The sad truth is that most women today are not meeting their breastfeeding goals. Three recent studies shed some light on the issues.
During the more than 30 years I've been helping breastfeeding families, it's been thrilling to see the rise in U.S. breastfeeding rates. In the early 1980s, only about 50% of American women breastfed even once. Now nearly 80% of new mothers breastfeed.
But this picture is still far from rosy. The sad truth is that most women today are not meeting their breastfeeding goals. Three recent studies shed some light on the issues. Here's what they found:
More than two thirds of women intending to breastfeed exclusively for three months didn't get there.
The most common reasons women give up on breastfeeding are:
- latching problems
- worries about milk production
- nipple pain
Sadly, most mothers who struggle with breastfeeding think the only solution is to try harder, but that's frustrating and exhausting. Wouldn't it be better instead to make breastfeeding easier? Rather than tackling every issue-latching struggles, milk supply, sore nipples--individually, why not use a single approach that addresses many challenges at once?
That is what a new approach called Natural Breastfeeding can do.
What is Natural Breastfeeding?
Let me back up a little and explain how this new approach came to be. By chance in 2008 I came across a U.K. study that rocked my world. It found that the breastfeeding positions we had been teaching new mothers for decades could actually be contributing to the ongoing epidemic of early problems. What did this study find? Human newborns' innate responses are similar to those of other mammal species--including puppies, kittens, and piglets--that feed on their tummies. In other words, our babies are hardwired to be "tummy feeders."
When I read that paper by Dr. Suzanne Colson (who calls her approach Biological Nurturing® or "laid-back breastfeeding"), my mind went first to the babies I'd seen in the breast crawl videos often shown in childbirth classes. The first breast crawl videos appeared in the late 1980s, when Swedish researchers found that when a newborn is laid tummy down on mother's body, within the first hour something magical happens. Without any help, a healthy baby will crawl up the mother's body, find the nipple, latch on, and begin breastfeeding. You can see this in action by doing an online search for "breast crawl."
What Baby Brings to the Table
Not long ago, scientists believed that most newborn reflexes were useless leftovers from our tree-dwelling ancestors. But now we know better. We know these reflexes are key to early breastfeeding.
Every brand-new baby comes into the world with a whole repertoire of responses that are custom designed by Mother Nature to make baby an active breastfeeding partner. Baby is born with what's needed so that--when conditions are right--breastfeeding and bonding happen easily and naturally. These responses work best when baby lies tummy down on mother with gravity anchoring baby there. I'd seen the breast crawl videos for years but somehow never made the mental connection between the babies' tummy-down position and the ease with which they took the breast.
Enter Dr. Theresa
I began trying this approach with the breastfeeding mothers I saw and found that it solved many problems. But some were reluctant to try it. Thankfully, around this time, I began meeting with a local obstetrician Dr. Theresa Nesbitt ("Dr. Theresa"). No longer delivering babies, now Dr. Theresa's primary interests are evolutionary biology and building healthy brains, so it's not surprising that she turned her attention to breastfeeding.
In our discussions, Dr. Theresa added more pieces to our puzzle. She described the work of the Prague School, where scientists identified the "pressure buttons" on babies' bodies that when pushed improve their coordination (they call this Dynamic Neuromuscular Stabilization or DNS). We discussed the work of Dr. Brian Palmer and why the act of breastfeeding is as important to newborn development as the milk. Dr. Theresa also shared key findings in the field of brain science.
Dr. Theresa and I devoted many hours to putting together these diverse but related puzzle pieces from around the world. What emerged is a new approach we call Natural Breastfeeding. It is "natural" because it takes advantage of what we know about the innate behaviors Mother Nature put in place to help women successfully feed and nurture their newborns. But while its concepts are solidly based in science, we knew from the brain research that for Natural Breastfeeding to catch on, we had to make it fun, jargon-free, and mother friendly. Images and videos would also be key, because that's how people learn best.
Learning to Breastfeed
What does the brain and learning have to do with breastfeeding? A lot, as it turns out. A crucial aspect of changing current practice involves highly specialized brain cells called mirror neurons.
You may have heard the expression "Monkey see, monkey do," which describes mirror neurons in action. When we see or hear something, mirror neurons record and remember it as if we are performing the action. Human mirror neurons are even stimulated by watching actions on a video. That's why it's quicker and easier to learn to dance, fry an egg, or ride a bicycle by observing a demonstration than it is to listen to an explanation or read instructions.
That is also why until very recently women didn't need to be taught how to breastfeed. Their mirror neurons already knew. When they gave birth, mothers in the past were familiar with how to nurse their babies because they saw it growing up.
But most of today's mothers don't have this advantage. Many have never even seen another woman breastfeed without a cover. And the only breastfeeding images they usually see are of women nursing in sitting-up-straight feeding positions-positions that also make it impossible for newborns to help. In light of these influences, our epidemic of early breastfeeding problems makes more sense.
The Power of Observation
Pictures are very powerful, especially the pictures in our mind. One of the biggest barriers to a smooth breastfeeding start is that most pregnant women have an image in their minds of what they think breastfeeding is like that is fatally flawed.
Mother is sitting in a chair comfortably holding baby in her arms. Baby is suckling gently at her breast with his lips pursed around her nipple
In this mental picture, the mother is breastfeeding her newborn in what is essentially a bottle-feeding position, which causes problems. Sitting straight up with your weight resting on your bottom after having a baby is painful. Holding baby close--so there are no gaps between you--quickly tires your arms, causing head, neck, and back strain. Baby suckling with pursed lips quickly leads to sore nipples
If the image in a woman's mind leads to challenges and pain, her dream breastfeeding experience can quickly become a nightmare. Yet this is not only how pregnant women imagine breastfeeding, this is how they are taught to breastfeed in hospitals and birthing centers around the world.
Feeding Positions and Early Breastfeeding
To understand why early feeding positions matter so much, let's look at what we know. To activate a newborn's internal GPS-so baby knows where she is and what to do-she needs to feel her entire front against her mother. This full frontal contact also activates the "pressure buttons" on a newborn's ribs, wrists, inside of the knees, and tops or bottoms of the feet, which stabilizes her spine, giving her more control over her movements so can feed more effectively. You can make this happen when you're sitting up straight. But why work this hard?
In the commonly used cradle, cross-cradle, and football/rugby holds, mothers and babies must fight the effects of gravity to get babies to breast level and keep their fronts touching. If gaps form between them (which can happen easily with gravity pulling baby's body down and away), this disorients baby, which can lead to latching struggles. The pull of gravity makes it impossible for a newborn to use his inborn responses to get to his food source and feed. For baby, it is like trying to climb Mount Everest. Instead of mothers and babies working together as breastfeeding partners, mothers must do all of the work. Instead of being able to relax while baby helps, most mothers sit hunched over, tense, and struggling.
To complicate things further, in these positions, gravity can transform the same inborn feeding responses that should be helping babies into barriers to breastfeeding. Head bobbing becomes head butting. Arm and leg movements meant to move babies to the breast become pushing and kicking. Mothers struggling to manage their babies' arms and legs in these upright breastfeeding holds have often told me: "I don't think I have enough hands to breastfeed."
How Natural Breastfeeding Can Help
In Natural Breastfeeding positions, baby rests tummy down on mother's body, ensuring the full frontal contact that activates his GPS. Baby's weight pushes the pressure buttons on his front, which improves his coordination for easier feeding. Natural Breastfeeding makes it possible for babies to be the active breastfeeding partners that nature intended. But it's not just good for babies. Mothers can relax completely and rest while baby feeds, often with both hands free. And gravity helps baby take the breast deeply, so there's no need to micromanage baby's latch.
Natural Breastfeeding positions are appropriate any time, but they are especially helpful during the first few weeks, when babies lack the muscular strength and coordination to overcome gravity's effects on their head. It takes a full year, after all, before babies can resist gravity enough to walk. But babies develop the head-and-neck control they need to fight gravity during breastfeeding much sooner-usually within four to six weeks.
That's why many mothers who had sore nipples at first discover that as the weeks pass, their pain goes away. It's not that their nipples "toughen up." (Nipples don't develop calluses like a guitar player's fingers.) Over time, babies just get coordinated enough to latch themselves on deeply, even in gravity-defying positions. But why wait? In Natural Breastfeeding positions gravity helps babies latch deeper, so mothers can breastfeed in greater ease and comfort right from birth.
A New Normal
If humans learn mainly by seeing and doing and nearly all of the breastfeeding images women see today show the sitting-up-straight positions, then it's not surprising that some mothers and breastfeeding supporters feel reluctant to try this this unfamiliar new approach.
Dr. Theresa and I realized that the key to changing perceptions about early breastfeeding is to make images of this new approach available to more women, especially during pregnancy. Our intention is to replace a lifetime of common but unnatural infant-feeding images with a "new normal" that will make it easier for mothers to meet their breastfeeding goals.
Please Help Spread the Word
We were very lucky that-for the benefit of mothers everywhere-the women featured in the Natural Breastfeeding program generously allowed their breastfeeding images and videos to be put online. Our basic videos are freely available in our "Natural Breastfeeding How-Tos" presentation. You can see more videos from the program on my YouTube channel as well. Please share links to these videos widely so that more women can experience an easier breastfeeding start.
Natural Breastfeeding is like the training wheels on a bicycle. It helps you avoid unnecessary pain and struggle while you and your baby are learning. Natural Breastfeeding makes the early weeks of breastfeeding easier by taking advantage of the innate newborn responses that are stimulated by gravity and contact. By making the most of what baby brings to the table, Natural Breastfeeding allows you to use the behaviors built in by Mother Nature to help you successfully feed and nurture your newborn.
Natural Breastfeeding positions are how expectant mothers should imagine themselves feeding their babies. Please help us spread the word!
Colson, S. D., et al. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev 2008; 84(7): 441-9.
Odom, E.C., et al. Reasons for earlier than desired cessation of breastfeeding. Pediatrics 2013; 131(3):e726-32.
Perrine, C.G., et al. Baby-friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics 2012; 130(1): 54-60.
Wagner, E., et al. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics 2013; 132(4):e865-75.
Widstrom, A-M., et al. Newborn behaviour to locate the breast when skin-to-skin: A possible method for enabling early self-regulation. Acta Pediatr 2011; 100: 79-85.