Case 11:
The Concorde-way of breastfeeding, more than just a trick
On a certain way of latching and how it changed lives
Case 11: The Concorde-way of breastfeeding, more than just a trick
On a certain way of latching and how it changed lives
It started with a trainee’s question after a consultation: ‘What did you just do with latch? I’ve never seen that before? And why were you talking about an airplane?’
At that moment I realized that I was supervising latching on in an unusual way. It had crept into my daily practice gradually. And because I normally work alone, I hadn’t noticed it so much.
- I let mothers hold their child in their arms as if it were Madonna pose, but in a different way.
- I had mom support her breast at the level of baby’s lower jaw. And that support was quite extreme, with mother’s fingers much closer to baby’s chin than I had ever been taught.
Initially I developed this way of latching while supporting mothers and babies with a short tongue or receding chin.
And I used the image of the nose of the Concorde airplane to explain the purpose of that shaping. See image below.
And then Concorde stopped flying… and a few years later no parent understood what I meant by using that example.
In the meantime, it had become clear to me that the added value of this method of latching is not only in the trick of shaping.
With the relaxed position and breast support, mother and child appear to reinforce each other and there was more cooperation. Mothers like being able to support their child. And through that support, the baby gets a better grip on the breast, experiences how drinking at the breast works and starts cooperating with mother.
And to my great pleasure, the word “concord” means concord, unanimity, agreement, beating. And that’s what breastfeeding is about as far as I’m concerned: mutual concord between mother and child. Not only nutritionally (antibodies and such) but certainly also in terms of contact and bonding.
Because in the “normal” feeding positions, and especially sitting through, the baby was often pushed so hard to the breast with good intentions that they were forced. I heard parents say, ‘if it has to be that hard, then I don’t have to’.
By working with gentleness together with the baby, feeding turned out to be more fun. And so the term Concorde could stay. Only I prefer not to talk about the Concorde posture anymore but about Concorde way of feeding. Because it is more than a trick.
Discussion
In all common feeding positions, the emphasis was and still is on what we as professionals and mothers can see for ourselves. And that is in all feeding positions: the upper part of baby’s face and the breast.
And when the breast is formed we see the mother’s forming thumb, and the baby’s upper lip and jaw. The rest is out of sight.
But when eating and drinking, including at the breast, all activity is in the lower part of the mouth: the lower jaw moves, the tongue moves. The upper jaw and palate are a static counterpart to this.
When drinking at the breast, the tongue must thereby lie over the lower jaw so as not to activate the bite reflex. In addition, because the sucking reflex lies deep in the mouth at the level of the transition from hard to soft palate, the baby must open the mouth far enough that the breast (or bottle) enters the mouth deep enough.
And a relaxed, open body posture is important for eating well, even in a baby:
- Coordinating sucking-swallowing-breathing is easier if you tilt your head back slightly. Think first aid: that’s the way to clear the breathing path there.
- With the face slightly tilted back (anteflexion), it is easier to stick out and lift the tongue.
- A baby with a small mouth (cavity) gets more space when the bite is wide and relaxed with the head slightly back. Not only does the mouth open wider when sucking, but there is also less pressure at the back of the mouth cavity.
Both 1. biological nurturing and 2. feeding in the side position promote that relaxed, open hooking in the baby. Often only through relaxed, open sucking does feeding become fine and effective for mother and baby.
But both feeding relationships have 2 disadvantages:
- They are awkward in public, and in order to breastfeed beyond the first few weeks, it is important and necessary for most women to be able to feed their child anywhere.
- The baby has to do it himself. When feeding lying down because mother can offer relatively little help: with 1 arm free you can either control your baby or your breast, but not both. In the more natural feeding positions, shaping or supporting the breast is not recommended.
In my experience, there are 2 main reasons why additional breast support may be necessary:
- The baby cannot reach far enough under the breast with the jaw and/or tongue without help. This may be due to a short tongue-tie that has not yet been treated, a receding chin, a small mouth*, a preferred posture due to, for example, prolonged descent (see Preventive) or birth trauma.
- The baby has not experienced why a wider grip is needed: due to lack of experience (always laid on with chin on breast), with very much milk and hard milk flow, with suboptimal use of a nipple cup and with early combination breast/bottle.
By actively supporting the breast where the baby needs it and offering it in such a way that baby’s feeding reflexes are optimally invited, mother and baby can actively work together.
And the breast has a built-in learning mechanism that, in mother and child, reinforces this learning. Every millimeter more grip yields something:
- For the mother, less pain and discomfort and later even really more pleasant feeling during feedings, so she will consciously and unconsciously start subtly steering in the desired direction. And faster feedings because the baby drinks more effectively.
- For the baby more milk with less effort, less false air and more fat because the breast can be emptied better and easier.
That process of mutual learning can only happen from relaxed cooperation: concorde.
*Small mouth: this may be because the baby is still small, or because the baby is predisposed to have a small oral cavity.
Approach and result
In practice, feeding in the Concorde hold means more than just positioning of hands, arms and baby in relation to the breast. There are many aspects in which mother and child can work together.
The mother can simply sit where she feels most comfortable. She can sit upright or reclined, cross-legged or in a chair, even lying on the sofa.
The baby’s head rests on the soft curve of the mother’s elbow. It is not balanced on the hard bony edge of the arm, the radius. When a woman has a baby sitting with her, this is often the position they take together.
The baby is supported on the lap, the adult’s arm is relaxed and eye contact is possible. Even newborn babies can see clearly from this distance.
From this position, the average baby can easily reach the average breast to drink.
No more feeding with a pillow, but in the mother’s arm.
Once a baby gets bigger, usually after about 6 weeks, belly to belly is no longer essential nor is a straight line ear-shoulder-hip. A young baby cannot yet turn his upper body, so his hip, shoulder and ear must be in a straight line to be stable and drink properly.
A slightly older baby is capable of making a gentle twist in the waist so they can drink effectively with only the shoulder and ear in a straight line.
The mother supports the breast as long as and when it helps. Sometimes this is only needed for a very short time until the baby has learnt to latch on.
If the baby has structural difficulties in latching on (with low tonus or to treat a short tongue tie), the support may be nescessary during the whole feed.
And for an older baby, re-applying breast support towards the end of the feed can help the baby finish more quickly.
And that’s helpful when mum doesn’t have an unlimited amount of time to wait for the baby to finish.
From an evolutionary point of view, it makes sense for humans to have breasts high up on the chest if we assume that we are sitting when we breastfeed. If human babies were meant to be fed horizontally, it would have made more sense for humans to have nipples on the lower abdomen*.
And so, assuming a Creator or evolution, in either case it would be very inconvenient for a woman’s breasts to be in such an illogical place on her body. Having breasts where humans have them only makes sense if breastfeeding sitting up is the norm.
*Evolution shows that our distant ancestors had a milk lining: a row of nipples from the groin to the armpit. Some women still have rudimentary glandular tissue under the armpit. As far as I know, this never happens around the lower abdomen. This suggests that these lower nipples have been unused for the longest time.
Prevention
Much breastfeeding education focuses on knowledge and technique around latching on and especially milk production.
Breastfeeding and taking seems like such a mechanical process, aimed at being as effective as possible, transferring as much nutrition as possible from mother to child. I may be exaggerating a bit, but not very much.
By also providing more information during education about feeding itself as a meaningful interaction with the baby, breastfeeding can take on a broader meaning. Feeding from mothers’ own bodies without specific postures and aids is an important part of this.
The Concorde way of feeding is fine and effective for many mothers and babies. And many parents note in practice that it looks more “natural” than the usual positions. By demonstrating this already in pre-education, we avoid an image of breastfeeding as a technically complex activity.
Extra attention if baby engages early
Babies who were engaged relatively early often give the appearance of a short or posterior tongue tie for days or even weeks after birth.
While engaged baby holds their head slightly tilted with their chin on their chest (the position in which you put on a tight turtleneck). And if they have lain in that position for a long time, they often keep their head in that familiar position for a long time after birth.
In that position, you see:
- a receding chin, often with distinct crease between chin and lower lip,
- a tongue held in the back of the mouth, even when crying,
- a small appetizer,
- and in doing so, these babies often dive for the nipple with their chin on the breast, so they latch on as if they have a short tongue.
By suggesting the Concorde way of feeding directly after birth to these very mothers and babies, we may be able to avoid unnecessary treatment of tongue-ties.
The 1st week
Touch is the first form of communication with a baby, and remains an important form of contact for life. And the way we are touched is at least as important as the place where we are touched.
If someone touches you, it makes a big difference if you are touched forcibly or kindly. And this is especially the case if that touch is in a sensitive or vulnerable area, like the neck.
Many parents have never held a very young baby when they have their first child. And most have seen few examples of nursing mothers.
Holding and moving with their child is then a challenge, and the resulting tension can be felt by the baby. This can create a vicious cycle.
Especially between feedings, parents can practice moving together:
- This can be done in relaxation from skin-to-skin contact. Then it often gives parents confidence to see how well the baby is moving and actively involved in the process.
- If holding the baby at all is exciting for parents, it can sometimes help to practice with a bag of oranges: awkward, heavy, and it won’t hurt if it goes wrong.
- Sometimes finding a good feeding position is easier with clothes on than skin-to-skin. Mother and child sometimes almost stick together, which makes even shifting an arm difficult.
- Practicing between feedings with clothes closed can lower the barrier to feeding. Point out to parents then that a hungry baby usually really cooperates by, for example, lifting the head to the breast.
The first 3 months
The feeding position that was fine during maternity week may soon literally no longer fit in the weeks that follow. Mother and child will have to keep moving with the rapid growth and development.
At 6-12 weeks belly-to-belly will often only work is mother reclines completely. And that’s fine for lazy couch feeding, but inconvenient on a patio or when you want to feed quickly.
In the Concorde way of feeding, the baby is stabilized by the buttocks/legs/feet on mom’s lap, and mom’s arm supporting along the spine. Within this, much variation is possible.
A slightly larger baby can often turn the upper body toward the breast just fine from a sitting position.
A baby who overstretches quickly can drink more calmly if the buttocks really “sink” between mom’s legs so that the hips are bent without the baby being held by force of mom’s hands.
And with a taller baby, the mother may need to spread the legs a little wider apart (like a guy on the subway), so that the baby comes out relatively a little lower.
As mother recovers from childbirth, it also becomes possible to sit more creatively. Sitting crossleged, lounging with one leg raised on the couch and hanging in bed all become possible.
After 3 months
When the sucking reflex begins to disappear around 3 to 4 months, many babies become temporarily more restless at the breast. By then really offering the breast again with support at the level of the double chin, a baby can learn to drink consciously(er).
Because of that active role of mother, breastfeeding remains something mother and child do together, with a role for both.
Mothers can also demonstrate during feeding what they want baby to do at the breast at a time when baby is looking at her:
- Open mouth wide and stick tongue forward.
Babies mirror, so chances are the baby will then open the mouth wider while drinking and bring the tongue forward. If the mother supports her breast at that moment and very subtly shoves the baby, the baby gets more grip.
And then there is an immediate physical reward: more milk with less effort.
Offering the breast again more consciously may also make the alternation between breast and bottle easier. Bottle drinking can be done with a small mouth and little grip with the lower jaw. Breast drinking requires and will continue to require a wide bite.
Parents can reinforce this by showing the baby the different mouth movements at cosy moments between feedings, preferably with a sound attached. For example:
- Ahhhh with mouth wide open and tongue out = chest
- Smack sounds with narrow lips = bottle
- Haphap with bite marks = for solid food; and this can be done even before the baby actually gets solid food because at this point it is mainly as play.
In this video, I demonstrate these mouth movements and sounds and explain how and when parents can apply them.
Working together and interacting makes feeding and eating so much more fun.