Kathleen Kendall-Tackett, Ph.D., IBCLC

Breastfeeding Made Simple

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Why Do We Need a Different Approach?

Is it lack of information?

It’s safe to say mothers areinundated

with breastfeeding information

Is it because

moms don’t want to learn?

Natural Laws—Why? • Bottle-feeding norms

• Basic concepts unclear

• Mothers missing key information and receiving conflicting advice

Rather than pelting women with more information……

Natural Laws—Why?Let’s help them tap into strengths and abilities that they already possess and that are built-in to the breastfeeding relationship

When the big picture becomes clear… the details fall into place

The 7 Laws:• Provide a

biological, mammalian framework independent of culture

Babies Are Hardwired to Breastfeed

Law #1

Babies know how to do this if we will let them Mothers don’t

breastfeed. Babies breastfeed.

Nils Bergman

Matthiesen et al. Birth 2001, 28: 13-19

“Newborns placed skin-to-skin with their mothers show an inborn sequence of behavior similar to that seen in other mammals….”

There are releasing stimuli for the baby’s instinctive feeding behaviors

Righard & Alade, Lancet 1990; 336:1105-07

Pediatrician Christina Smillie has observed that these feeding behaviors are surprisingly robust and can be reactivated for several weeks after birth

• Left-brained instructions

• Mother-led feeding

• Unstable hold

•Logical

•Verbal

•Practical

•Sequential

•Analytical

•Objective

•Focuses on parts

•Detail oriented

• Emotional• Intuitive• Creative• Synthesizes

information• Subjective• Focuses on wholes• “Big picture”

oriented• Symbols and

images

Mothers are in Right-Brain Mode Postpartum

While we are often in Left-Brain Mode

Latch

Cradle Hold

C-hold

Asymmetrical latch

Milk transfer

Lactogenesis II

Engorgement

What?

What if, instead of presuming that there is a cognitive deficit……

…we assume there might be a survival advantage to a right-brained orientation

The right-brain state facilitates emotional attachment between mother and baby

Breastfeeding is a Right-Brained Activity

• Baby is ready to feedo Early hunger

cueso Calm—

emotionally open to interacting

Baby’s torso skin-to-skin with mother, vertical between her breastsThis triggers breast-seeking behaviors

Mother encourages instinctive behaviors • She strokes,

talks, and makes eye contact

• As needed, she helps support and align the baby

Law #2 Mother’s Body is Baby’s Natural Habitat

• Kangaroo Mother Care in South Africa and Columbia

• Dramatically decreased infant mortality

• Babies’ survival depends on being in the habitat

• Mother and baby regulate each other’s physiological state

Better state regulation

Heart beat BreathingOxygen levels Body temperature

Lower stress response to painful procedures Better parent-child relationship

Full-term babies not skin-to-skin

• More feeding problems

• 10x more crying• Elevated cortisol• Unstable body

functionso Temperatureo Blood sugaro Breathingo Heart rate

Christensson, Acta Paediatrica 1992, 81:488-936

• Mother/baby sleep/arousal cycles are synchronized

• Babies spend less time in deep stages of sleep

• Co-sleeping creates more variable physiological experiences for infant

McKenna, Encyclopedia of Med Anthro 2004: 506-517

We regulate each other’s physiological state throughout our lives

• Married people have a lower premature mortality rate

• Higher rates of metabolic syndrome, diabetes and MI in people without social connections

“Adults remain social animals; they continue to require a source of stabilization outside themselves. That open-loop design means that in some important ways, people cannot be stable on their own—not should or shouldn’t be, but can’t be.”

Lewis, Amini, Lannon, A General Theory of Love 2000, p. 86

Law #3

Better Feel and Flow Happen in the Comfort Zone

Mother-led Approach

• Bringing baby to breasto At a difficult

angleo When baby is

not ready• Unstable hold • Forcing baby

to breast

The Comfort ZoneIllustration: Peter Mohrbacher

Chin first Head tilted slightly back (instinctive feeding position)

• Lower jaw first takes ≥ 3-4 cm of areola

• Angle allows the nipple to extend into the comfort zone

Photo credit: Catherine Watson Genna, BS, IBCLC

©2005 Peter Mohrbacher

Animation on www.breastfeedingmadesimple.com

Photo credit: Catherine Watson Genna, BS, IBCLC

Baby’s upper torso firmly against mother, chin touching breast

Gives baby more head control during latch

Law #4

More Breastfeeding at First Means More Milk Later (The First Week)

• Labor medications sedate baby

• Separation of mother and baby

• Hospital routines

• Cultural assumptions

Law #5 Every Breastfeeding Couple has its Own Rhythm

• Feeding frequency

• Feeding length• Feeding patterns• Affected by

o Infant stomach sizeo Milk supply ebb and

flowo Culture

Pattern of feeding in mammals determined by maturity at birth and composition of milk

Cache Mammal • Deer, rabbit• Feed every 12 hours • Milk highest in protein

and fat

Follow Mammal•Giraffe, cow•Feeding more often than cache mammal

• Milk lower in fat and protein

Nest Mammal• Dog, cat• Feed every couple of hours

• Milk lower yet in fat and protein

Carry Mammals• Apes, marsupials• Feed around the clock

• Milk lowest in fat and protein

Of all mammalian milks, human milk has the lowest levels of fat and protein

• Breastfeeding in the early days is challenging

• Moms may assume that they are doing it wrong unless they know about the normal course of breastfeeding

The Work of Breastfeeding

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10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 52

Weeks

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Breastfeeding Bottlefeeding

Adjustment Period

Law #6

More Milk Out Equals More Milk Made

Degree of breast fullness

• Drained breasts make milk faster

• Full breasts make milk more slowly (FIL)

• Factory analogy

Daly & Hartmann, J Hum Lact 1995, 11(1), 21-26

Storage Capacity Influences•One breast or two•Number feedings/day•Night feedings

May mean:• Fewer or shorter

feedings• Longer sleep

stretches earlier • Always one

breast

May mean:• More feedings • Longer feedings • Continued

night feedings• Always both

breasts

• Restricting to one breast or insisting on both breasts

• Coaxing longer feedings or limiting times

• Decreasing number of feedings

• Adding feedings

• Low milk supplyo Low weight gaino Drop in supply

over time

• Oversupplyo Fussy/breast

refusalo Mastitiso Reflux disease

Applying Bottle-Feeding NormsApplying Bottle-Feeding Norms

• Pressure for fewer/larger feedings

• Human milk vs. formula intakeo At 6 mos. babies on

formula take 22% more o Effects of delivery

systemo More milk more quicklyo Appetite control

mechanism

Law #7

Children Wean Naturally

• Some mothers and HCPs worry that babies will nurse “forever” if allowed

• Some believe women are “forcing” babies to continue to nurse past a certain age

• In fact, babies in U.S. culture often wean prematurely

• Current recommendations for age of weaningo American Academy of

Pediatrics −At least 12 months and as

long thereafter as is mutually desired

o World Health Organization Innocenti Declaration−At least age two for

infants worldwide

• Later weaning is the dominant pattern oIn historyoIn other

cultures

Stuart-Macadam, Breastfeeding: Biocultural Perspectives, 75-99

• Babylon (3000 BC) specified nursing for 2 to 3 years

• Hebrews (Torah) Weaning at 3 years

• Egyptian papyrus, weaning at 3 years

• Medical Ayurvedic texts (1500 to 800 BC) recommend only breast milk for first year, breast milk and solids for second year, gradual weaning after that

Stuart-Macadam, Breastfeeding: Biocultural Perspectives, 75-99

• Byzantium (400 to 700 BC), weaning 20 months to 2 years

• Qur’an: Islamic children should be breastfed at least 2 years

• Talmud (536 BC), babies are to be put to breast immediately and suckled 18 months to 2 years

Stuart-Macadam, Breastfeeding: Biocultural Perspectives, 75-99

• Samoans, 1 yr• Australian

aborigines, 2-3 yrs

• Greenlanders, 3-4 yrs

• Hawaiians, 5 yrs

• Inuit, 7 yrs

Wickes, Arch Dis Child 1953, 28: 151-158

• Gambia, 21 months

• Ivory Coast, 42 months

• Northern Sudan, 2 to 3 years

• Morocco & Algeria, at least 2 years

• Pakistan, 92% still breastfeeding at 2 years

Stuart-Macadam, Breastfeeding: Biocultural Perspectives, 75-99

Sugarman & Kendall-Tackett, Clin Pediatrics, 1995, 34: 642-647

• U.S. Sample• Average age of

weaningo 2. 5 years for

oldest childreno 3 years for last

child• Range of

weaning ageso 6 months to 7

years

• Unsolved breastfeeding problem

• Return to work• One doctor’s

opinion• Mother or baby ill or

hospitalized• Mom needs to be on

meds• To encourage

independence• To make mom’s life

easier

• Mom is readyo She’s met her goals or

decided time is right• Baby/child ready• Confirmed medical

issue

Story of Survival

• Mother, 16 year old African American

• Boyfriend delivered her baby while in the attic of their home during Hurricane Katrina

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