Positioning and Latch-on Skills
Many breastfeeding problems (sore nipples, insufficient milk, or mothers not enjoying breastfeeding) can be resolved with improving basic technique (see Multimedia File 1-5).
- Position yourself
- Get comfortable sitting up in a bed, rocking chair, or armchair.
- Place pillows behind your back, on your lap, and under the arm that will be supporting your baby as needed.
- Use a footstool if you are sitting in a chair.
- You can also lie on your side in bed facing your baby with pillows as needed to support your head, back, and upper leg (see Multimedia File 2).
- Position your baby
- Start with baby only lightly dressed or even undressed to promote skin-to-skin contact.
- Nestle your baby in your arm in a cradle hold (see Multimedia File 4). This involves cradling the baby with your arm on the same side as the breast being presented. The baby's neck rests in the bend of your elbow, her back along your forearm, and her buttocks in your hand.
- Turn your baby's entire body on its side so he is facing you, tummy to tummy.
- The baby should be straight, not arched backward or turned sideways.
- The baby should not have to turn his head or strain to reach your nipple.
- Raise your baby to the level of your breast by putting a pillow on your lap or by using a footstool, otherwise you may strain your back and arm muscles or cause the baby to pull down on your breast.
- Tuck your baby's lower arm into the pocket between her body and yours below your breast.
- If her upper arm keeps interfering, you can hold it down with the thumb of your hand that is holding the baby.
- If your baby is premature or has trouble latching on, try the clutch hold (see Multimedia File 5).
- Sitting up in bed or in an armchair, set a pillow at your side, wedge it between you and the arm of the chair, and place your baby on the pillow.
- Position your baby in close along the same side as the breast you are using and cup the back of the baby's neck in the same hand. Direct the baby's legs upward so that they are resting against the pillows supporting your back.
- Be sure that baby is not pushing with its feet against the back of the chair or pillow, causing the baby to arch its back. If this happens, position baby bent at the hips with legs and buttocks against the back pillow.
- Once baby is sucking well, wedge a pillow up against the baby's back to help hold the baby close.
- Present your breast
- With your free hand, manually express a few drops to moisten your nipple.
- Cup the breast, supporting the weight of your breast with palm and fingers underneath and thumb on top.
- Keep your hand back toward your chest wall so your fingers stay clear of the areola, away from baby's latch-on site.
- Using your milk-moistened nipple as a tease, gently massage baby's lips, encouraging her to open her mouth wide.
- The moment your baby opens her mouth wide, direct your nipple into the center of the baby's mouth and with a rapid movement pull the baby in very close to you with your arm.
- Your baby's gums should bypass the base of the nipple and take in at least a 1-inch radius of the areola or the nipples will be sore after just
one or two feedings. Babies should suck areolas, not nipples (see Multimedia File 1).
- Many babies tighten or purse their lips, especially the lower one.
- Help your baby open its mouth wider by using the index finger of the hand supporting your breast to press firmly down on your baby's chin as you pull the baby on.
- You may be able to do this while the baby is latched on by using your index finger to evert (turn out) the baby's lips.
- Make adjustments for the baby's breathing: If your baby's nose seems to be blocked, pull baby's bottom closer to you, change the angle of baby's position slightly, or use your thumb to press gently on your breast to uncover the baby's nose.
- Support your breast
- After you have baby correctly latched on, hold your breast throughout the feeding so the weight of your breast does not tire your newborn's mouth.
- Supporting the breast will be less necessary as baby gets older and you will then have a free hand during most of the feeding.
- Breaking off: To avoid trauma to your nipples, do not pull your nipple from baby's mouth without first breaking the suction by inserting your finger into the corner of baby's mouth, wedging it between the baby's gums.
- Positioning and latch-on skills for breastfeeding are all much easier than they sound once you get the hang of breastfeeding. Observing another mom breastfeeding first will help greatly if you have the opportunity.
Allahyar Jazayeri, MD, PhD
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