Positioning, Latch-On, and the Baby’s Suck – Positioning

Positioning, Latch-On, and the Baby’s Suck – Positioning

During the early weeks of breastfeeding, while the mother and her baby are learning the basics, encourage the mother to give special attention to how she positions herself and her baby and how he latches on to the breast. Good positioning and latch-on will help prevent sore nipples, as well as give the baby more milk for his efforts. A baby who is well-positioned and latched-on will better stimulate the mother’s milk supply and get off to a healthier start. If the mother has persistent sore nipples or frequent mastitis or the baby is gaining weight slowly, poor positioning and latch-on may be contributing factors.

If both mother and baby are doing well, she no longer needs to be overly concerned about positioning and latch-on. As mother and baby become more practiced at breastfeeding, they will naturally find themselves nursing comfortably in a variety of positions and settings as they go about their daily activities.

Mother and baby are both active partners in the breastfeeding relationship. Mothers sometimes blame themselves when breastfeeding does not go smoothly, imagining that if they just knew more or did things differently, breastfeeding would have been easier. Although the mother’s knowledge and skills can make a difference, the baby’s coordination, skill, and temperament—as well as any special physical needs—are all important factors, too. Both mother and baby influence the progress of breastfeeding in the early weeks.

Good latch-on and sucking come easily to some babies. Other babies find it more difficult. For example, a baby who sucked his fingers or tongue in utero may need extra help learning to keep his tongue down while latching on to the breast in the early weeks.

If the baby seems to be having a difficult time, assure the mother that it is not her fault and with time, patience, and practice the baby will learn to breastfeed well. The first six weeks are the adjustment period, when mother and baby work together to find a good “fit.” For some, a good “fit” comes easily; for others it takes more work.

POSITIONING

breastfeeding positions

The Mother’s Posture—Getting Comfortable

Since the mother will spend several hours a day breastfeeding her baby, it is important that she position herself so that she can hold the baby close to her breast and relax without any of her muscles straining.

Ask her where she will be nursing at home (in a chair, on a sofa, in bed) and discuss ways she can make herself more comfortable. Encourage her to use pillows, cushions, rolled-up blankets, or other props to support her baby’s weight and—if she is sitting up—to use a stool or low table for her feet.

Sitting Up to Breastfeed

Sitting Up to BreastfeedDuring the early weeks of breastfeeding, when the mother nurses sitting up, suggest she try to find a chair in which she can sit upright. A straight-backed armchair may be more comfortable for breastfeeding than a cushioned chair or sofa. The chair should have good back support so that she doesn’t have to lean over her baby or lean too far back. Leaning over the baby may cause back and neck strain and leaning back too far can pull the mother’s breast tissue away from her baby, making it more difficult for him to latch on well and keep the breast in his mouth.

For comfort’s sake, suggest that she find a chair that’s low enough so that her feet are flat on the floor and her knees are slightly raised. Even then, she may find it more comfortable to use a low footstool or table to prop her feet while she nurses.

If the mother prefers to breastfeed on a cushioned chair or sofa, suggest she use pillows behind her back and shoulders, under her arms, and anywhere else that will help her sit upright and feel well-supported. It may take quite a few pillows or cushions to accomplish this.

It is difficult to sit upright with legs outstretched or crossed underneath, which is why most women find it difficult to breastfeed sitting up in bed. If the mother wants to breastfeed this way, suggest she put something firm behind her back and a pillow under her knees.

Because each mother has different physical characteristics—arms of different lengths and breasts at different heights—encourage the mother to experiment to find the most comfortable position for her.

An important part of this is making sure that the baby is well-supported so that the mother doesn’t have to use her arm, shoulder, neck, and back muscles to support his weight throughout the feeding. Even a small baby can feel very heavy within a short time.

When nursing sitting up, most mothers will need to use pillows, cushions, or other props under the baby to support his weight. A mother with high breasts may need several pillows to support her baby at breast height.

Some large-breasted women have difficulty putting their babies to breast because when they are sitting their breasts come down almost to their lap. In this case, suggest the mother roll up a diaper or baby blanket and put it under her breast for support, to lift it high enough to allow the baby to latch on to the nipple more easily. This will also help her to see how the baby is latching on. Supporting and lifting the breast also helps to keep the breast from covering the baby’s nose. Some large-breasted mothers find that breastfeeding goes more smoothly when they use the football hold position, because it gives them more control over their baby’s head and other movements, as well as a better view of the latching-on process.

Lying Down to Breastfeed

laying down to breastfeedIf the mother nurses lying on her side, encourage her to experiment to find a position that is comfortable for her and her baby. A pillow under the mother’s head is usually a must. Some mothers prefer several pillows or cushions to raise their upper body even more. Pillows are important behind the mother’s back so she can lean back into them for support. Without pillows behind her back, a mother tends to lean forward toward the baby rather than pulling the baby close to her to nurse. A pillow under the mother’s upper leg can make a big difference in helping her relax more completely.

The baby’s position is also important. The baby’s whole body should be facing the mother so that he doesn’t have to turn his head or strain his neck to nurse. If the mother is lying on her side, this means the baby should also be lying on his side with his whole body facing his mother. Some mothers find it more comfortable to have the baby positioned with his head on the bed; other mothers rest the baby’s head on their upper arm. Encourage the mother to use the position that feels most comfortable to her.

Nursing lying down is sometimes easier for large-breasted women than it is for small-breasted women, because the mother’s breast may rest on the mattress, where her baby can easily latch on without the mother having to support her breast or her baby’s head with her arm.

To offer both breasts without rolling over, the mother can shift her position so she is leaning over her baby or—depending on the shape of the mother’s breast—the upper breast may reach her baby’s mouth without any change in the baby’s position. If the mother wants to roll over to nurse her baby on the other breast, it may make the process easier if she holds her baby to her chest as she rolls over.

How the Mother Holds the Baby

Once the mother is in a comfortable position, encourage her to bring the baby up to breast level, rather than leaning over to him. Leaning over to breastfeed can cause back and neck strain in the mother. In a large-breasted mother, leaning over can also affect latch-on by causing the baby to slip down onto the nipple as he breastfeeds, resulting in sore nipples and less effective breastfeeding.

Whether the mother is sitting up or lying down, the baby will nurse better if he is pulled in close so that his face is directly in front of the breast, with his mouth at nipple height or slightly below. In the cradle hold or the side-lying position, this would mean that he is on his side with his whole body facing hers. In the football hold, this would mean that his body is well-supported at breast height at his mother’s side.

If a baby has to turn his head to reach the breast, it can make swallowing more difficult and can contribute to nipple soreness.

The baby’s head should be straight, in line with his body, not arched back or turned sideways. If the baby has to turn his head to breastfeed, it can make swallowing difficult and can contribute to nipple soreness.

The easiest position for a baby to nurse is with his head slightly back, with his chin pressed gently into the mother’s breast. If the baby’s chin is tilted down toward his chest, swallowing would be more difficult. (The exception to this is the baby who is using his tongue improperly. He may nurse better if his chin is positioned slightly down toward his chest.)

If the baby feels well-supported and secure, it will enable him to concentrate on breastfeeding, rather than on how he is being held.

The baby should be supported at breast level, or slightly lower, so that the mother is not leaning forward to reach him and he is not straining to reach her nipple or pulling on the nipple once he is on the breast.

Pillows, cushions, or other supports under the baby will help keep him at breast level without straining the muscles in the mother’s arms, shoulders, neck, or back.

Common Breastfeeding Positions

Cradle Hold

Cradle Hold
This is the most common hold once babies are a little older and have started gaining control of their necks. Baby lays in the arm of the side they are feeding on. The babies head, neck, and shoulder will lean on moms arm.
The cradle hold is a commonly used nursing position.

To get comfortable, suggest the mother use pillows behind her back and shoulders, under the elbow of the arm she will be using to hold the baby, and in her lap to support the baby’s weight.
The mother holds the baby securely, with his head resting on her forearm or in the crook of her arm, whichever is more comfortable. His back is supported by her forearm, and her hand cups the baby’s buttocks or thigh.

The baby should be positioned on his side with his knees pulled in close to his mother. He should not have to turn his head to take the breast. If he were naked, his umbilicus would not be visible. His ear, shoulder, and hip should be in a straight line.

The baby’s bottom arm can be either under the mother’s breast or tucked around her waist, depending on which is easier and more comfortable.

If the mother has a forceful let-down or the baby has low muscle tone, he may tend to gulp and choke more easily. If this is a problem, have the mother try positioning her baby so that his neck and throat are higher than her nipple. She can do this by using the following positions.

  • Add a third pillow under the baby and lean back slightly so that her breast is angled upward.
  • Lean back in a rocking chair with her feet on a pillow, stool, or low table and her knees drawn up.
  • Lie on her side with a folded bath towel under the baby so that his face is angled slightly downward toward her nipple.

Football or Clutch Hold

Football Hold
In football hold babies rest their arms and legs straight down under the mothers armpit. This is a way of breastfeeding that is suggested for mothers who have had a C-section because it keeps the baby away from the incision site.
To get comfortable, suggest the mother put a pillow behind her shoulders and firm pillows at her side to raise the baby up to the level of her breast.

The baby faces the mother while his body is tucked under her arm along her side. The baby’s bottom rests on the pillow near the mother’s elbow with his hips against the back of the chair, sofa, or against the wall, if she is sitting up in bed. The baby’s upper back rests along his mother’s forearm while she supports his neck with her hand. (With the hypertonic—or arching—baby, it may be necessary to cover the mother’s hand with a cloth and tuck up his feet so that nothing touches his soles.)

After the baby latches on, the mother settles back comfortably with her elbow nestled into the pillow at her side. If her arm tires, the mother can support her forearm with her thigh by bending her knee and placing her foot on a footstool or low table. An extra pillow or folded blanket can also help to support the wrist and hand under the baby’s head.

Because the football hold offers the mother a clearer view of her baby and better control of the baby’s head, it works especially well in certain special situations, for example, for the mother with large breasts or flat or inverted nipples.

The football hold is a good choice for a mother who has had a cesarean birth, because it allows her to breastfeed without putting pressure on her incision. (Also see “Finding a Comfortable Nursing Position” in the chapter “Cesarean Birth.”) It may also be helpful for the baby who is sleepy or having difficulty learning to breastfeed.

The football or clutch hold works well for premature babies and babies with a weak suck, as it gives a good view of the baby’s face, gives the mother control over the baby’s head, and allows her to apply gentle pressure to the back of the baby’s head, if needed.

Side-Lying

Side-Lying Position
If you choose to have your baby in your room for those first months where they are feeding every couple of hours the side-lying feed is a position you will love! You can still have your head resting as your little one eats. This position involves both mom and baby laying on their sides.
In the side-lying position, the mother lies on her side. To get comfortable, she can put pillows under her head, behind her back, and under the knee of her upper leg. Her body is at an angle to the bed as she leans slightly backward into the pillow behind her back.

The baby is on his side facing his mother with his back resting against his mother’s forearm and his knees pulled in close to his mother. (The cesarean mother may need to protect her incision from her baby’s kicks with a small pillow, rolled baby blanket, or towel placed between her baby and her abdomen. This can also be tucked under the mother’s abdomen to support her sagging muscles if they cause discomfort.)

To keep the baby on his side facing his mother, a folded towel, a rolled receiving blanket, or small pillow may need to be propped behind his back.

The mother can offer both breasts while lying on one side or she may prefer to roll over on her other side while the baby lies on her chest. A cesarean mother can minimize the pulling on her stitches when rolling over by pulling her baby to her chest with her arms and using the muscles in her legs to scoot her hips over to the other side, making sure she gets comfortable before she starts nursing again. (For a step-by-step description, see “Finding a Comfortable Nursing Position” in the chapter “Cesarean Birth.”)

One advantage of the side-lying position is that it allows the mother and baby to rest or sleep while they nurse. Because the baby’s weight does not rest on the mother’s lap, it may be more comfortable for cesarean mothers than the cradle hold. Some mothers and babies master the side-lying position quickly, others find that it takes time. But even if it takes days or weeks of practice for mother and baby to get comfortable, it is well worth the time and effort. Once a mother learns to nurse in the side-lying position, she can rest or sleep while the baby breast-feeds, day and night, giving her more energy to care for her baby.

Breastfeeding Positions for Special Situations

Slide-Over

If a baby is refusing one breast or reluctant to nurse on one side, the slide-over position may help persuade him to nurse on the less preferred breast.

Suggest the mother nurse the baby first on the preferred breast, and after the let-down occurs, slide the baby over to the less preferred breast without changing the baby’s body position, finishing the feeding with the preferred breast. (For other suggestions, see “Refusal of One Breast” in the chapter “Fussy at the Breast and Breast Refusal.”)

Cross-Cradle, Modified Clutch, or Transitional Hold

cross-cradle hold
The cross-cradle hold is an easy way to breastfeed for new moms with small newborns. It gives you a lot of control and lets the babies head rest in your hand. The baby’s body rests opposite of the breast they are eating from.
In the cross-cradle hold, the mother’s hand is placed directly behind the baby’s head for support and guidance. This is especially useful for a baby who is having difficulty latching on, as this hand gives the mother more control in guiding her baby quickly onto the breast as his mouth opens, which helps a baby latch on more effectively.

This hold may also be helpful for a premature baby (who tends to roll up into a ball when the cradle hold is used) or a baby with low muscle tone, a weak rooting reflex, or a weak suck. These babies will be able to stay on the breast more easily with gentle, steady pressure applied to the back of their heads.

To use the cross-cradle hold, suggest the mother:

  • Position herself comfortably, with pillows behind her, leaning slightly back so that she does not have to bend over the baby.
    Positioning/Latch-On
  • Support the baby in her lap on a pillow or cushion in a horizontal or semi-upright position.
  • Hold the baby using the arm opposite the breast at which he will feed, i.e., the right arm when nursing at the left breast. The mother’s hand supports the baby’s neck and head; his body extends along the length of her forearm.
  • Use her same-side hand to support the breast, i.e., her left hand, if she will be nursing on the left breast.
  • Position the baby’s mouth at the level of her nipple, or slightly lower, with baby’s body on his side facing her.

Unusual Positions

The following positions are rarely, if ever, needed, but there are situations in which they may be useful. If the mother has a sore spot on her nipple that is aggravated by the usual nursing positions or wants to try new positions for a persistent plugged duct, suggest she try these. Some may also be helpful for a baby who is having problems positioning his tongue correctly, such as the baby with a short tongue or frenulum, or the baby who is pulling his tongue up in back. Gravity may help bring the baby’s tongue down when the baby approaches the breast with his head down (Marmet and Shell 1993; Maher 1988).

Prone PositionProne positions. In all of these positions, the mother lies on her back with her head slightly elevated, and the baby lies face down on top of mother. The mother may be more comfortable if she supports her head and knees With pillows and puts pillows along her body on both sides to help support her arms as she holds the baby (Marmet and Shell 1993). In each of these positions, the baby’s body position varies in relation to the mother’s. In the horizontal prone (also known as the Australian position), the baby lies horizontally across the mother’s chest, his body perpendicular to hers. In the vertical prone, the baby’s body lies parallel to the mother’s, with his feet resting on the same-side leg as the breast he is latched onto. In the lateral prone, the baby’s body lies parallel to the mother but slightly off to the side; most of his weight is on the side of his body nearest the mother’s arm, and he is cradled by her arm (the mother of twins can use this position with a baby at each arm). In the diagonal prone position, the baby’s body is on an angle to the mother’s, with his feet against the mother’s opposite side. In the over-the-shoulder prone position, the baby lies on a pillow and approaches the breast over the mother’s shoulder. This position works best with the older baby who has some head control.

Some mothers have found these positions helpful in the following unusual situations:

  • The baby who is having trouble staying on the breast (gravity pulls baby toward the breast),
  • The baby who is having trouble extending his tongue, i.e., short tongue, short frenulum, tongue thrust, tongue up in back, or retracted tongue (gravity helps draw down the tongue), and
  • The baby who is having problems coping with a fast milk flow (gravity slows the milk flow).

These positions might also be helpful to the mother with a persistent plugged duct who wants to try various positions in order to improve the milk flow from different areas of the breast or the mother who has a sore spot on her nipple and is working to correct her baby’s suck.

A disadvantage to positions in which the mother lies on her back is that gravity pulls the mother’s breast tissue back, making it more difficult to achieve a good latch-on. To help overcome this disadvantage, suggest the mother hold her breast well behind the areola and compress the breast tissue slightly.

Upside down side-lying. The mother lies on her side with her baby lying on his side upside down in relation to her, with his feet pointing toward the mother’s head. This position may offer some relief for nipple soreness, for example, for the mother who is working to correct her baby’s poor suck. It is also another choice for the mother with persistent plugged ducts.

Hands and knees. The mother raises herself on her hands and knees above her baby, who lies flat on his back elevated by pillows to breast height. This is another position that offers an unusual angle for the mother with a persistent plugged duct or for nursing twins.

In addition to the prone positions described above, an upright nursing position may also be helpful for the baby who is having problems coping with milk flow. For example, a baby with a cleft palate may find these positions easiest because they can help prevent milk from leaking into his nose. (For other suggestions, see “Cleft Lip and/or Palate” in the chapter “The Baby with Special Needs.”) If the mother has a very active let-down (or milk-ejection) reflex, a baby may also find it easier to cope with the fast milk flow if he is more upright. Possible positions to try include:

  • A modified football position. If the mother is sitting on a sofa, have her sit the baby upright— facing her—at her side, with his legs along her side and his feet at her back. His bottom should be on the sofa or on a pillow (if he needs to be raised to breast level) with a pillow behind his back.
  • The mother can then support the baby’s back with her upper arm and his head with her hand. The mother may need to support her breast with her thumb on top and four fingers underneath.

  • Straddle position. Suggest the mother sit her baby in her lap, facing her, with his legs straddling her abdomen. If the baby is small, it may be neces-sary to raise him to breast level by putting pillows under him. The mother may need to tip the baby’s head back a little as baby latches on so she can position him carefully.

By leaning back when the baby is in the cradle or football hold, the mother can also take advantage of gravity in slowing the milk flow. A rocking chair or lounge chair may make this easier.

Summary In Points

Introduction

  • Encourage the mother to give special attention to positioning and latch-on during the first week or two of nursing. After the early learning period, this is not necessary unless there is a problem.
  • Some babies are able to latch on and suck well from birth, while others need more help and practice. Both mother and baby influence the progress of breastfeeding in the early weeks.

The Mother’s Posture—Getting Comfortable

  • The mother needs to be well supported and comfortable so that she can hold her baby close to her breast and relax without straining any muscles.

Sitting Up to Breastfeed

  • Sitting up to breastfeed is usually more comfortable if the mother sits upright and has good support for her arms, back, and feet.
  • It is difficult for most women to find a comfortable position to breastfeed while sitting up in bed.
  • Encourage the mother to use pillows or other props to bring her baby to breast height, so she doesn’t have to support his weight throughout the feeding.

Lying Down to Breastfeed

  • If the mother lies on her side to breastfeed, pillows and other supports can help make nursing more comfortable.
  • The mother can offer both breasts while lying on one side or roll over to nurse on the other breast.

How the Mother Holds the Baby

  • Encourage the mother to bring the baby to the breast, not the breast to the baby.
  • Suggest the mother hold her baby close so that he directly faces her breast and doesn’t have to turn his head or strain to reach the breast.
  • The baby’s ear, shoulder, and hip should be in a straight line and his head tilted slightly back, so that he is not pulling at the breast and can swallow easily.
  • The baby’s body should be well supported, so he feels secure.
  • The baby’s head should be at nipple level or slightly below when he is ready to latch on.

Common Breastfeeding Positions

Cradle Hold

  • In the cradle hold, the mother sits up. The baby’s head is resting on her forearm or in the crook of her arm. He is on his side facing her, pulled in close.
  • If gulping and choking are a problem due to forceful let-down or low muscle tone, the baby can be positioned so that his neck and throat are higher than the mother’s nipple.

Football or Clutch Hold

  • In the football or clutch hold, the mother is sitting up. Her baby’s head faces the breast with his body tucked under her arm at her side. The baby’s bottom rests on a pillow near his mother’s elbow.
  • The football hold gives better visibility and control over the baby’s head and may be preferred in certain special situations.

Side-Lying

  • In the side-lying position, the mother and baby lie on their sides facing each other, with the baby’s knees pulled in close.
  • The side-lying position allows the mother to rest or sleep while her baby nurses. It is comfortable for cesarean mothers, because it puts no pressure on the mother’s incision.

Breastfeeding Positions for Special Situations

Side-Over

  • The slide-over position can be helpful in persuading a baby who is refusing one breast to nurse on the less preferred breast.

Cross-Cradle, Modified Clutch, or Transitional Hold

  • The cross-cradle, also known as the modified clutch or transitional hold, is an effective position for babies who are having difficulty latching on. It is also effective for most small premies and babies with low muscle tone, a weak rooting reflex, or a weak suck, as the extra head support may help them to stay on the breast

Unusual Positions

  • If the mother has a sore spot on her nipple that seems to be aggravated by the usual nursing positions or wants to try new positions for a persistent plugged duct, suggest these unusual ones.
  • A baby who is having problems coping with milk flow may benefit from nursing in an upright position.