Positioning: A New Perspective

Positioning: A New Perspective

Categories: Leader Today

Mary Francell, Atlanta, Georgia, USA

When I first became an LLL Leader over 20 years ago, I was told that breastfeeding is a learned behavior. This always struck me as a little odd. After all, aren’t we mammals? Other mammal babies seem to know what to do. Not surprisingly, it turns out that human babies know what to do too. When held on a caregiver’s chest, healthy newborns will bob their heads and begin moving towards the closest breast—whether it contains milk or not!

Suzanne Colson, the British midwife who coined the term “biological nurturing,” states that the learned breastfeeding theory began with obstetrician Mavis Gunther, who believed that because chimpanzees in zoos sometimes need to be shown how to breastfeed, human mothers also need breastfeeding instruction. Ultrasound studies of nursing infants in the 1980s led to specific teaching about the best way to latch a baby. These positioning and attachment instructions included directives such as “sit upright,” “tummy-to-mummy” and “tickle baby’s lips with the nipple,” but Colson was unable to find any supporting research for such “rules.” In fact, obstetrician Christina Smilie believes that this sort of cognitive learning activity interferes with the right-brained, instinctual behavior of new mothers, possibly even inhibiting oxytocin release.

Laid back breastfeeding

In her research, Colson found that when placed tummy down on their reclined mothers, primitive neonatal reflexes (PNRs) such as stepping, head bobbing, arm cycling and rooting all helped the baby find the breast. This had previously been described by other researchers and popularized in an online video from UNICEF called Breast Crawl, although many people believed this only applied to newborns shortly after birth. Babies actually retain this ability for the first month or two of life. Smilie’s video, “Baby Led Breastfeeding, the Mother Baby Dance” (see link below), shows how mothers instinctually know how to help their infants with self-attachment as long as mother reclines with baby tummy down on her chest.

In hospitals today, new mothers are typically taught several upright breastfeeding positions (cradle, football/rugby, cross-cradle) that place pressure along the infant’s back. Colson calls this dorsal feeding and states that this pressure can inhibit PNRs or produce behaviors that thwart latching, such as head shaking and arm thrashing. In addition, these upright postures can be uncomfortable during long nursing sessions, particularly the cross cradle position, which may lead to mothers leaning forward with the arm holding the breast out to the side like a “chicken wing.”  Of course, these positions can sometimes be very useful but may not be useful for most new mothers.

Breastfeeding expert Nancy Mohrbacher believes that these popularly taught upright positions are actually modified bottle feeding holds—and indeed, many mothers often try to push the breast into the baby’s mouth like a bottle. Mohrbacher’s Natural Breastfeeding program encourages mothers to lean back and let gravity stabilize the baby on mother’s body so baby can latch naturally. She encourages mothers to first adjust their body, then adjust their baby, then adjust their breast by compressing or lifting if the baby needs extra help latching.  In addition to a program online that mothers can purchase, Leaders can also refer to Mohrbacher’s free videos on YouTube (see link below).

Swaddling can interfere with natural reflexes

New parents often assume that swaddling is an expected part of baby care when hospital staff hand their newborn to them wrapped like a burrito. While swaddling has been part of traditional cultures for thousands of years, in the past it was primarily used for transportation (carrying a swaddled baby on mother’s back) or safety (keeping baby quiet and out of harms way). In the early part of the 20th century, swaddling became popular in Western societies as a way to soothe newborns who were routinely separated from their mothers in hospital nurseries.

Swaddling has recently seen a resurgence with the popularity of Dr. Harvey Karp’s The Happiest Baby on the Block. In 2010, there was a debate between Mohrbacher and Karp on the merits of swaddling in the pages of the International Journal of Childbirth Education. Mohrbacher commented that

…research has found that regular swaddling can contribute to negative breastfeeding outcomes. Routinely swaddling babies during the first few days of life is associated with a delay in the first breastfeeding, less effective suckling at the breast, decreased intake of mother’s milk and greater infant weight loss.

Swaddling an infant, especially in a tight wrap, interferes with a baby’s natural PNRs. Babies suck their hands to organize themselves as well as use their hands to feel for the breast and nipple, so it’s also a good idea to avoid the use of baby mittens. Some mothers swaddle because in upright positions, the PNR of arm cycling can become breast boxing. Encouraging these mothers to lean back instead and to place baby’s hands on either side of the breast allows baby’s arms to help rather than hinder nursing. Newborns also use their feet to propel themselves into position, so mothers might be encouraged to “unwrap the burrito” fully before nursing.

Nursing pillows, yes or no?

Nursing pillows are recent inventions that sometimes cause more problems than they solve. The popular Boppy® Nursing Pillow was invented in 1989 as a tool to help babies around six months of age to sit unassisted; it quickly gained popularity as a breastfeeding aid. However, these types of pillows often place a baby too high or too low, usually in a horizontal position that does not allow for other angles where baby’s head is higher than her bottom. Nursing pillows tend to reduce contact between mother’s and baby’s bodies, often contributing to baby rolling onto her back while latched.

These products can contribute to back pain by encouraging a mother to lean forward in an awkward position and can also result in dependency (and difficulty nursing in public) when a mother “can’t” nurse without one. Nursing pillows can even be dangerous—an exhausted mother runs the risk of her baby rolling into the gap between her body and the pillow without her noticing. While a nursing pillow can sometimes come in handy for a mother of multiples, even in this case regular pillows often work just as well.

Of course, there are times when a mother needs extra help or support to nurse her baby—that’s where LLL Leaders and other lactation personnel come in. But often, a healthy mother just needs to lean back and spend time holding her baby while they learn breastfeeding together. Other mammals don’t need specific instructions, special swaddling blankets or expensive pillows to nurse their babies. Most of the time, human mothers and babies don’t either!


Breast Crawl UNICEF India
Biological Nurturing Colson
Baby Led Breastfeeding, the Mother-Baby Dance Smilie
Breastfeeding in the First Hours After Birth Global Health Media Project
Natural Breastfeeding Mohrbacher

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Mary Francell and her husband Howard are the parents of three breastfed children, aged 24, 20 and 17. She has been an LLL Leader for over 20 years and is currently Area Professional Liaison for LLL of Georgia, USA and a Contributing Editor for Leader Today. An International Board Certified Lactation Consultant, Mary works part-time at a pediatric office and also sees clients on contract with a private lactation practice in Atlanta, Georgia, USA.