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Mothers Should Be Semi-Reclined to Nurse More Effectively

Study Challenges Conventional Breastfeeding Advice, Suggests Mothers Should Be Semi-Reclined to Nurse More Effectively

Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding.
Colson, S. D., Meek, J. H., & Hawdon, J. M. (2008).
Early Human Development, doi: 10.1016/j.earlhumdev.2007.12.003. [Abstract]

Summary: In this descriptive observational study, researchers videotaped 40 healthy breastfeeding mother-infant pairs in the first month after birth to explore whether maternal posture and infant positioning affect the expression of neonatal reflexes that support effective, pain-free breastfeeding. To be eligible, women must have had low-risk pregnancies and given birth to healthy, term infants with 5-minute Apgar scores of at least 9. Effort was made to recruit an ethnically diverse sample, and data were analyzed according to the gestational maturity of the infant at the time of videotaping.

The researchers divided videotaped feeding episodes into pre-feed, latch, and ingestion and examined each period for instances of any primitive neonatal reflexes, defined as "inborn unconditioned reflex responses, spontaneous behaviors and reactions to endogenous or environmental stimuli developing during fetal life and observed in all normal healthy term neonates at birth".

Examples of these reflexes include hand-to-mouth movements, gaping of the mouth, cycling movements of the arm or leg, and bobbing or nodding of the head. After recording instances of reflexive behavior, the researchers interpreted the type and function of the reflexes and their relationship to effective, pain-free breastfeeding. Maternal and infant postures were characterized by whether they were consistent with "biological nurturing" (BN), a breastfeeding approach in which the mother is encouraged to lean back and the baby is held prone, facing the mother and in contact with her body contours.

Twenty primitive neonatal reflexes were described, which the researchers categorized into four types: endogenous, motor, anti-gravity, and rhythmic. Some of these reflexes seemed to function to find or latch onto the nipple while others supported milk transfer. More primitive neonatal reflexes were observed when women were in full-BN postures compared with when women were in partial- or non-BN postures such as sitting upright.

Some reflexes such as head bobbing, rooting, and hand-to-mouth movements seemed to act as barriers to effective breastfeeding in partial- or non-BN positions while they appeared to stimulate and support breastfeeding in full-BN positions. When mothers who were experiencing breastfeeding problems assumed BN positions, the researchers observed that "gulping and gagging diminished, [and] the baby often became the active agent controlling the feed, aided by the different types of [reflexes]".

This study also suggests that women, too, may have innate behaviors that facilitate those of the infant. In full-BN positioning, women instinctively elicited their infant's primitive neonatal reflexes in a sequence that promoted effective feeding, behaviors not seen with partial or non-BN positioning. Said an untutored woman in full BN position after spontaneously assisting her baby's efforts, "Breastfeeding is so easy. I wish more of my friends were doing it".

Significance for Normal Birth: "Babies are born to breastfeed." Research demonstrates that, left undisturbed after birth, healthy term newborns perform a sequence of reflexive pre-feeding behaviors culminating in self-attachment to the mother's breast. Despite this normal behavior, many breastfeeding mother-infant pairs encounter feeding problems in the early days and weeks. These problems can cause women to discontinue exclusive breastfeeding earlier than planned.

While the phenomenon of newborn self-attachment is well documented, there is a much smaller body of literature mapping newborn reflexive behaviors to breastfeeding effectiveness after the initial feeding. This study provides evidence that an approach to breastfeeding that proponents have termed "biological nurturing" stimulates reflexive behaviors in newborn and mother alike. These synchronized reflexes seem to support both effective, pain-free latch and ingestion of milk.

In contrast to prevailing advice that breastfeeding mothers should sit upright and support the baby's back and head, biological nurturing involves semi-reclined positioning with the baby prone and in close contact with the mother's body. Babies in full-biological nursing positions employ anti-gravity reflexes to locate the breast and latch without dorsal support, and their mothers assist them in that task. Additional research is warranted, but the researchers offer a compelling case that breastfeeding continues to be mediated by newborn reflexive behavior well after birth, that postures and positions may either support or hinder these reflexes, and that by inhibiting or overriding instinctive maternal behaviors, typical breastfeeding instruction may be counterproductive.