Helping Your Baby to Attach
Nearly all breastfeeding problems in the early days come down to one thing:
a baby who is well-attached to the breast can effectively remove milk which satisfies hunger and maintains milk supply
It sounds simple yet it is probably the biggest barrier we face in meeting our breastfeeding goals.
We talk about positioning and attachment in Australia, which is also referred to as the latch or latching-on in the US.
Attachment
How the baby takes the breast and nipple into their mouth.
Positioning
How the baby’s body is held against the mother.
When your baby is well attached it will feel better. This is the primary indicator, more important than how it looks. However, those supporting you will also be looking for visible signs of good attachment, including how much areola they can see.
The skin around your nipple is very individual. Some breasts have pale areola while others are quite dark. Some are small enough to completely disappear into the baby's mouth while others extend beyond the area touched by the baby's face.
What we are actually looking for is how much of the breast is taken into the baby's mouth. The areola is just a visual marker for this, not a functionality significant thing. If you can still see the areola above the baby's nose, that is not a concern. It is likely you can't see the area below the mouth as that will be well-covered by the chin.
When a baby takes a full mouthful of breast tissue, the nipple is in a better position. It should feel better but might still be tender if it is grazed or cracked from existing damage. Healing is supported by better attachment.
Good positioning leads to good attachment
When it comes to positioning your baby, it’s easy to feel overwhelmed. Here is what you need to keep in mind:
"Chest to chest and chin to breast"
This is all about presenting your baby in the best orientation to seek the breast and attach well.
Decades ago, when #breastfeeding rates were at a historical low, bottle feeding techniques got mixed up with breastfeeding advice. We held our babies on their backs, swaddled tightly to keep their hands out of the way and brushed their cheek so they would turn their head towards the breast. This position meant babies had to grasp the nipple with their head twisted towards their shoulder - obviously not a comfortable position for anyone! Babies would grab the nipple and hold on for dear life, because it would spring out of their mouth the moment they paused.
It makes so much sense that a relaxed, comfortable position will allow your baby to comfortably take a mouthful of breast tissue and keep it in their mouth without losing their latch. It's comfortable for babies and their mothers.
When positioned this way they are embracing their mother with their belly against hers, hips in close and their head free to move as they bring their mouth into just the right spot. There is no need to support the head as gentle support across their shoulders and hips keeps their head in the right place.
Getting the position right makes breastfeeding more comfortable for both of you.
Your position when you are breastfeeding is just as important as your baby's. There is no use getting them attached only to find you are now stuck in an uncomfortable position for the next hour. You won't be able to relax and that can delay your let-down reflex.
While you are establishing breastfeeding, it helps to set up your feeding spaces at home.
Ideally, you can feed lying down as much as practical to maximise rest and recovery (especially if you had a caesarean or complicated delivery). At other times choose a seat where you can leave any pillows or cushions you are using in place.
Laid-back breastfeeding (also called biological nurturing) is generally more comfortable than sitting upright with pillows packed around you. Breastfeeding pillows were designed when the focus was lifting the baby higher off your lap when sitting upright. This position works okay once breastfeeding is going well and your baby is practiced at seeking and latching but while you are both learning, lying back lets gravity work with you rather than against you.
A sofa or couch is a good set-up. Arrange your pillows to support you in a reclining position. You might be more comfortable with a pillow under your knees as well. By leaning back this way you can lay your baby on their tummy against you. When you are comfortable doing so, this is great for skin to skin contact as well. Once baby is attached and feeding you can pull a light blanket or throw over both of you to stay cosy.
As you become more confident feeding, you can bring sitting upright into your range of positions. If you feel you need to lean your breast down to your baby when seated this way, keep a pillow or cushions handy to tuck in to support their weight. The baby is still positioned with their tummy against yours. The cushions or pillows are there to support your arms as you hold your baby. You might find a cushion tucked under your elbow on the side of the breast you are feeding from relieves any tension in your arm and shoulder. Consciously relax your upper body, shoulders and neck when feeding. If you feel uncomfortable anywhere, check if you need more support.
How you hold your baby can affect their position
Sometimes it's the little things which make the biggest difference. And babies arms and breastfeeding are a great example of this. In the fuss and bother of getting baby to the breast, it's easy to think it can't really matter that much if an arm is in the way. But it means your baby can't be as close as they need to be and that can make the Latch just that bit more shallow.
Imagine how difficult it is getting close to the dinner table in those final weeks of pregnancy. Your body shape means you need to lean your head in closer to bring your food to your mouth. It changes your posture and uses muscles in a different way, which can be fatiguing.
It's the same for your new baby at the breast. If they need to stretch a bit more to reach the breast, they need to hold that position or the nipple will slip out of their mouth. They "keep coming off" can be they are struggling to hold the breast in place.
If we bring their body as close as possible, then the breast is right in front of them. They can relax and focus on removing milk without having to stretch to reach.
Attachment is important. But don't overlook the other half of the equation: positioning. Getting the position right enables good attachment. Poor positioning hinders it.
Babies Use their Hands to Breastfeed
Babies hands are an important tool in getting a good attachment to the breast. Unfortunately this is something we have had to relearn as we overcome the loss of breastfeeding wisdom in the past century.
In the womb, babies suck their hands. You might have seen your baby doing so on ultrasounds. This means they have a strong association between their sucking reflex and their hands long before birth.
When babies are seeking the breast they use their hands to guide them. If their face isn't in contact with the breast, their hand might find the nipple first. They might then turn their face to their hand, bringing it in line with the nipple.
After sucking on their hands and realising there is no milk, they will soon begin seeking the nipple again and now it is close to their face and likely to be erect from contact with the baby. They can then seek and latch with a wide mouth in anticipation of being near their target.
The physical contact of hands against the mother's skin will also stimulate the let-down reflex and milk might seep from the nipple. The baby can smell this, further guiding them to the source.
Restricting babies hands confuses and frustrates them. They have lost a primary tool in seeking the breast, are distracted by sensory feedback on their hands unrelated to feeding and might "fight" to bring their hands back up to their face.
Sore or damaged nipples make mother's fearful of tiny hands with brand new fingernails. It is natural to want to get those away from tender skin. However good attachment prevents further damage and supports healing. If you can, begin the feed on the least sore side to take the edge off their appetite and allow you the benefit of relaxing hormones before repositioning to latch on the other breast.
As babies develop skills in finding the breast, they use their hands less and less. It is part of the learning period but passes after the early weeks. Older babies will pat or stroke the breast to stimulate let-downs throughout the feed and to bond and connect with their mother. Keeping their hands free continues to be important.
Try not to confuse your baby
Babies have wonderful reflexes in place to help them breastfeed. One is referred to as the "rooting reflex".
When we think of the natural carrying position of young primates on their mother's chest, gripping on to her body hair with hands and feet as she moves about, being able to find the breast by facial touch makes sense. A baby swiping their face backwards and forwards across the chest area would be able to zero in on the nipple area which would feel different to the surrounding skin.
The "rooting reflex" works best when there are no false signals from other touch. A hand supporting the head, clothing tickling the face or fingers brushing a cheek will all trigger the baby to focus in that direction. Confusing for baby and frustrating for mum. Waving the nipple around like a moving target will also confuse them.
To support your baby in naturally seeking the nipple, focus on supporting their body close to yours without holding the head. Make sure bra straps, clothing etc is clear of the breast (strip down when you are at home) and remove all blankets, wraps and mittens. Babies hands help guide them. Allow your baby to brush their face against you. Keep your breast in a natural resting position and don't "chase" the mouth with it.
The touch of breast tissue on their face will trigger them to open their mouth wide and start bobbing in the nipple area, seeking just the right spot. This takes practice and they may go on poorly. You can detach them gently and they will try again.
Supporting babies by holding their heads doesn't help them. They might push back, twist in reaction to your touch or present to the breast in a poor position, with their chin tucked down. .
If your support people suggest or demonstrate head holding, be aware this is an out-dated approach from the past.
Baby-led Attachment allows your baby to follow their instincts and use their natural reflexes to breastfeed.
Babies arms! Why are they always in the way when you are trying to breastfeed?
It turns out, Babies practice sucking in the womb and will suck on whatever gets close to their mouth ... basically, their hands! Although a newborn doesn't have much intentional control of arm and hand movements, they do seem to have some reflexive drive to bring their hands to their mouths at feeding time.
It's tempting to take an idea from the past and tightly wrap your baby in a blanket to restrict arm movements. Unfortunately, this not only confuses them but prevents them assuming the natural position to come to the breast.
Instead, focus on supporting your baby close to you, with their chest against your body and their arms embracing you, like a hug. Keeping the lower hand below the breast means it won't get in the way of attachment. Be patient as your baby mouths their upper hand as part of seeking the breast: a hungry baby will quickly work out they are sucking the wrong thing and begin rooting around seeking the breast instead. This interest in their hands and arm waving decreases gradually over the early weeks as they mature and learn through practice.
Avoid having an arm caught between your bodies as it prevents baby getting in close.
Your patience will be tested at times! Minimise the time between early feeding cues and attachment by keeping your baby within arms reach so you can respond as soon as they begin to stir. Delay changing nappies until they have taken the edge of their hunger with the first breast and will be calmer during the interruption!
There are many positions you can use when breastfeeding but the positioning is the same in each: chest to chest
