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Kathleen Kendall-Tackett, Ph.D., IBCLC
Breastfeeding Made Simple
www.GraniteScientific.comwww.BreastfeedingMadeSimple.
com
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 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
www.GraniteScientific.comwww.BreastfeedingMadeSimple.
com
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