Authors Breast feeding in a baby carrier: Micaela Notarangelo, PhD, IBCLC, [email protected] Private Practice, Lerici (SP), Italy Marta Mroz, PhD, Certified Babywearing Consultant and Birth Operator, [email protected], Segrate (MI), Italy meeting the needs of and baby (safely) Valentina Ghilardotti, MA, Doula, Doula Trainer, former LLL Leader, [email protected], Milano, Italy

Breastfeeding in baby carriers is an important tool to facilitate , and families need to receive correct information about this practice. Babywearing and breastfeeding in Italy Cradle position: BW vs BF Babywearing (BW) increases the responsiveness of to infants1,2, improves breastfeeding3 (BF) and its duration4. Notwithstanding reasearch, in Italy BF in baby carriers is not encouraged by BW consultants. The concern for safety has led most Italian BW schools (differently from We suggest t hat t here is a m isunderst anding about t he definit ion of t he ?cradle? posit ion, many international ones) to discourage the use of ring slings before 4 months of age, w hich m ight be one im port ant reason w hy BW consult ant s discourage BF in baby carriers. especially in the ?cradle? (horizontal) position. Generally, the training of BW consultants in Italy teaches that BW and BF should be separated moments and that the mother should In the BW world the Cradle position is with the ?s side towards the mother, head often supported by the cloth: the rest while BF. Therefore, just a few BW schools teach how to breastfeed in a baby carrier, risk of suffocation due to ?chin-to-chest? or because the cloth and in the vertical position only, which is impractical and uncomfortable with a pushes the nose into the breast is high. In addition, BF in this newborn. However, breastfeeding in the early weeks is very intense, and mothers position is not likely to be effective because it would require often feel trapped if they have to sit all the time and do nothing else. Being able to the baby to turn their head to the side. The risk of suffocation breastfeed while using a baby carrier would allow them to acquire mobility and further increases when used in the version with the face breastfeed more easily, thus improving their BF experience. covered by the cloth. . Babywearing and safety The correct use of baby carriers is necessary for safety, but excessive concern following the recall of a pouch sling in 20106 has led to the unnecessary discouragement of BF in baby carriers. A Correct BF posit ion in fact is inherent ly safe, as airway patency is a necessary condition for efficient breastfeeding10, and in a good the head is slightly extended with the nose not touching the In the BF world, the Cradle position means breast.11 Therefore it respects the main requirements of international guidelines on BW safety.7, 8, 9 ?belly-to-belly? with the whole body in alignment. The sling supports the bottom and the trunk, but not the head which is supported by the mother?s Risk f act or s f or asphyxia arm, allowing an asymmetric latch (chin to the - chin bent towards the chest, which reduces airway patency breast, nose far from the breast). This is not strictly - face pressed against the body of the caregiver or the cloth a ?carrying? position, as it is not completely hands - face covered free. However, it allows mobility, and the free use of one hand while safely BF. Source 7, 8, 9, 12, 13, 14, 15,

The Survey Sam ple size 360 Carrying (C) 315 (87,5%) * M et hod: Online survey from 360 respondents in Italy about their experience of BW and of whom breastfeeding in baby carriers (BFC): 177 (49,2%) BF, with both multiple choice and open questions. The survey was sent to former clients of whom not breastfeeding in baby carriers (nBFC): 138 (38,3%) and contacts of the authors and of their colleagues. We acknowledge a probable selection Not carrying (nC) 45 (12,5%) bias in the sample. * Questionnaire at https://www.laviadellatte.it/index.php/allattare-in-fascia

Why do you breast feed in a baby carrier? How did you learn t o breast feed in a baby carrier? Would you have liked t o t ry? BF in baby carriers by t ype of support

In the survey nearly 50% of respondents breastfeed in baby-carriers, with as many as 91.5% of them finding it convenient or convenient enough, due to the following perceived In the nBFC group almost 40% did not The decision to breastfeed in a baby carrier seems to be benefits: increased comfort and convenience, increased mobility, receive information about the possibility influenced by the choice of the support, as relatively more easier managing of siblings, improved BF relationship, soothing to breastfeed in baby carriers or were users of a ring sling (a intuitive and flexible support) of the baby. Only a minority (7.9%) finds it inconvenient, and this discouraged to do it, and almost 30% breastfeed in the baby carrier. Structured supports are the is reflected in the small number of those who breastfed in baby Mothers mostly learned how to breastfeed in a baby thought that this could have im proved least suitable for breastfeeding, and wraps need more carriers only for ?emergency? situations (6.6%). carrier by themselves. t heir BF experience. guidance to correctly position the infant at the breast.

Babywearing and Breastfeeding together can make a difference! Conclusions Ring slings and wraps have a great potential to be used as tools for solving complex breastfeeding issues, because of the firm and physiological support they provide. Genna7 points out how using a soft sling could address feeding resistance, tactual defensiveness and help the infant organize before We believe t hat BW can be a feeding. In fact, a correctly positioned sling stabilizes the infant?s hips and trunk, providing the distal support necessary for proximal stability of the head pow erful t ool t o facilit at e BF, and for efficient sucking and swallowing16. The soothing effect of being carried17 contributes to the organization of movements. Some of the respondents in the survey used the baby carrier to facilitate BF in difficult situations, such as reflux or breast aversion, and we experienced especially in t he first w eeks. some cases in which the ring sling was instrumental in solving BF issues, or breastfeeding helped with the carrying experience. Correct information about how to Im proved breast feeding by use of a ring sling Im proved carrying by m eans of breast feeding: breastfeed in a baby carrier is important Case 1: A sensitive infant, following a Case 2: A hypertonic infant for a safe and effective practice. It is complex beginning of BF, resisted being resisted being carried in any brought close to the breast. When the carrier, while she relaxed when necessary to build a bridge between mother held her in the sling, initially just breastfed. We therefore breastfeeding and babywearing rocking her to sleep, she relaxed and decided to let her latch on the soon accepted the breast latching on a breast in the wrap in BF cradle professionals to give coherent support to nipple shield. The second time the latch position. Her muscular tone families. Effective support starts from improved further to a wider gape. We relaxed as she breastfed, and communication and cooperation between observed improved latch using a ring she later accepted to be moved sling in several other cases. to a vertical position of BW the BF and BW worlds. (while not breastfeeding).

1. Williams, L. R., et al. (2020). Infant carrying as a tool to promote secure attachments in young mothers: Comparing intervention and control during the still-face paradigm. Infant Behavior and Development, 58, 101413. 2. Little, E. E., et al. (2019). Culture, carrying, and communication: Beliefs and behavior associated with babywearing. Infant Behavior and Development, 57, 101320. - BW can support BF in many ways 3. Little, E., et al. (2018). Mother?Infant Physical Contact Predicts Responsive Feeding among U.S. Breastfeeding Mothers. Nutrients, 10, 1251. 4. Pisacane, A., et al. (2012). Use of baby carriers to increase breastfeeding duration among term infants: the effects of an educational intervention in Italy. Acta Paediatrica, 101, e434?e438. - Mothers desire to breastfeed in baby 5. Weber, E. (2013). Portare i piccoli: un modo antico, moderno e ... comodo per stare insieme. Il leone verde. 6. Consumer Product Safety Commission (CPSC), 2010, Infantino Recalls to Replace SlingRider Baby Slings; Three Infant Deaths Reported, USA, https://www.cpsc.gov/Recalls/2010/infantino-recalls-to-replace-slingrider-baby-slings-three-infant-deaths-reported 7. Consumer Product Safety Commission (CPSC), 2017, CPSC approved new standards for infant carriers, USA, https://www.cpsc.gov/Newsroom/News-Releases/2017/CPSC-Approves-New-Federal-Safety-Standard-for-Infant-Sling-Carriers carriers 8. Product Safety Australia (PSA), AUS, Baby sling safety, 2015, AUS, https://www.productsafety.gov.au/news/baby-sling-safety 9. Government of Canada, Baby sling and carrier safety, 2014, CAN, https://www.canada.ca/en/health-canada/services/infant-care/baby-slings-carriers.html - Mothers need education in how to 10. Genna, C. W. (2016). Supporting Sucking Skills In Breastfeeding Infants. Jones and Bartlett Publishers. 11. Glover, R., et al. (2016). They Can Do It, You Can Help: Building Breastfeeding Skill and Confidence in Mother and Helper, In C. W. Genna (ed.). Supporting Sucking Skills In Breastfeeding Infants (pp 113-156) Jones and Bartlett Publishers. breastfeed safely in baby carriers 12. Bergounioux, et al. Rambaud, C. (2015). Sudden deaths in adult-worn baby carriers: 19 cases. European Journal of , 174, 1665?1670. 13. Byard, R. et al. (2011). Infant deaths associated with baby slings. Medical Journal of Australia, 195, 321?321. 14. Castellote, E. M., et al. (2012). Asfixia grave en una lactante por uso incorrecto del pañuelo portabebés. Anales de Pediatr??a, 77, 416?417. - The BF cradle position is safe and 15. Madre, C., et al. (2013). Infant deaths in slings. European Journal of Pediatrics, 173, 1659?1661. 16. Redstone, F., et al. (2004). The importance of postural control for feeding. Pediatric Nursing, 30, 97?101. useful to breastfeed in baby carriers. 17. Esposito, G., et al. (2015). The calming effect of maternal carrying in different mammalian species. Frontiers in Psychology, 6.

All information presented in this poster conforms to the WHO International Code of Marketing of Breastmilk Substitutes and Subsequent WHA Resolutions. The authors declare that they have no conflict of interest with regard to the content of the poster.