The Art of Position and Latch for Optimal Breastfeeding
There are so many women that believe that breastfeeding is supposed to hurt. I always hear my patients say, “My mother said nursing would hurt, but after a few weeks it gets better.” Why endure even a day of nipple pain if you can help it? The key to painless breastfeeding is good positioning and latch.
Let’s start with the basics, YOU! Moms are mostly focused on the baby’s positioning, but the biggest factor to positioning going south, is MOM! Too many moms hunch over the bed, chair, or couch, have no back support, lack arm support, forget about foot/leg support, etc…. Your body’s discomfort will lead to poor body mechanics when latching, and this is contributes to a poor latch. Bottom line: mom’s nipples end up tender, sore, and even cracked and bleeding. What’s worse, if your nipples look or feel like they’ve been through the wringer, chances are your baby is not getting fed very well.
Just as a straw in a beverage needs to be round for one to get enough liquid when taking a drink, the nipple needs to be round in order for baby to drink as well. A pinched nipple or one that is slanted like a new lipstick is a nipple that is suffering from a poor latch. As with the previous straw analogy, if a straw is pinched when one is drinking, the liquid does not flow through in great volume, or maybe even at all. This is one of the most common reasons a baby may not feed well when the latch is less than optimal. The flow of the milk is kinked up and can’t get out.
Okay, let’s make a great latch! First, when feeding, sit somewhere that’s comfortable, is wide enough for your pillows, and there’s a place to put your feet up. This can be a chair, the couch, or a bed. Make sure you have back support. Common offenses when breastfeeding in bed is sitting up over the side of the bed without back support. Try sitting in the bed with your back against the headboard or wall.
Good. Now that you have your comfy place to nurse, let’s get the pillow situation clarified. Many women buy expensive breastfeeding pillows, these aren’t necessary. Good bed pillows or throw pillows can do just as good of a job, if not better. Many popular nursing pillows lack the proper support and can actually contribute to nipple pain as the baby starts to slip away while on breast. Key points to getting a good pillow set-up are: make sure that the pillow table is just below your breast by the ribcage and not down by your waist. Having the pillow too low creates “drag” on the nipple. OUCH! Make sure there’s support all around you. You’ll need support for both arms, so situate the pillows to where they wrap around the side of the ribs and elbows, but are also in front of you by your belly. I like setting up my bed pillows like a “V”.
Great! We have you set up, now let’s get the baby set up. Many women want to breastfeed in the common cradle hold that we see on the cover of mothering magazines and in those old Renaissance paintings. The cradle is a more advanced breastfeeding hold, intended for a baby who can look, turn, and latch on his/her own. Your newborn is not at that place yet. This is why those grandmas had nipple pain initially and no longer experienced pain after a few weeks of nursing. The baby learned how to do it by him/herself and became a pro after a certain amount of time. However, if you want to nurse as pain-free as possible, from the get-go, these positions will help you get the best, deepest latch possible. Here are three of the most popular and most loved breastfeeding holds, in no particular order.
The Cross Cradle Hold, aka: The Cross-Over Hold
The baby is positioned in front of you- perpendicular (cross-wise) to you, and belly-to-belly and chest-to-chest with you. The ear, shoulder, and hip of the baby should be in a straight line, and his/her legs should start to curl around the side of you- perhaps even wrapping around your ribs. Your arm and hand opposite the breast you’re going to feed on is the one that will hold the baby. The hand on the same side as the breast that you’re going to feed on is the breast holding hand. Start by working your arm up the baby’s spinal column, but first making sure to tether the baby’s bottom in the crook of your elbow. Follow the baby’s spine all the way up to the base of the head at the neck. This is where that bone sticks out at the back of your head (called the occipital bone or occiput). The “U” made by your thumb and forefinger should rest just under the occiput, and the end of the thumb and forefinger should rest on the little bones behind your baby’s ears. The rest of the fingers should lie on the under side of the baby’s face on the jaw-line and cheek. Good, you should have full control of your baby’s body without the neck being too loose or the head being too floppy. Now, back the baby away from the breast just enough so that you can tickle the baby’s lip with your nipple. Just the tip of the nipple should graze the lips. If the baby is too close, then she/he will latch to the tip only. When the baby is far enough to graze the lips with the tip of the nipple only, the baby will have enough room to initiate a gaping wide mouth. As soon as you see the wide gape, move the baby in quickly onto the breast.
The latch should be pain free, the baby’s lips should be flanged outwards, the baby’s tongue should be under the nipple and over his/her gum-line, and the areola should be somewhat engulfed by the baby’s mouth. The baby’s forehead should not be protruding forward and the baby’s chin should be buried into the underside of the breast.
Your handhold of the breast is also very important. Many moms use the index finger and the middle finger in a “V” shape to hold each side of the breast. This hold is usually never wide enough to be behind the areola, in order to allow for a deep latch. A great way to hold the breast is to begin with the entire hand on your rib, under the breast. Find the “chunky” area of the breast, and bring your index finger up to meet that spot. Without moving the fingers, bring the thumb around to the top of the breast. The thumb and index finger should be in the same area on opposite sides of the breast. Now squeeze down on the breast like you would squeeze down on a sandwich. You should have a good hold of the breast and your fingers should be far enough back on the areola to accommodate a good, deep latch. Your wrist shouldn’t be kinked in an awkward bend that could make your wrists weak with tendonitis or carpal tunnel syndrome. This hold should feel as comfortable as putting your hand into the front pocket of your favorite jeans.
The Football Hold, aka: The Clutch Hold
In essence, this hold is almost like the cross over hold, with the exception of the placement of the baby to the side of you. The pillow table, once again is at the height of the breast, however, the pillows will be placed so that they are to the side of your body on the side you are feeding on. A slight slope may be more comfortable. Ensure that the slope is slightly lower where the baby’s bottom is and slightly higher at the front where the baby’s head is located. One of the most common mistakes mom’s make with the football hold is having obstructions by the baby’s feet.
Babies have a stepping reflex in the first few months of life. If there are pillows where his/her feet are supposed to be when in the football hold, they will launch off of the pillows and look like they “don’t like that position” or moms struggle so much to get the baby to hold still that they don’t like that position. A quick way to fix this problem is by making sure that your back support pillow(s) are not sticking out any farther than your ribcage on that side. I like standing the pillow straight up vertically instead of having it laid horizontally.
Now, once again you’re going to grab the baby from behind his/her bottom with the crook of your elbow, then following the baby’s spinal column all the way up to the occiput where your hand will support baby’s head, neck, and jaw line. One slight difference to that of the cross-cradle hold, in the football hold the arm and hand that will hold the baby is the one that is on the same side as the breast you are feeding from. The hand holding the breast is the one on the opposite side. You’ll initiate the breast hold in the same way. Start by the ribs, etc… This time, the breast hold starts on the cleavage side of the breast.
The Side Lying Hold, aka: Mom's Favorite Hold
We've heard it time and time again, the most loved position of nursing moms is the Side Lying Hold. Lie comfortably on a bed, couch or floor and bring baby close. She should be on her side, turned toward you. Lift your breast upward with your upper hand and gently stroke your baby's mouth until she opens to latch on. Once your baby has emptied the lower breast, you can either turn over and place him on the other side or raise him with a firm pillow to the level of your upper breast. You can also turn your body to lower your upper breast to her mouth.
Tip: Babies can be “grabby” with their hands. If your baby has “octopus arms” when latching and is trying to grab the nipple or breast when you’re trying to latch him/her on, bring baby’s arm (the one that’s closest to your body) all the way down to his or her hips (straight arm down the side of his/her body) then tether his/her arm between their hip and your ribs.
Written for Nursing Bra Express by Veronica Tingzon, IBCLC