The Study I've Waited for Is Finally Here!

Is there a specific approach to early positioning that nursing families can use to reduce by half the incidence of nipple and breast problems? Yes, according to THIS brand-new randomized controlled trial from Italy.

This New Italian Study

For years, when giving talks to lactation supporters, I asked aspiring researchers to please study the impact of using the Natural Breastfeeding (NB) approach to early positioning (aka “biological nurturing” and “gestalt breastfeeding”) on the incidence of nursing problems. The NB approach involves using relaxed, semi-reclined feeding positions (see photos) rather than sitting upright to nurse. From what I knew from experience and previous studies, its impact was huge.

Finally, the study I was hoping for is here, and its conclusions are just what I expected. Its research team randomized 188 pregnant women to one of two groups. Before delivery, the usual-care group was taught to nurse sitting upright. The intervention group watched videos of families using the NB approach. After birth, both groups had skin-to-skin contact with their newborns, were encouraged to nurse on cue, had 24-hour rooming-in, and as needed, were helped in the hospital with the approach to positioning that was consistent with their group.

During the first 4 months of nursing, the researchers found significant differences between the two groups. Compared with the usual-care (upright) group, those using the NB (semi-reclined) approach experienced about half the incidence of nipple and breast problems, such as nipple pain and cracks, engorgement, and mastitis. Before hospital discharge, the NB group had fewer latching struggles. Although not statistically significant, the study team noted a trend toward more exclusive breastfeeding among those in the NB group.

The study’s authors concluded that the NB approach was effective in a real-life hospital setting and that anything that cuts in half the incidence of nipple and breast problems “has the potential to become an important public-health measure for the promotion of breastfeeding.” These conclusions were the same I reached more than a decade ago.

The Natural Breastfeeding Approach

My own “aha moment” about early positioning came in 2009, when I happened upon a UK STUDY that challenged my assumptions and changed my practice. As I began to use this new positioning strategy, I saw many families quickly overcome some of the thorniest nursing challenge simply by making small changes in their nursing positions. There will never be an intervention that works 100% of the time, but because this one takes advantage of the innate feeding behaviors present in healthy babies at birth, I’ve found that in most cases, it makes a great starting point.

When I promoted this approach during my talks to clinicians, sometimes my colleagues were willing to give it a try—often only as a last resort—but more often they weren’t or told me later, “I tried it once and it ‘didn’t work.’”

An entrenched practice such as upright positioning can sometimes be difficult to change. But I kept honing my message and developing new teaching tools, because I saw with my own eyes what a night-and-day difference it made for so many families struggling to nurse their newborns.

NB Digital Teaching Tools

As I attempted to find the words and images that made this approach easier for parents and professionals to use, I partnered with OB Dr. Theresa Nesbitt. We named this approach Natural Breastfeeding and created a simplified vocabulary and easily accessible visuals. We included a free demo video on the home page of our Natural Breastfeeding website HERE, so families can become familiar with this approach both before and after birth. We hoped that watching a diverse group of mothers with different body types discussing the adjustments that worked for them might get the message across in a format many of today’s parents prefer. I created an ad-free YouTube channel HERE, where families and colleagues can watch short clips of mothers and newborns using the NB approach.

For providers, we created the Natural Breastfeeding Professional Package (NBPP) HERE, which offers licensing rights to use our teaching videos and images in hospitals, public-health departments, and private practices. (See also our short video about the NBPP HERE.) A subscription to the NBPP allows providers to give an unlimited number of families access to our 6-module NB digital program. A perfect educational option during a pandemic, families can view this lactation course (and its more than 60 short videos) before and after birth at their own pace on their phones, tablets, and computers. The NBPP also includes staff training materials and handouts.

For those who still think that nursing upright during the newborn period is best, it’s time to rethink this assumption. Please read this new study, watch our videos, and give the NB approach a try. For a more detailed, fully referenced explanation of the NB approach, see Chapter 1 of my new book for lactation supporters, Breastfeeding Answers, Second Edition.