By Tracy G. Cassels

One of the things you hear regularly when women talk of the difficulties of breastfeeding is that it’s “not instinctual”, that we aren’t born knowing how to breastfeed a baby and it doesn’t come naturally with birth.  The problem with this argument is that if breastfeeding were not instinctual at all, none of us would be here.  The very first humans and billions after have had to breastfeed without the help of various organizations there to tell them how to breastfeed (though of course they have had cultural learning by watching women breastfeed around them for their lives and other women to help when necessary).  And they do it, most of the time successfully.  How?  Well, it turns out the question isn’t whether or not breastfeeding is instinctual, but rather for whom breastfeeding is instinctual.  That’s right – all this focus on whether or not moms instinctively know how to breastfeed and get her baby to latch properly is silly because it’s actually our infants’ who have the instinct.  Their desire to stay alive means they are born with the knowledge of how to suckle and how to get to that breast if we leave them alone to do it.

Now it’s important to note that the infant’s instinct is intertwined with the natural instinct for a mother to immediately hold her infant on her chest, skin to skin.  In fact, the umbilical cord serves to keep mom and baby together, suggesting a period of time in which the two are to remain close right after birth.  While mammals and humans have “cut” through the cord at some point, it has never been immediately after birth until adopted as a standard practice by obstetricians.  This time of connectedness after birth is key to developing the breastfeeding relationship as it allows the infant to do what he or she instinctually wants to do – get to that breast.

But isn’t getting to the breast exactly what many hospitals have you do nowadays?  Yes, but there’s a difference between trying to get your infant on the breast and allowing your infant to find the breast.  The first time the midwives and nurses tried to show me how to breastfeed, it was the most awkward position I’d ever encountered.  It felt unnatural and I wasn’t sure how I could hold it for any extended period of time.  If what I experienced is at all the norm for women today, it’s no wonder so many have problems getting a good latch and thus breastfeeding.  But what the nurses and midwives didn’t count on was that in my prenatal class (taken with my doula), I learned about the Breast Crawl.

For those of you who haven’t heard of the Breast Crawl, it’s the movements a baby will make while lying on his or her mother to get to the breast and latch properly.  It is the epitome of allowing a baby to follow his or her instincts when it comes to breastfeeding.  Here’s a link to a video to help exemplify the process (it should open in a new window, so don’t worry about losing your spot):

The Breast Crawl

In scientific studies examining the success of the Breast Crawl, it was found that nearly all infants can accomplish latching and sucking on their own while a small percentage require a bit of help latching.  In fact, over four separate studies, only 1 infant failed to make it to the nipple

[1].  Compare this to the breastfeeding behaviour found in many hospitals in today’s Western societies.  At the end of a breastfeeding initiation program in Boston, 86.5% of women initiated breastfeeding and only 33.5% exclusively breastfed[2].  In Italy, only 85% of mothers initiated breastfeeding and only 19% were breastfeeding at 6 months (not exclusively either, just simple breastfeeding)[3].   And it’s not that Western moms are choosing not to breastfeed either, but rather a cascade of factors intervenes in their ability to do so both at all and exclusively.  For example, in a review on breastfeeding initiation and duration, most women reported ceasing breastfeeding early due to problems breastfeeding[4].  The biggest problems with breastfeeding (physically-speaking) are latch and milk supply.  Latch issues are known to be associated with early cessation of breastfeeding[5][6], and of pain to the mother and decreased milk supply[7].  In fact, in one study of women who intended to breastfeed a minimum of 8 weeks, only 68% were doing so while the reasons for stopping for the other 32% were primarily low milk supply, painful nipples, and latch problems[8].

 

These physical problems are ones that can be helped by utilizing the Breast Crawl.  While many of the advantages of the Breast Crawl[1] are due to early breastfeeding (within the first hour of birth), others are due to the skin-to-skin contact that is absent for many mothers who are breastfeeding for the first time, the initiation by the infant of the suckling behaviour (indicating the infant is ready and capable of suckling), the position of the infant for optimal latching versus the cradle or side-hold that is common in many Western settings, and the bonding that occurs when mom and baby are left for 30-60 minutes post birth without any interventions.  This last point is key because at this stage, most infants will have completed the breast crawl and thus if an infant has not, care can be given to help the infant along.  Most hospital settings (even midwives) in Western countries do not leave mom and baby alone for a full hour, and yet interruption of skin-to-skin contact has been found to be very deleterious on breastfeeding (see point 5 in [1]).  In short, the entire process of the Breast Crawl works to help establish a positive breastfeeding experience – one that will hopefully continue for long.

Importantly though, while the breast crawl can help the mom and infant dyad begin a healthy breastfeeding relationship, we must also focus on support for women to maintain this positive relationship.  While it’s true that historically individuals didn’t have Certified Lactation Consultants or La Leche League Chapters, they did have similar support from other women in their tribe or community and this cannot be discounted.  Women have historically had lots of support with respect to breastfeeding, but our society’s isolation of the mother from other moms has nearly eliminated this built-in support network that previously allowed for women to exclusively breastfeed their infants.  These groups strive to allow women to feel confident in breastfeeding, a factor that is crucial to any mom continuing to breastfeed, while offering tips and suggestions when things don’t go as planned.

So while we must continue to provide support to mothers and infants, let’s do away with the idiotic comment that breastfeeding isn’t instinctual.  It may not always be easy and it certainly has gotten harder in the current birthing culture that is prevalent in Western societies, but it is instinctual.  We just have to be willing to accept that our little babies actually know a thing or two to appreciate the instinct behind it.

Did you try the breast crawl?  Did it work?


[1] For a review of the evidence, see http://breastcrawl.org/science.shtml (Accessed Feb 2, 2012)

[2] Philipp BL, Merewood A, Miller LW, Chawla N, Murphy-Smith MM, Gomes JS, Cimo S, Cook JT.  Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting.  Pediatrics 2001; 108: 677-681.

[3] Riva E, Banderali G, Agostoni C, Silano M, Radaelli G, Giovannini M. Factors associated with initiation and duration of breastfeeding in Italy. Acta Pædiatr 1999; 88: 411–5.

[4] Dennis C-L.  Breastfeeding initiation and duration: a 1990-2000 literature review.  Journal of Obstetric, Gynocologic & Neonatal Nursing 2002; 31: 12-32.

[5] Santo LCdE, De Oliveira LD, Giugliani ERJ. Factors associated with low incidence of exclusive breastfeeding for the first 6 months. Birth 2007; 34: 212–219.

[6] Kumar SP, Mooney R, Wieser LJ, Havstad S.  The LATCH scoring system and prediction of breastfeeding duration.  Human Lactation 2006; 22: 391-397.

[7] Geddes DT, Langton DB, Gollow I, Jacobs LA, Hartmann PE, Simmer K.  Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound.  Pediatrics 2008; 122: e188-e194.

[8] Lewallen LP, Dick MJ, Flowers J, Powell W, Zickefoose KT, Wall YG, Price ZM.  Breastfeeding support and early cessation.  Journal of Obstetric, Gynocologic  & Neonatal Nursing 2006; 35: 166-172.