The first edition of Breastfeeding Made Simple, which I reviewed a few years ago, is one of my favorite breastfeeding books. So I was pleased to see that an updated edition has been released.
What I liked so much about the first edition of the book was that the authors had boiled down the most important concepts into “laws” which are easy to remember. They’re the kind of thing that might ring in your ears when you run into trouble. Like Aesop’s Fables for breastfeeding. Those “laws” still form the heart of the book.
The biggest difference between the two editions is the section on positioning and latch. In the first edition the authors provided a detailed and comprehensive discussion of how to achieve a comfortable and effective latch. I really liked how clear and illustrative this section was.
Similarly to the current edition of The Womanly Art of Breastfeeding, the new edition the authors have rewritten this chapter to place a significant emphasis on “laid-back breastfeeding,” or Biological Nurturing, a concept developed by Suzanne Colson, a British midwife and researcher. Biological Nurturing describes positions which allow for the expression of infant feeding reflexes - relfexes Coslon identified and after observing babies nursing in these positions. In laid-back breastfeeding positions, mothers lie back as they might when watching TV, and place their babies on top of them. This allows gravity to keep the baby close to the mother, and releases these feeding reflexes - reflexes which can’t be used to much effect in across-the-lap or side-lying positions.
In the new edition of Breastfeeding Made Simple, the authors a first recommend the laid-back position. They give no specific advice about achieving a latch in this position, instead stating, “When you find a comfortable angle for you both, simply lay your baby tummy down between your breasts and make your breasts accessible so she can easily make her way there.” They state, “don’t feel shy about helping her whenever it’s needed,” but apart from that they don’t offer any instructions on latch.
The authors then describe the traditionally taught breastfeeding positions (cradle, cross cradle, side lying), and state that in these positions, a more directed approach is required. Here they present the information from the first edition of the book on how to acheive a comfortable and effective asymmetrical latch.
Let's just pause for a moment to appreciate the significance of Suzanne Colson's findings which form the basis for Biological Nurturing. She has identified dozens of infant reflexes which were previously unrecognized or probably considered random or a form of disorganization. Previously we had identified, what, four? Thee findings are very significant. And the concept that humans are front feeders, not dorsal feeders? Amazing. Suzanne's work is significant in ways that extend far beyond breastfeeding. (Evolutionary biologists and anthropologists, are you listening?)
So lest you conclude from the following comments that I don't appreciate the significance of Biological Nurturing, please know that I find them revelatory and immensely powerful.
What I worry about is how we translate this information into effective advice for mothers. I'm very sensitive to things that have the potential to hang mothers out to dry, so I was a little surprised at how quickly and completely the sea change in advice has occurred. Here are a few reasons why I worry:
We're expecting a lot of our newborns - that they will consistently self attach and lead the way - at a time when we birth in a manner unique in human history. More than three quarters of our babies are born after receiving medications known to impair feeding reflexes. One third are born by cesarean section. Nearly one fifth are born early at 37 or 38 weeks, at a time when brain functions related to feeding are still maturing. Will all of them be able to latch on on their own in this position?
I'm concerned that when babies don't self attach, or when they do so in a manner that is painful and/or ineffective, mothers won't get the help they need, or that they'll conclude that breastfeeding isn't for them.
Finally, will this position match everyone's lifestyle? You know, the mom (and by "mom" I mean "me") who likes to type when she feeds. Or the mom (and by "mom" I mean "just about everyone I know") who likes to doze while feeding her baby in the side-lying position. I worry that mothers aren't getting the message, as Suzanne Colson clearly states, that human mothers are very adaptable creatures and can feed successfully in a number of positions.
Call me a late-adopter, or call me flat out wrong, but I do worry about these things.
There are other updated sections in this edition. The passage on introducing solid foods has had a makeover, now advocating the method known as Baby-Led Weaning (see my podcast interview on this). There are a few other differences (“milk supply” becomes “milk production”), there is another nod to Colson's work identifying maternal instincts, and thankfully there is an index in this edition, but these are minor in comparison to the changes in the positioning/latch section.
All in all, this book is as powerful as it was in the first edition. Its "natural laws" are so resonant and enduring, and I continue to recommend it to all mothers I meet.
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