Dr Thompson showed that the cross-cradle hold and asymmetric face-breast bury worsen women's experience of nipple pain during breastfeeding

In 2011 Dr Thompson published an important historical account of Australian breastfeeding practice over the past 40 years.

Then in 2016, Dr Thompson led a well-conducted retrospective medical record analysis of 654 new mothers who were referred to her, which investigated for causes of nipple pain and engorgement. This very important study showed increased risk nipple pain occured when the breastfeeding woman

• Used cross-cradle hold

• Used breast shaping to achieve nipple-to-nose

• Used asymmetric application of ‘4 points’ of the infant's face (the two cheeks, chin, and nose)

• Had inflammatory mastitis.

There has been no peer-reviewed and published theoretical basis for, or explanation of, the Thompson Method in the research literature

The Thompson Method has become a commercially successful approach to fit and hold in breastfeeding, though parents who sign up receive a lot of other information about infant care as well.

However, there are no peer-reviewed or published theoretical frameworks demonstrating the development of the Thompson Method. There is no published, peer-reviewed discussion of the clinical steps the Thompson Method recommends. As a result, it remains difficult to know how the Thompson Method is distinguished from other methods (e.g. the gestalt method).

In a major project, the Brisbane Mater Mothers Hospital upskilled hospital midwives in, and informed patients who intended to breastfeed about, the Thompson Method. Patients reported that the hospital's midwives also referred these women to Dr Thompson's private business for further assistance when problems emerged.

The Possums Clinic was a community-based breastfeeding support clinic, run by a small charity in the adjacent suburb to the Mater Mothers Hospital at the same time as staff were being upskilled and the Thompson Method was being rolled out to all the hospital's postbirth patients. In my summation of the Thompson Method strategies here, I rely anecdotally upon the many patients who presented to me over the years with breastfeeding problems who had been taught the Thompson Method as inpatients at the Mater Mothers Hospital. Again, there is no publicly available information to rely upon, other than a broad overview of the Thompson Method offered in the Allen 2023 evaluation.

According to anecdotal information shared with me from both patients and health professionals using the Thompson Method, the method

• Does not routinely recommend that women semi-recline as they breastfeed (a fundamental biological nurturing strategy which activates the baby's mammalian reflexes)

• Does not educate women in a coherent model of the biomechanics of infant suckling

• Gives advice for infant-care and management of unsettled baby behaviour which blends multiple theoretical models without a coherent evidence-base (e.g. 'rest and digest over the knees between breasts whilst breastfeeding')

• Does not clarify use of language and health professional educational 'scripts'.

How was the Thompson Method evaluated?

The primary objective of the Allen et al 2023 study was to evaluate the effect of the Thompson Method on breastfeeding at two time points: hospital discharge (direct breastfeeding) and 3-months postpartum (exclusive breastfeeding).

13,667 mother-baby pairs were subject to interrupted time series analysis and 495 mothers to postnatal surveys. Surveys were primarily used to measure impact of Thompson Method on exclusive breastfeeding at hospital discharge and at 3 months.

Two baseline surveys were conducted (n = 164 2011 - 2012; 2016 - 2017 n = 8,350). Implementation occured between January and March 2018. Two post-implmentation periods were evaluated, April 2018 - June 2019 n = 5,317; May - November 2019 n = 331).

What did evaluation of the the hospital-wide implementation of the Thompson Method show?

The Allen et al 2023 evaluation of the Thompson Method's implementation

• Acknowledged that there had been limited evaluation of Thompson Method prior to implementation

• Showed that breastfeeding rates at that tertiary hospital (Mater Mothers, Queensland) declined dramatically between 2011 and 2019. Rates of exclusive breastfeeding at hospital discharge remained lower in 2019 than in 2011.

• Showed no statistically significant change in exclusive breastfeeding rates at 3-month follow up after implementation of the Thompson Method

• Showed a small rising monthly trend in midwife-reported nipple damage after implementation of the Thompson Method, with no change found in attachment difficulties.

• Partial implementation despite hospital wide initiative (one third of women completely unfamiliar with the method). This could suggest that many of the midwives did not find the Thompson Method clinically helpful, and this was what I had heard locally, anecdotally.

Recommended resources

All agree that fit and hold problems are the most common cause of nipple pain. So why isn't every woman shown how to prevent it, or how to do a quick and early repair?

What does the research tell us about approaches to fit and hold currently used for breastfeeding support?

The belief that 'there is no right way to breastfeed, only your way' doesn't help breastfeeding women (and may cause harm)

What does the research tell us about skin-to-skin contact or Kangaroo Mother Care for term infants?

An ultrasound study shows that a brief gestalt intervention immediately improves the suck of breastfeeding babies who fuss at the breast or who cause maternal nipple pain

Selected references

Allen J, Germain J, O'Connor M, Hurst C, Kildea S. Impact of the Thompson method on breastfeeding exclusivity and duration: multi-method design. International Journal of Nursing Studies. 2023;141:104474.

Thompson RE, Kildea SV, Marclay LM, Kruske S. An account of significant events influencing Australian breastfeeding practice over the last 40 years. Women and Birth. 2011;24:97-104.

Thompson RE, Kruske S, Barclay L, Linden K, Gao Y, Kildea SV. Potential predictors of nipple trauma from an in-home breastfeeding programme: a cross-sectional study. Women and Birth. 2016;29:336-344.