotcontroversial:Thiscan’tberocketscience.Afterall,afrogmaylayhundredsofeggsata
sitting,onlytwoofwhichneedtoreplaceherandhermateinherlifetime.Sothesurvivalrateforanyoneegg
isextremelylow.Adoghasalitterofunderadozen,withafewlittersinherlifetime,sotheirsurvivalrate
needstobehigher.Ahumancanproduceoneoffspringayear,topspeed.Itwouldmakezerosenseforbirth
accidentstobecommon,orforbabiestodieofstarvationinthefirstweekortwobecausetheycouldn’tfigure
outhowtofeedthemselves.No,thisisaverysturdysystem.But.
Babies are built to withstand common risks like somewhat difficult births, cold, temporary separation, early
hungerandthirst,andpathogens.Thesearealleverydayhazards,anditwouldbeapoorsystemindeedthat
producedyoungatsuchaslow,physicallyexpensiverateanddidn’tprotectthemwellduringthepregnancy-tobreasttransition.Whatbabiesarenotnecessarilybuilttodealwitharedrugsandsurgicalinterventionslike
prematurecordcuttingandcesareans,becausetheyneveroccurnaturally.
Interestingly, our culture makes huge efforts to protect newborns from somewhat difficult births, cold, even
briefseparations,earlyhungerandthirst,andpathogens.Butwe’vebeengenerouswiththedrugsandsurgical
interventions.Istheresomeconnectionwithourbreastfeedingproblems?Thedrugscansurepackawallop.
Andmothersaren’tpreparedfordrugsorsurgeryeither.Sowe’vespentyearstryingtoteachmothershowto
teachtheirbabies.Ithasn’tworkedverywell.Soweswungtheotherway.Maybetoofartheotherway.
The World Health Organization, UNICEF, and the World Alliance for Breastfeeding Action (WABA) have a an
onlinevideodemonstratingthe“breastcrawl”asapartialsolutiontoearlybreastfeedingproblems.Theidea
hasitsrootsintheworkofLennartRighardandMargaretAlade,whose1995videoshowsnewbornscrawling
tothebreastallbythemselvesonasupine(face-up)motherwhooffersnohelpbeyondkeepingthebabyfrom
fallingtothefloor.Buttheirideahadbeentoshowwhatbabiescoulddowithouthelp,notwhatbabieshadto
dowithouthelp.
TheWABAvideoandcertainbreastfeedingprogramsbecamesoenthusiasticaboutbabies’instinctiveabilities
that they began urging all maternity facilities to implement the “breast crawl” But the approach overlooks
somerealproblems:
•
Nomotherinherrightmindwouldlieflatorsemi-reclinedandmotionlesstoexaminehernewborn.She
would sit up at least partway. Imagine lying flat on your back and having someone put an intriguing,
compellingpresentontopofyou.Wouldyoustayflattolookatit?
•
Nomotherinherrightmindwouldstayhands-offwithhernewborn.Itsurelytakescarefulandcontinuing
instructiontokeepanewmotherfromtalkingto,shifting,admiring,grooming,andsoothingherbaby.
•
Allthismeansthatthemotherisstillbeingleftoutoftheinfantfeedingequation.Sheisstillbeinggiven
instructions,rules,andprohibitions.Sheisimportantnotasthecenterofherbaby’sworldbutasafood
source.
•
Whenamotherliestoofarback,herbreasttissuesagstowardherchestwall,awayfromthebaby’smouth.
Theprone(face-down)babiesinwhatI’vecometothinkofasthe“DeadMotherVideos”grabamouthful
ofnipple,yes,butIhaveyettoseeavideothatshowsareallydeeplatch.Andbabiesaren’tdesignedto
nursewiththeirbuttockslevelwithorevenhigherthantheirhead,withtheirfullbodyweightpressingon
thosenewly-operatingribsandlungs.
Morerecently,someofushavetaughtmotherstowatchfortheseriesofinstinctivestepstolatchingthatneed
tooccurinthefirsthour.Themotherismoreupright,thoughit’snotalwaysapparentinthevideos.Butshe’s
stillinstructedtowatchherbaby,ratherthaninteractingwithherbabyinwhateverwayshechooses.
AsfarasIknow,allothermammalmothershelptheirbabies.Theydon’tgivemuchhelp–thedogrollsonher
sideinsteadofstandingup;thehorseandkangaroostandupinsteadofrollingontotheirside;manymammals
may give the baby a vague nudge in the right direction if he strays – but they do help. I think we’ve overassistedintherecentpast,andnowwe’rehavingtroublebackingoffappropriately.
Christina Smillie’s “Baby-led breastfeeding”1 means exactly that: baby-led, but not mother-dead. She
encouragesmothersjustto“helpthebabydowhathe’stryingtodo.”Buttoday’smothershavelearnedtheir
“how to” lessons too well, and many are almost literally paralyzed when they’re urged to follow the baby’s
lead.
Sowheredoesthatleaveus?Well,whathappenedinthedaysbeforeweknewanything?I’vetalkedwitha
numberofusgray-hairs,andweallseemtosaythesamethings:“Idon’tknow;wejustdidit.”“Ididn’tknow
anythingatall.Fortunately,mybabydid.”“Ihad‘TheWomanlyArtofBreastfeeding’andKarenPryor’sbook,
‘BreastfeedingYourBaby,’andwejustsortofworkeditout.”Andsoon.Overandoveragain,“Idon’tknow;
wejustdidit.”
Butwhat,exactly,didwedo?LaLecheLeague’soriginalmimeographed“WomanlyArtofBreastfeeding”from
1958offeredonlythis:
Whetheryousituporliedownwhileyounursehimisuptoyou.Whicheverpositionyoufind
mostcomfortableisbestforyou.Don'ttrytoshovethenippleintohismouth.Resthischeek
againstitandhe'llturnhisheadtowardsitandlatchon.
TheWABfrom1963–thethinbluevolumethatmanyofusold-timersused–hadmore:
Whicheverpositionyoufindmostcomfortableforyouandthebabyisthebestforyou.During
theearlyweeks,youmayfinditmorerelaxingandconvenienttoliedownwhileyounursethe
baby. Certainly this is the thing to do for those middle-of-the-night suppers, so that you can
dozebacktosleepwhileheisnursing.Lateron,youmayprefertositinachairorinacornerof
thesofaformostofhisfeedingsduringtheday.
Inthebeginning,whenyouarelyingdown,andyouaregoingtonurseyourbabyontheright
side,liedownonthatside,putyourrightarmupoverthebaby’sheadorunderit,whicheveris
more comfortable for you. With the left arm, bring the baby toward you till his cheek is
touchingyourbreast[italicsoriginal],withthenipplenexttohismouth.Hewillturnhishead
towardit,forthisisthewayheisbuilt,andopenhismouth.Whenhedoes,pullhiminabit
closer, just enough so he can get the nipple into his mouth and suck. For nursing on the left
side,reverseallthis.Ifyoupullhislegsclosetoyou,itangleshisbodyenoughtokeephisnose
free.Thiskeepshimwarmandcozybesides.
There’s information embedded there that we’ve overlooked for a quarter century. First, notice that there’s
nothingatallabout“positioningthebaby.”Ithinkthat“position”startedtobeusedasaverbwhenweadults
startedtakingfullcontrolofTheLatch.Untilthen,wefound“acomfortableposition”forourselves,andheld
ourbabiescomfortably.Theonlythinginitalicsistheencouragementtoletthebaby’scheektouchthebreast.
My first baby was born in 1979. Most of us oldsters remember touch-the-cheek-with-the-nipple as the only
instruction we received. Our babies were separated from us most of the time in the hospital, and many or
mostofthemreceivedbottlesinthehospital,butmysenseisthatnever-latchingbabiesweretrulyuncommon.
Many of us had sore nipples to overcome (mine lasted six weeks), and many of us failed because of terrible
managementadvice.ButwhenInursedmyfirstborninpublic,womenwouldcomeuptometotellmethat
theymissedthosedays,orthattheyhadwantedtobreastfeedbuthadn’thadenoughmilk.Nooneeversaid
tome,“Iwantedtobreastfeed,butmybabyneverlatchedon.”Thatpartwasconfidentlyassumed.Byallof
us.
Then came the early to mid 1980s. In an effort to end those sore nipples, breastfeeding helpers began to
dissect“TheLatch”.Mysixweeksofsorenesswerenodoubtcausedbecausemybabynursedwithhishead
turnedtotheside.Irememberholdinghimsunny-sideupatfirst,butalaterpictureshowsmeholdinghim
facing me. Maybe that’s when I stopped being sore. My second was born in 1982, and I used the latest
positioningtechnique:holdthebabytummytotummybutdon’tlethimtouchyourbreast.Instead,ticklehis
lipswithyournippleandquicklybringhisopenmouthoverit.Thatwayhedoesn’tturnhishead,andwithout
theturnedheadhe’smuchlesslikelytotugonyournipple.Sureenough,Iwasonlymildlysoreforonlypartof
aday.ButwhileIremembernolatchingproblemswithmyfirstbaby,Iremembermysecondbabyshakinghis
headinconfusion.“It’srighthereinfrontofyou,”Itoldhim,andindeedhisconfusiondidn’tcauseusmuch
problem.Still,Iwonder,lookingback,ifweweretheleadingedgeofthenon-latchinggeneration.
InstructionsinTheWomanlyArtofBreastfeedingwentfromthosesimpleparagraphstolongerdescriptions,to
4numberedstepsplus3morecommentsinoneedition,toatotalof10numberedstepsinalaterone.
Wethoughtwewerebeinglogical.Thebabyturnshisheadinresponsetoacheektouch,andthatmeanshe’ll
enduptuggingonthenipple.Solet’shavehimfacethebreast–notthatsunny-side-upbottle-feedingposition
weusedbefore.Hmm,butifhefacesthebreasthe’lljustbesmushedintoit,orhemighttrytolatchbefore
we’reready,solet’skeephistummyagainstusbutkeephisheadawayfromthebreastandwe’lldecidewhen
heshouldlatchon.
Whatwedidwasremovealmostallhisfeedingcues.Newbornsdon’tlatchbasedonvision,theydoitbyfeel.
Leftwithonlyanunpredictabledabbingofhislipstothenipple,thenewbornofthe1980shadlittlesenseof
whatwasbeingaskedofhim.Weworkedharderandhardertodefineoneortwosignalsforhim–weadded
thecross-cradlehold,wedabbedupperlip,lowerlip,bothlips,nosetochin,cornertocorner,lookingforthe
magic button that would make him open wide. We used a Rapid Arm Movement. We made sure his lower
body was pasted to us. We used specialized pillows. But we steered completely clear of that basic rooting
reflex, as if, powerful though it was, it was some accident of nature to be avoided. And some babies never
attached. We blamed the kind of pillow, the post-birth separations, the bottles, the birth medications (but
remember,theseparationsandbottlesandsomeprettyheftybirthmedicationshadbeentherebefore).And
we came up with new and more meticulous approaches to The Latch, which was now a noun instead of an
actionthatbabiesundertook,stillwithoutallowingtherootingreflextobeapartofthataction.
Co-bathingseemedtoworkformany,andsodidskin-to-skin.Nursesreportedleavingmothersinskincontact
with their babies, and coming back to find them nursing. Was it the water in the bathtub? Was it the skin
contactinthebed?Orwasitsomethingevensimpler?
SuzanneColson’sBiologicalNurturing®techniqueputgravityinthedriver’sseatforbothmotherandbaby.2,3,4
Themotherleansbackcomfortably,everypartofherheadandbodywell-supportedandrelaxed.Thebabylies
proneontopofher,butremember,sheisn’tcompletelyflat.She’ssomewhatupright,soherbabyistoo.Her
position “opens her torso”, so that her lap isn’t an obstacle and the baby can lie in any of a near-infinite
number of positions. Often, he plants a foot on her thigh, bracing himself as most baby mammals do when
theynurse.Shemayinstinctivelyplaywithhisfeet,accomplishingthesamething.
The well-supported baby (who is no fool) lies on her with his head turned, precisely so that his face isn’t
smushedintohismother.Thatgiveshimcheekcontactwithherskin,andthatpromptshimtolifthishead,
straightenit,androot…andloandbehold,there’sthenipple,eitherrightbyhisgapingmouthorwithinheadbobbing distance. If he can’t seem to find it, his mother (who is also no fool) responds and repositions her
baby,herbreast,herownbody,oranycombination,andhesearchesagain.Thisisn’taone-manshow.
With his front well-supported by gravity but angled enough that his head is above his bottom and his lungs
aren’tcompressed,hecanrelax.Handsandfeetcanstopgrapplingwiththinair,tryingtofindsomethingsolid.
Everyone can calm down. And that frees a host of reflexes in both mother and baby. It’s everything the
bathtubgaveus,withoutthewater.Anditworks.Muchofthetime.
Butthere’sstillthatword“technique.”We’vebeentherebefore,andithasalwayshasitslimits.Onething
BiologicalNurturing®hasdoneforusistore-openthedoorfor,um,wellhowabout“casualnursing”or“just
nursing”or“naturalbreastfeeding”?Anamewithnoreferencetoaposition,nospecificrulesatall.Aname
thatallowsforeverypositionwegray-hairsusedbeforeweknewtherewerepositions.Wefiguredouthowto
usegravity.Weleanedforwardandsupportedourarmonourthigh.Orweslouchedbackonthesofa.Orwe
satcross-leggedonthefloor,withthebabysnuggledinthecriss-cross.Noholdsnamed,noholdsbarred.
NancyMohrbacher’smaterialputallthese“naturalbreastfeeding”ideasandmoreintovideoform,sobesure
tobookmarkit.5Forthebabywhoneedsalittlemorehelp,RebeccaGlover’swork6isalsoatechnique,butshe
doesanespeciallygoodjobofsummarizingthemechanicsandmeldingthemwithcasual,comfortablewaysto
sitandlie–anexcellentandgentleassistwhencertainbabiesneedmorehelp.Themotherusesasinglefinger
or thumb and presses at the base of her nipple on the same side as the baby’s nose, tilting the nipple away
fromthebabyandpresentinga“pouf”ofbreastthatentersthemouthfirst,withhernipplefoldinginafterit.
Sowhathavewegainedfromaquartercenturyoftechniques?We’verediscoveredthevalueoftherooting
reflex.Andwehaveamuchbettergraspofthebasicmechanicsofthewholething.
Fortheeasiestnursing,babiesseemtoneed:
•
Stability,oftheirfrontsandifpossibletheirfeet.
•
Gravityworkingwiththem,notagainstthem,tohelpstabilizethem.
•
Asomewhatverticalposition,likeallotherhigherprimates
•
Lowerjawaccess,sothattheir“workingjaw”hasplentyofroomtolanddeeplyonthebreast
•
Theirchinstabilizedagainstthebreast,thewaywestabilizeourwristwhenwewrite
•
Headtippedslightlyback,toallowlowerjawaccessandastabilizedchin
•
Face/cheekcontactwiththebreast,sotheycanroottowardthetouch
•
Afeedingsequence–anorderinwhichtheyapproachthenipple–thattheycontrol
•
Alittlehelpfromtheirmothers
•
Aright-brainedapproach–notoverthinking!–forboththemselvesandtheirmothers.
Andweneedtorecognizethatnoneofthosethingsmattersatallwhenbreastfeedingisgoingfine!
We’veworkedhardtoregainwhatthemothersofthe1980sandearlierbroughttotheexperience:
•
Beingcomfortableisanimportantplacetostart.
•
Whilebreastfeedingisbaby-led,itisn’tmother-dead.
•
Babieshaveapowerfulurge,whichwe’vebeenignoring,toroottowardacheektouch.
•
Gravitycanworkagainstus,oritcanbeourally.
•
Detailedinstructionscan’tpossiblybeasroutinelynecessaryaswe’vemadethem,ornomammalwouldbe
abletofeedherbabies.
Andmaybemostimportant:
•
Mothersandbabiesaren’tdesignedtobeginthisrelationshipundertheinfluenceofdrugsorsurgeries.
•
Mothersandbabiesaren’tdesignedtobeginthisrelationshipundertheinfluenceofrules.
Helping mothers with breastfeeding starts with helping them reclaim birth. If we can facilitate a good birth,
offeralittlebasicbreastfeedinginformation,givethemtimealone,makesuretheyhaveanon-goingcheering
section in the form of mother-to-mother support, and help them in more technical ways only as needed,
maybewecanhelpmothershaveastartlikewhatwegray-hairshad…thistimewithoutthesoreness!
1.
2.
3.
4.
5.
6.
ChristinaSmillie’sDVD,availablethroughwww.geddesproduction.com
SuzanneColson’sDVD,availableatwww.biologicalnurturing.com
ColsonSD.AnintroductiontoBiologicalNurturing.HalePublishing,L.P.,Amarillo,TX.2010.
Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating
breastfeeding.EarlyHumDev2008;84(7):441-9.
Youtube.com/nancymohrbacher
RebeccaGlover’sDVD,brochure,andcharts,availableatrebeccaglover.com.au