Changing How We Teach Breastfeeding

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 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: Laid-Back Breastfeeding


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.

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