Could a laid-back approach to breastfeeding help your baby latch on?

baby_cryingAlthough it’s perfectly feasible to feed your baby any way that feels comfortable, four positions are commonly recommended. These are the cradle hold, the football hold, lying on your side, and the cross-cradle hold. This last position requires you to sit up with a straight back, hold your baby sideways on, and carefully position him with his nose opposite your nipple so he has a large mouthful of breast when he latches on. It can seem like quite a complicated process for a beginner, particularly when a crying baby is added to the equation. Nevertheless, it is particularly recommended to new mothers, as it is apparently the best position in which to ensure your baby is latching on correctly – something that many women (and babies) can find quite difficult.

Despite the strong recommendation of these feeding positions, there appears to be virtually no scientific evidence to justify their use. In practical terms, it is easy to see why being able to discreetly breastfeed whilst sitting up is a useful skill to master, but for a new mother, simply being able to comfortably nourish her baby may be a more immediate priority.

A recent study conducted at hospitals in the UK and France calls into question the idea that the traditionally recommended feeding positions are automatically the best ones1. During the study, 40 women whose babies were less than a month old were videotaped breastfeeding in a series of recording sessions. As long as feeding was going well, mothers were not advised or guided in any way: they were simply left to get on with it in whichever was most comfortable for them. In the ‘best’ recorded feeding session 21 of the mothers sat upright to feed their babies, one lay flat on her back, and one lay on her side; the remaining 17 were semi-reclined with their babies lying on their tummies (a behaviour termed ‘Biological Nurturing’).

There were some striking differences in the feeding process when mothers adopted a reclining position, as opposed to sitting upright. When babies lay on their mothers’ tummies, their mothers’ hands were free to gently guide them. Stroking their babies’ feet seemed to be particularly helpful, as it released mouth and tongue reflexes that helped them to latch on. By contrast, when babies were held in their mothers’ arms, their legs and feet were left in thin air, and the foot-to-mouth connection was lost.

The reclinining group did not need to line up the nose and nipple, and make sure the baby’s mouth was open wide enough before initiating the latch: as the baby was on top, gravity pulled his tongue and chin forward, allowing him to attach himself, even when he was sleepy. Gravity also automatically ensured a close fit between the baby’s chin and the mother’s breast, facilitating deep suckling and producing the ear and jaw movements that indicate successful feeding.

Perhaps the most interesting result, however, was that babies exhibited reflexes that helped feeding when their mothers were reclined, but hindered it when their mothers were upright. When they were lying on their mothers’ tummies, head-righting and -lifting reflexes allowed the baby to orientate himself for successful latching on. When mothers were upright however, these irregular, jerky head movements had the opposite effect: the head bobbing that resembled ‘nodding’ when a mother was reclined was perceived as ‘head butting’ when a baby was held sideways against an upright mother. The gravitational forces that had helped attachment in reclining postures dragged babies away from their mothers when they sat up. It was harder to keep the baby latched on, and mothers reacted by tightening their grip, resulting in back arching and arm and leg cycling that appeared like thrashing or flailing.

It is important to view these results in context: this was an observational, rather than a controlled study, so the data cannot ‘prove’ that one feeding method is better than another. Many of the mothers who participated fed quite happily whilst sitting upright – as do many women every day – so it’s clear that a reclining posture is not required for successful feeding.

Nevertheless, this research does call into question the idea that a position like the cross-cradle hold is the best one to recommend to new mothers. Innate early breastfeeding behaviours were observed to help attachment when a mother lay back with her baby lying on her tummy, but not when she sat up;  reflexes and gravitational forces which aided latching on when a mother reclined, hindered it when she was upright. If, as this study suggests, women can just lie back and let nature take its course, the often fraught early days of breastfeeding could potentially be a much more relaxed affair.

  1. Early Hum Dev. 2008 Jul;84(7):441-9.

6 Responses to “Could a laid-back approach to breastfeeding help your baby latch on?”

  1. Naomi Says:

    I’m 4 months into feeding my second baby and have had 5 bouts of mastitis. Biological nuturing was my saviour. It helped me empty my infected breast completely when other positions did not. It also allows the baby to wind itself during the feed with no mother intervention and it clears their noses if they are congested with a cold and can’t feed properly. I wish I’d know about it earlier, as I would have done it straight after the birth to see if it avoided the truly awful cracking and pain I experienced at the start.

    • Elizabeth Jay Says:

      Thanks Naomi, that’s really interesting. I hadn’t heard about the potential wind/congestion clearing advantages to biological nurturing positions before.

  2. memordee Says:

    I think any way that works for a mother and her baby is the best way 🙂 Having too many rules to follow to get breastfeeding right makes it sound complicated.

  3. Amy Says:

    Very interesting! I think if I’d tried this with my other two I would have had more success. I will try it with bub number 3 when he/she comes along in 6 months time. So many things make sense now.
    Also I think if bub is laying on it’s tummy it would help to clear any wind as it builds up without bub needing to be winded so often as Naomi pointed out. Exciting!

  4. Breastfeeding while lying flat on my back? - Breastfeeding Forum Says:

    […] I read this, I thought of this:…baby-latch-on/ I never got the hang of feeding while laying on my side as DD would latch off and my let down […]

  5. Anna Moore Says:

    This is fascinating. I found once I was home and stopped trying to follow the “rules” about cradle hold and so forth and just held my baby all of a sudden breastfeeding was easy. Next time I definitely won’t be worrying about any particular way it is supposed to work and will have the confidence to just do it. Problem is, as a first time mum we usually have no confidence and are very vulnerable to the “rules” provided by health professionals (or the old wives tales from everyone else). Articles like this are fantastic – as a new mum with a physiology PhD and an interest in health science, I really love finding properly researched evidence based articles on baby-related health topics. I feel like we’ve lost a lot of respect for our own biology – nature might be indifferent and things don’t work all of the time, but they do usually work well most of the time or we wouldn’t exist so going back to basics can be quite enlightening.

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