Hi Sandy:

Welcome back.  I perhaps have a different view on Biological Nurturing based on the Manhattan experience.  

Here in Manhattan there are many hospitals where some staff members are still using methods like the "RAM"  (Rapid Arm Movement), but many have moved on to "Assymetric Latching".  Some have adopted "Laid-back breastfeeding" or "Biological Nursing".  

OUTSIDE the hospital I would say that "Assymetric Latching" and "Side Lying" were used by most IBCLCs who worked in IBCLC-owned practices as far back as 15 years ago.  I would also say that most of these lactation consultants often threw out the "rules" and used what worked.  My experience in running groups with a "sit on the floor on mats with your back against a padded wall" started about 9 years ago and I immediately discovered that leaning back in a semireclined position against padded walls worked much better for many women.  When I went on to run my own groups separately from the pre and postpartum education center where I had previously done groups, I purchased beach chairs that enabled women to lean back comfortably at any angle that feels best to them.  I think many of my colleagues in the IBCLC-owned practices have used some variation of this approach for many years as well.  And as for U and C holds -- I think I abandoned any mention of those except as historical anachronisms about 7 years ago and "football" or "cradle" hold terminology was eliminated from my handouts at least five years ago.  

What Suzanne Colson achieved with her small observational sample size of women who experienced relatively normal births (at least in the context of industrialized settings) was an excellent description of the factors that made this particular population of women comfortable while they nursed.  Furthermore she grounded her observations with plausible linkages between her  findings and the many normal newborn reflexes triggered from this type of positioning.  This descriptive and observational analysis is very important for setting the stage for expectations of normal physiological responses to positioning that is likely to be comfortable for mothers and babies alike.  It enhances our general understanding of how babies attach to the breast.

Initially, at least in the talk I went to, Suzanne Colson seemed open to and receptive to other positions that would create comfort for mothers and babies.  Now it seems that the "description" of "biological nurturing" has reached the state where it has become a "certifiable method".  I have a bit of difficulty with "methods" being "certified".  I don't recall anyone ever "certifying" the RAM method or "certifying the "assymetric latch" method.  Since had essentially adopted the "biological nurturing" position before Suzanne Colson's research, I don't believe that any of the material I have developed would constitute copy right infringement, nor would I need to be "certified" in something mothers were doing naturally that I had already adopted anyway.

What I am finding emerging in the New York City environment, however, is the notion among some breastfeeding helpers is that "biological nurturing" cures all ills.  Often the nuances of comfort are thrown out by applying "RULES" extrapolated from the descriptive analyses of Suzanne Colson.  The certificate seems to embolden the persistent notion that we can cure everything with the ONE PERFECT LATCH.  Unfortunately, what could be described as a biological nursing positioning does NOT work for all mothers and babies and does NOT work for all breastfeeding problems.  Unfortunately, subtle differences in positioning WITHIN what might be considered "biological nursing" can make the difference between comfort and discomfort.  Sometimes the shift of an angle of mom's wrist or the angle of the baby's head of as little as an eighth of an inch -- can make a huge difference in comfort when there are breastfeeding problems.    

While I think it is important for all IBCLCs to understand the history of the analysis of the QUEST for the PERFECT POSITIONING -- I think it is every bit as important to observe, listen and dialogue with mothers about what THEY feel and observe and listen to what babies are trying to communicates through noises and body language.  Furthermore, I believe that "touch" is a very important sense that has been disappearing from medical professions in favor of medical equipment.  While I am a firm believer in appropriate use of tools -- use of our hands through touch is as important a tool as any machine made tool.  This does not mean grabbing and shoving and doing the work for mom.  

Instead it means allowing mothers to show you what they are doing and gentle appropriate (with consent) touch to FEEL what is going on in mom's body and the baby's body.  You can feel muscle tension in hands, wrists, shoulders -- many body parts while mom is trying to convince you it "is not so bad" verbally.  Feeling what mom is doing can inform how to assist her to gently shift angles so that the basic positioning that she adopts that may be "familiar" to her body can be molded into positioning that evolves into more "comfortable" positioning for her body.  

The final comment I just remembered is that Pamela Morrison who worked for many years in Zimbabwe commented on how women do NOT lean back where she lived in Africa and this lead to a discussion that you might look up that I found interesting. I think this thread emerged from some comment attributed to Suzanne Colson about assumed differences among American women and those in Great Britain -- but my memory is fuzzy on that point.

In broad strokes, I think that there may be differences from women who live in rural areas where you frequently swat, sit on low stools instead of chairs (leaning forward with a straight back), carry heavy objects on your head, and your babies on your backs from women who live in industrialized countries where you tend to slump curving your shoulders forward when you sit in straight backed chairs, push your babies in strollers or carry them in front carriers, carry heavy objects dangling from your arms and probably don't walk as much.  My memories of women nursing in Africa was seated on low stools leaning forward and I don't remember anyone under the age of 70 complaining about back pain. 

Sincerely, 
Susan E Burger

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