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Biological Nurturing: Laid-back Breastfeeding

Photo courtesy of Debi Bocar.

Colson and colleagues conducted a descriptive study to explore how primitive newborn reflexes (PNRs) affect breastfeeding behavior, and to describe and compare those reflexes observed during biological nurturing and in other feeding positions.

They begin by describing the positioning and latch techniques used by most mothers. These include a side-lying or upright position in which the baby is “[placed] ‘tummy to mummy’ at the breast level; then they attach the baby, positioning nose to nipple, leading with the chin following mouth gape. Previous trials, however, have demonstrated few benefits associated with this approach.” The investigators therefore looked at the mechanisms of behaviors and positions collectively termed Biological Nurturing (BN).

How did researchers design the study?

Forty mother and newborn pairs were observed and videotaped during the first month after birth, either at the hospital or in their homes. Alternative positions were suggested to the mother only if the dyad experienced feeding problems. Clear operational definitions were provided for breastfeeding, PNRs, neonatal position, neonatal lie, neonatal behavioral state, maternal posture, successful breastfeeding, and other observations.

  • During 24 hours of footage, 20 reflexes were identified during a total of 93 episodes occurring in 50 sittings.
  • There were three observers, and an inter-rater reliability of 93 percent.
  • The results showed that every mother-baby dyad achieved a successful feeding during the “best” episode.
  • The 20 PNRs were described; they fell into 4 categories. The PNRs clustered into two functional groups: (1) finding/latching and (2) milk transfer.

What did they learn about reflexes?

The “best episode” of breastfeeding describes the mothers’ and babies’ postures (BN) and compares the mean number of PNRs when in those postures. Specifically, they found that during the “best” episode,

  • 21 mothers were upright (in non-BN postures),
  • 2 were in partial BN postures (one lying flat, one side-lying)
  • 17 were in a full BN semi-reclined posture.

During this “best” episode, the mean number of PNRs was 11.6 when the mother was in a non-BN posture, compared to 15.9 when they were in full BN postures. “A significantly greater number of PNRs were observed, aiding latch and sustaining feeding when mothers were in full BN postures (p ≤0.0005). When problems occurred and mothers changed to a full BN postures, gulping and gagging was reduced, and “the baby often became the active agent controlling the feed, aided by the different types of PNRs.”

Summing up the study

This is apparently the first study to describe maternal posture having a significant impact on the process of successful latching and suckling. Although previous studies addressed the role of rooting, suckling and swallowing, this study looked at 17 other PNRs as related to feeding.

However, the authors warn that this study provides only observations; it was not designed to examine relationships, significance, or effect. (In other words, this is a non-experimental study.)

Although not an experimental study, there are clinical implications in terms of how we can stop “teaching” mothers and newborns to breastfeed, and rather, simply encourage mothers to recline in a BN posture, which best allows newborns to use primitive reflexes.

This study was published more than a decade ago. However, I am astonished at the number of people who have still not heard about biological nurturing.

For even more insight into this fabulous study, listen to my interview with the lead author, Dr. Suzanne Colson. You might also want her book, “An Introduction to Biological Nurturing: New Angles on Breastfeeding.”

Have you tried biological nurturing? How effective do you think it is? 

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  1. Margie Saiz

    Yes as an IBCLC I’ve used this biological nursing position frequently. It worked especially well with a 2 month old diagnosed with reflux. The mother also had an overactive milk ejection reflex. During a breastfeeding using laid back positioning the baby was in control of the feeding. No sputtering or choking observed in this position. Mom was thrilled to learn to breastfeed in a position that was so relaxing for her and let her baby feed without choking. I often use this position immediately after a vaginal birth. Place baby skin to skin with mother and usually the baby will self latch after kneading the breast during the first attachment. Amazing stuff happens if we let nature take its course.

    • Marie Biancuzzo

      Agreed! Only one hesitation here. If you listen to my interview with the author/researcher, Dr. Suzanne Colson, note that she is very clear in saying that the laid-back position alone is *not* biological nurturing (BN). So I agree that the position is effective, but Colson says it’s not *just* the position. I was worried that the title on this post might imply that the terms are synonymous, but they are not.

  2. Jeanne

    Excellent information, thank you. I find that in my practice, this position is not utilized enough. I will keep informing my patients and colleagues about it.

    • Marie Biancuzzo

      Yay! Yay! I agree, this needs to be used much more often. And, here’s another thing: I predict that a decade from now, this will be the go-to position for neonates, that is, babies in the first 28 days of life. (Note that her research, and my original summary, was more than a decade ago, and it has taken a long time to become more “popular” here in the US.)

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