THE FIRST WEEK: POSITIONING AND LATCH
Breastfeeding is a gift only you can give your baby. A healthy, full term baby is likely to know instinctively what to do at the breast.
During the early weeks skin-to-skin contact helps your baby be connected to his instinctive breastfeeding skills and helps you and baby enjoy breastfeeding. Each mother discovers what works for her, and what works for one mother may not work for another.
Mary Renfrew wrote in Journal of Human Lactation that learning to breastfeed is like mother and baby learning a dance. Use what works in these suggestions and tailor them for you and your baby. Trust that you know what works for you and your baby.
You will know when the positioning is ideal for you, when you and your baby are comfortable. When positioning is right for you, your nipples stay healthy and your baby can feed most efficiently. Concern about sore nipples or breastfeeding comfortably is a common reason that mothers contact La Leche League. Improving positioning helps eliminate many cases of sore nipples.
You may have noticed this description is long. Be assured that many mothers have successfully accomplished breastfeeding their babies for centuries and you too will learn how to best position your baby. These suggestions are not meant to tell the mother that if she follows all the steps the position will be “right”. The suggestions are meant to gives you ideas on how you and your baby can learn to breastfeed and enjoy the breastfeeding experience.
However, like other seemingly simple tasks, it takes a lot of words to describe what other mothers have found works well for them. LLL Leaders are experienced in guiding mothers through the positioning process. If you feel overwhelmed by preparing to breastfeed your baby, contact your local Leader for information and support. She will be happy to simplify matters for you.
In the first three to five days after birth, if you experience nipple soreness beyond a slight tenderness when your baby latches on, it may be a sign that something isn’t right with the baby latch, position, or suck. An adjustment to the latch or positioning can help your baby be more comfortable. When you have mastered the “dance” of breastfeeding, sore or cracked nipples are allowed to heal.
If nipple pain worsens after the early days of breastfeeding your nipple pain may be due to other causes like thrush, bacterial infection, or tongue-tie. Contact a La Leche League Leader or lactation consultant for help if you need further assistance to improve your sore nipples. See information on sore nipples for more information.
Learn to recognize your baby’s early feeding cues so you have time to get in a good position before he becomes desperately hungry. Early cues include opening his mouth, moving his head side to side – also known as rooting reflex or sucking on hands and fingers. Don’t wait for baby to cry to let you know he is hungry. Crying is a very late hunger cue.
BASIC STEPS FOR POSITIONING
We will discuss several different positions. If you have pain or feel uncomfortable, try a different position. Adjusting the position can significantly improve breastfeeding pain.
Some general tips are:
Position yourself comfortablywith back support, pillows supporting your arms and your baby, and your feet supported by a footrest or a telephone book.
Position baby close to you, with his hips flexed, so that he does not have to turn his head to reach your breast. His mouth and nose should be facing your nipple. His body should be so close that he is touching you. If possible, ask your helper to hand you the baby once you are comfortable.
Support your breast so it is not pressing on your baby’s chin. Your baby’s chin should touch your breast, then the baby’s nose.
Attach or latch baby onto your breast.Encourage him to open his mouth wide and pull him close by supporting his back (rather than the back of his head) so that his chin touches your breast first. His nose will be touching your breast. Your hand forms a “second neck” for your baby.
Enjoy!If you are feeling pain, detach baby gently and try again.
These steps may need to be repeated frequently during the early weeks. You and your baby will find a technique that works for you after some practice.
Going Beyond the Basics
As you and your baby become more experienced at breastfeeding, you will find that breastfeeding positions can be altered in many ways, even from feeding to feeding. As long as you are comfortable and baby is nursing successfully, use what works for you. Try experimenting with the four positions below.
Remember, in any of these positions, it is very important to bring the baby to your nipple height.
Leaning over your baby can cause backaches, neck/shoulder strain or sore nipples.
LAID-BACK BREASTFEEDING OR BIOLOGICAL NURTURING
Laid-back breastfeeding, or Biological Nurturing, means getting comfortable with your baby and encouraging you and your baby’s natural breastfeeding instincts.
Dress yourself and your baby as you choose. Mother and baby skin-to-skin is good option too.
Position yourself comfortably in bed, on the couch, or in a recliner with back support, and pillows to also support your head, shoulders, arms. Lean back, with your pillows for support. When you comfortably lean back, and put your baby on your chest, gravity will keep him in position with his body molded to yours.
Let your baby’s cheek rest somewhere near your bare breast. Rub your nipple on baby’s upper lip to encourage baby to open wide. Bring your baby close. Have his chin touch your breast first, and then his nose will touch your breast.
Position baby close to you, with hips flexed, so that he does not have to turn his head to reach your breast. Baby’s feet need to be supported by your body so they don’t dangle in the air.
Use one hand to hold your breast as needed and the other hand to support baby’s thigh or bottom.
If you feel pain, detach baby gently by using your finger to touch the corner of baby’s mouth and try again.
Relax and enjoy each other.
The cradle position is most commonly used after the first few weeks. The cross-cradle position (see below) gives you more control.
To nurse your baby while cradling or holding him across your lap, he should be lying on his side, resting on his shoulder and hip with his mouth level with your nipple. His whole front of his body should touch the front of your body.
Use pillows to lift your baby and support your elbows to bring your baby up to nipple height, especially during the first few weeks.
Support your breast with either the “U” hold” or “C” hold as described in the “Breast Support Techniques” section below.
Your baby’s head will be on your forearm and his back will be along your inner arm and palm. When you look down, you should see his side.
His mouth should be covering at least a half inch of the dark area around your nipple. Be sure his ear, shoulder and hips should be in a straight line. As a newborn, your baby’s head and bottom should be level with each other.
During the early weeks, many mothers find a variation of the cradle position, called the cross-cradle position to be useful.
To nurse your baby in this position, your baby is supported on a pillow across your lap to help raise him to your nipple level. Pillows should also support both elbows so your arms don’t hold the weight of the baby; they will tire before the feeding is finished.
If you are preparing to breastfeed on the left breast, your left hand supports that breast in a “U” hold. If you are breastfeeding on the opposite breast, reverse hand used. (See the “Breast Support Techniques” section of this FAQ for a description of this hold.)
Support your baby with the fingers of the right hand.
Do this by gently placing your hand behind your baby’s ears and neck with your thumb and index finger behind each ear. Your baby’s neck rests in the web between the thumb, index finger and palm of your hand, forming a “second neck” for baby. The palm of your hand is placed between his shoulder blades.
As you prepare to latch on your baby, be sure his mouth is very close to your nipple from the start.
When baby opens his mouth wide, you push with the palm of your hand from between the shoulder blades. His mouth will be covering at least a half-inch from the base of your nipple.
CLUTCH OR FOOTBALL POSITION
This is a good position for a mother who has had a Cesarean birth, as it keeps the baby away from the incision. Most newborns are very comfortable in this position. It also helps when a mother has a forceful milk ejection reflex (let down) because the baby can handle the flow more easily.
In the clutch position you support your baby’s head in your hand and his back along your arm beside you. You support your breast with a “C” hold. (See “Breast Support Techniques” section of this FAQ for a description of this hold.) He is facing you, with his mouth at nipple height. Your baby’s legs and feet are tucked under your arm with his hips flexed and his legs resting along the your back rest so the soles of his feet are pointed toward the ceiling. (This keeps him from being able to push against your chair.) Pillows help bring the baby to the correct height.
For some mothers, this position works best after the early days of breastfeeding. The other positions may be easier to learn first. Some mothers find that practicing with this position during the daytime is very helpful.
Many mothers find lying down to nurse a comfortable position, especially at night. Both mother and baby lie on their sides facing each other. You can use pillows behind your back and behind or between your knees to help get comfortable. A pillow or rolled blanket behind the baby’s back will keep him from rolling away from you. The baby can be cradled in your arm with his back along your forearm. Having his hips flexed and his ear, shoulder and hip in one line helps your baby get milk more easily.
BREAST SUPPORT TECHNIQUES
As you hold your baby in any of the above positions, you may need to support your breast with your free hand. This removes the weight of the breast from the baby’s chin, allowing him to breastfeed more effectively.
“C” hold–See the cradle hold illustration above. Support your breast with your thumb on top, well back from your areola (the darker skin surrounding the nipple) and the fingers underneath. Your fingers should also be well back from your baby’s mouth. This hold is helpful when breastfeeding in the clutch or football position as well as the cradle position.
“U” hold–Place your fingers flat on your ribcage under your breast with your index finger in the crease under your breast. Drop your elbow so that your breast is supported between your thumb and index finger. Your thumb will be on the outer area of your breast and your fingers will be on the inner area. This hold is helpful when breastfeeding in the cradle and cross-cradle positions.
IS MY BABY LATCHED ON WELL?
When latching on your baby, use your nipple to tickle the center of your baby’s bottom lip. This will encourage him to open his mouth wide (like he is yawning). Aim your nipple slightly towards the roof of his mouth, bringing baby to you, chin first.
Good latch-on checkpoints for your baby include:
His nose is nearly touching your breast, that is, no further away than a credit card edge
His lips are flanged
At least ½ inch of your breast around the base of your nipple is in his mouth.
If the latch is uncomfortable or painful, gently place your finger in the baby’s mouth, between his gums, to detach him and try again.
A baby who is offered the breast will suck without swallowing as he positions the nipple in his mouth and tells your breast he is ready for the milk to let down. When he begins to receive milk, you will see his jaw working all the way back to his ear. His temples will wiggle. You will also hear him swallowing, quickly at first, then more slowly, as his appetite is satisfied.