Laid-back Breastfeeding in Hospital Setting
Laid-back Breastfeeding in Hospital Setting
The so-called biological nurturing (BN) - or laid-back breastfeeding (LB BF), a new
 neurobehavioral approach to breastfeeding (BF), has the potential to enhance BF initiation
 and to reduce breast problems (pain, fissures, etc.), while easing the newborn attachment to
 the breast. BN focuses on facilitating the mother to breastfeed in a relaxed, laid-back
 position, with her baby laying prone on her, so that the baby's body is in the largest
 possible contact with mother's curves. This position opens up the mother's body and promotes
 baby's movements through the activation of 20 primary neonatal reflexes stimulating BF.
 Neurophysiological studies show that, through this approach, infants instinctively know how
 to feed, thanks to the presence of neonatal reflexes, at the same time mothers being able to
 instinctively activate the same reflexes.

 The main objective of this study is to assess the effectiveness of LB BF compared to standard
 hospital practices on the frequency of breast problems (i.e., pain, fissures, etc.) at
 discharge.
Despite the fact that breastfeeding (BF) benefits are largely known and that this practice is
 highly recommended, available data at national and international level show that exclusive
 breastfeeding rates are still low. Among the main determinants that can be addressed to
 improve BF prevalence, the quality of care and the support provided by health staff to women
 during labour and delivery seem to have a particular relevance. In hospital settings, an
 adequate support to women initiating BF is not always granted, especially where time
 availability of staff is limited and their specific skills inadequate.

 In most recent years, a growing scientific evidence on neonatal primary reflexes opened new
 windows of intervention. In particular, the so-called biological nurturing (BN) - or
 laid-back breastfeeding (LB BF) - has the potential to enhance BF initiation and to reduce
 breast problems (pain, fissures, etc.), while easing the newborn attachment to the breast. BN
 is a new neurobehavioral approach to BF initiation, which focuses on facilitating the mother
 to breastfeed in a relaxed, laid-back position, with her baby laying prone on her, so that
 the baby's body is in the largest possible contact with mother's curves. This position opens
 up the mother's body and promotes baby's movements through the activation of 20 primary
 neonatal reflexes stimulating BF. Neurophysiological studies show that, through this
 approach, infants instinctively know how to feed, thanks to the presence of neonatal
 reflexes, at the same time mothers being able to instinctively activate the same reflexes.

 The method is simple, given that there are no "correct" positions nor the need to follow
 particular procedures to BF, whilst with the traditional approach precise indications on the
 right BF position and attachment are to be provided to and followed by the woman. The
 effectiveness of BN has however not been adequately studied through randomized controlled
 trials, particularly in hospital settings.

 The main objective of this study is to assess the effectiveness of LB BF compared to standard
 hospital practices on the frequency of breast problems (i.e., pain, fissures, etc.) at
 discharge. Secondary study objectives are to assess the effectiveness of the intervention on:
 exclusive breastfeeding at discharge and during the maternity ward stay; exclusive
 breastfeeding at 7 days and 1 and 4 months of life; frequency of breast problems at 7 days
 and 1 and 4 months of life; frequency of use of nipple shield at discharge, at 7 days, and at
 1 and 4 months. Furthermore, the study will assess the feasibility of the LB BF approach in
 hospital setting and the degree of mother satisfaction.
Inclusion Criteria:

 -  women who plan to give birth at the Institute for Maternal and Child Health Burlo
 Garofolo, Trieste, and who express the intention to breastfeed, identified during the
 visit for their 3rd routine antenatal ultrasound scan (30/32 weeks gestational age).

 Exclusion Criteria:

 -  presence of problems with potential negative impact on BF (e.g. severe cardiovascular
 problems, severe obesity as defined by body mass index above 32; hypertensive
 disorders);

 -  antenatal diagnosis of foetal complex diseases (i.e., congenital pulmonary adenomatoid
 malformation);

 -  twin pregnancy. The need for admission at birth or during hospital stay to Intensive
 Care Unit of both newborn or mother and the appearance of pathological jaundice in
 newborn are reasons for exclusion after randomization.