Thursday, June 9, 2011

Beyond the first hour - why baby-led is the secret to successful breastfeeding

It is well-recognised that the first hour or so after a baby's birth is a magical time when - if all goes uninterrupted - a newborn baby placed straight on his mother's bare chest will search for and attach to the breast unaided.

What isn't widely-known is that the reflexes and instincts that are active at that time do not switch off or go away, but remain for weeks and even months after birth.

In our work at the Breastfeeding Centre, a lot of what we do is helping new mothers work through attachment issues in the days and weeks after they leave hospital, often with sore and damaged nipples and usually supplementing with expressed breast milk and/or artificial baby milk. By the time they see us, they are well-versed in the theories of good positioning and attachment and have had many different hands attempt to get their baby on the breast.

Here we use a different approach. A combination of strategies  variously called baby-led breastfeeding, baby-led attachment, laid-back breastfeeding, biological nurturing and, more generally, skin to skin (skin2skin, S2S). We refer to the work of Dr Christina Smilie and Suzanne Colson, using their DVDs and other resources to guide women and their babies to a more intuitive way of breastfeeding.

In its most basic form, we encourage mothers to change from mother-led attachment, where the baby is held against her body and she controls when the mouth goes on the nipple to a baby-led approach, where the baby follows his natural reflexes and goes onto the breast unaided. This apparently simple refocus has amazing results and works for the majority of mothers/babies who come to us for help. It is so simple, so effective and so different from what they have previously been shown that they ask why it is not taught in hospitals. The answer to that is complex.

Along with every other breastfeeding counsellor, midwife, child health nurse and lactation consultant practising in the 1990s, I embraced the revolution that was positioning and attachment. Led by wise women such as Chloe Fisher, we learned the mechanics of how a nipple was positioned in a baby's mouth when well-attached and developed teaching techniques for mothers and those helping them to achieve this. With diagrams, dolls and knitted breasts, we progressed from the traditional Madonna or cradle-hold to the cross-cradle hold, which allowed the mother or her health professional to control when the baby's mouth touched the breast and quickly brought the mouth onto the breast before it began to close. Midwives began checking off a list - special K mouth, lower lip turned out, more areola showing above the mouth than below, tummy to tummy, chest to chest - and none of these are or were wrong. But somewhere along the line, we all forgot the baby! 

While everyone was trying to achieve this most natural of connections, we were working against the oldest tools in the world - instinct and reflexes. Even as we learned about the magic of the breast crawl, we still persevered with sitting mothers in an upright position, juggling pillows and cushions to get the baby's body just so and making the whole process more and more complex, more reliant of professional help - and more distressing when it didn't go well.

That leaves us with an awful lot of people to re-educate, a lot of rules to retract and a lot of confidence to rebuild. Even within the breastfeeding community, there is confusion about how to incorporate the good and remove the bad from this mix of techniques and approaches. 

Put simply, all we adults need to back off and allow the baby to show us what he needs and then help him do it. Rather having the mother sitting stiffly, hunched over the baby perched on a specially-designed pillow, we need to encourage her to sit comfortably, lie back if she wishes and take her time. We need to do away with seemingly compulsory nappy changing before feeds and other delaying practices that simply distress a baby and take away his ability to transition from sleep to feeding without crying and suppressing his natural feeding cues. We need to hold our babies in that most-natural position against our body and allow them to search for the breast, attach and feed, without assessing and checking and making sure it is "right". Mothers need to tune into the feedback they get - which includes pain and discomfort - and change what they need to make it feel better. No third person can tell a woman if her baby is "on right" as only she can feel if it is comfortable.

Well, it looks like he is on right ...

So, that's mostly what we do here. Show, encourage, support and learn. And watch as the magic of a relaxed mother and calm baby help hormones, milk and tears flow and confidence return. Yes, there are times when it still doesn't click and then we look to physical barriers - mouth issues, birth trauma or other factors in the baby making it hard or impossible to feed in the comfort zone. But mostly, we just watch the baby show his mother how beautifully he can breastfeed and that is magic too.

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