By Yasmin Dera
IBCLC, Maternal Health Coach, Doula, Educator
The early days of breastfeeding are often a mixed bag of emotions-most new parents experience the initial shock, joy and excitement of meeting their newborn to the exhaustion of postpartum recovery and some of everything else between. Breastfeeding is no different. Though it is a natural and normal human experience, it is also a learned skill. Think of it in terms of any new relationship, you and your baby essentially just met and are learning and working together on your first big project!
As an IBCLC with almost a decade of experience, one of the most common issues I’ve seen in the immediate postpartum period is not about milk supply. Surprise?! It is positioning. How you sit or lie while you hold your baby, as well as how your bodies align, significantly impact the quality of your baby’s latch and ultimately your breastfeeding session. When positioning is not comfortable for both mom and baby, the latch suffers and is often shallow. This leads to nipple pain, poor milk transfer to the baby and frustrated feedings for mom and baby. The upside is, positioning can be improved with a few simple changes. For example back support improves posture as well as comfort, a breastfeeding pillow can also be very useful for keeping the baby tucked in closely during the feeding. Your baby’s alignment can also transform a painful breastfeeding session into a comfortable, efficient one.
First, we need to understand what a good latch looks like so we can understand why positioning matters. Breastfeeding is not like bottle feeding. A baby does not simply suck on the tip of the nipple on a breast to transfer milk. For milk to flow efficiently and for the mother to remain comfortable, the baby needs to take a big mouthful of breast tissue. This seems counterintuitive, but the more breast tissue inside the baby’s mouth, the less painful the latch. When a baby opens widely and latches deeply, the nipple reaches far back in the mouth near the soft palate. This encourages the baby’s rhythmic tongue and jaw movement to compress the breast and activate the milk ducts to release a bolus of milk. The deeper the latch, the more milk expressed. You should feel a strong “tugging” or “pulling” sensation, but never sharp pain nor pinching during the feeding.
If the baby is not well positioned, they may “pinch” the nipple. Most nipple pain in the early days of breastfeeding is usually caused by a shallow latch. One thing to note is, your baby is always communicating with you about their needs. When your baby is fussy during the latch on, check in to see if your baby is well aligned. Is your baby’s head turned to the side while their body is flat on their back? Try swallowing your own saliva with your head turned toward your shoulder, or with your chin pointed to your chest. It is terribly uncomfortable and difficult to do!
You may also find yourself leaning forward offering your breast to your baby. Not only is this uncomfortable for you, it also is not sustainable. Eventually this will be a strain on your neck, back and shoulders. The pull of gravity downward encourages your baby to pull, tug and eventually slip off along with other cues like clicking, smacking, or a nipple that looks flattened or wedged resembling a new tube of lipstick. If you notice these cues after a feed, know these are all signals that the positioning needs a minor adjustment. As counterintuitive as it may seem, your baby needs to come to the breast. This is where having back support can transform an uncomfortable feeding into a comfortable seated or lying position to complete a 30-45 minute feeding with comfort.
Your baby’s alignment is universal no matter which position you decide to use for feeding. Think about how you eat your meals, you are forward facing your meal. Your baby also needs to be face forward towards their meal, which in this case in you. Your breast and the nipple/areola are the target! First you want to, bring your baby into your breast. Remember pillows are your friends and aid in supporting your back, arms and your baby. They allow your body to be in a neutral seated position. When using a breastfeeding pillow, your baby should be right at the level of your nipple - without you having to adjust your posture. You can also include a footstool to reduce any strain on your back and pelvis.
Now your baby is resting on your pillow, you will want to focus on hugging your baby close to your body, “tummy to mummy”. You can ensure your baby’s optimal comfort by looking down to see that your baby’s ear, shoulder and hip make a straight line. This is universal for every breastfeeding position -sidelying, cradle cross-cradle, football/clutch. Your baby’s ability to open with a gaped, wide open mouth relies on these three points being straight and aligned. Once you note the alignment is correct, be sure to double check that there is minimal to no space between your tummy and your baby’s tummy. You can now adjust their nose to align with your nipple, ready to be scooped up and prepared for the latch.
Bring the baby in so the chin touches the breast first, with the nose slightly away or barely touching, almost like your baby will sniff your breast. This allows the baby to tilt their head back slightly-for the gaped wide-open mouth. When you see this position you will want to bring your baby to you. Bring your baby to the breast quickly to get a mouth full of breast tissue for your baby to drink milk from.
Starting out, there seems to be so many breastfeeding positions. This can seem overwhelming for some, while other parents decide one and think it will be their forever position. Allow yourself flexibility and time to see which one(s) work for now. It may change in a few weeks or even later on today. The great thing is that you know there is more than one position and your “winning” position can change, as your baby changes.
In the immediate postpartum, many mothers are taught cross-cradle in the hospital. In the cross-cradle position, you use the hand that is opposite the breast you are feeding on to support the baby’s neck and shoulders. This helps you to have maximum control when you bring your baby to the breast for a deep latch. The hand on the same side as the breast you are feeding on can be used to support the breast, preferably in a U-shape. Once you note your pain level is little to none, you identify audible swallows and signs of milk transfer, and that the latch is secure, you may want to switch into the Cradle Hold. This position is where the baby rests in the arm on the same side as the feeding breast.
If you are a mom with larger breasts or recovering from a c-section delivery, the football/clutch hold is often a favorite. In this position, your baby gets tucked under the arm of the breast you will feed on. Think of why it is called a football/clutch hold. Your baby is exactly in the same location, keeping the weight off of your incision and/or allows a better view of your baby’s latch. For moms who cannot sit on their bottom or if your body needs to relax from being upright, you can try the Side-lying position. You and your baby both lie on your sides facing each other. Many moms love this position during the night feeds as well.
Another position great for babies who have challenges with maintaining a deep latch, is the Laid-Back (Biological Nurturing) Position. Your body will be reclined at a 45-degree angle with the baby lying vertically on your chest. This stimulates the baby’s natural feeding reflexes. Gravity also helps the baby sustain a deep latch onto the breast, whereas in other positions the baby may have been unable to stay on for any significant period of time.
The U-hold is a way to help your baby grasp enough breast tissue during the latch. You will want to place your thumb and index finger on either side of the breast -specifically at the 9 and 3 o’clock positions. Gently compress the breast behind the areola, to form a “U” shape with your fingers. This makes a “breast sandwich”, narrowing the breast tissue and making it comfortable for the baby to get more breast into their mouth during latching. The key is, keep your fingers slightly behind the areola. This ensures that the baby has enough space to latch on deeply.
If the latch feels pinchy or as if you’re being bitten, this is not the time to “grit and bear it”. Labor is over and now is the time for recovery and to feed your baby. You will want to break the seal gently with a clean finger sliding into the corner of their mouth. Once you hear a “smack” you will know the seal is broken. You can either tuck your nipple out of your baby’s mouth or guide your baby’s mouth away from your breast. Reposition the baby’s body either in the same or a different position. Be sure that the previous tips on alignment are observed. Do not worry about having to do this multiple times before achieving a deep latch. It definitely beats the pain and damage of a shallow latch and a fussy, hungry baby later. It’s better to remove and start again.
Remember breastfeeding is not done perfectly, nor is it about perfection. This is your time to slow down, connect with your baby and put your best breast forward. You are finding your way and so is your baby. You are cultivating a unique rhythm as your baby grows and your confidence strengthens. However, if breastfeeding is consistently painful, your nipples are damaged, or your baby is routinely unsettled especially after long feedings, you will want to contact an IBCLC/Lactation Consultant for professional support. A session or two with an IBCLC may be all you need to propel you forward on your breastfeeding journey with improved positioning, a deeper, comfortable latch and confidence and knowledge of the breastfeeding process.
Disclaimer:
This article is intended for general educational purposes only and is not meant to provide medical or clinical advice or replace individualized care. Every parent and feeding journey is different. If you are experiencing ongoing pain, concerns about milk production, or persistent pumping challenges, please seek personalized support from an International Board Certified Lactation Consultant or other qualified healthcare professional who can provide guidance specific to your situation.
