Positioning

The First Week: Positioning and Latch

Breastfeeding is a gift you can give your baby. A healthy, full term baby is likely to know instinctively what to do at the breast.

During the early weeks skin-to-skin contact helps your baby connect to their instinctive breastfeeding skills and helps you and your baby enjoy breastfeeding. Each person discovers what works for them, and what works for one may not work for another. Mary Renfrew wrote in Journal of Human Lactation that learning to breastfeed is like mother and baby learning a dance. Use what works in these suggestions and tailor them for you and your baby. Trust that you know what works for you and your baby. You will know when the positioning is ideal for you, when you and your baby are comfortable. When positioning is right for you, your nipples stay healthy and your baby can feed most efficiently. Concern about sore nipples or breastfeeding comfortably is a common reason to contact La Leche League. Improving positioning helps eliminate many cases of sore nipples.

You may have noticed this description is long. Be assured that many nursing parents have successfully accomplished breastfeeding their babies for centuries and you too will learn how to best position your baby. These suggestions are not meant to tell you that if you follow all the steps the position will be “right”. The suggestions are meant to gives you ideas on how you and your baby can learn to breastfeed and enjoy the breastfeeding experience.

However, like other seemingly simple tasks, it takes a lot of words to describe what other mothers have found works well for them. LLL Leaders are experienced in guiding mothers and other nursing parents through the positioning process. If you feel overwhelmed by preparing to breastfeed your baby, contact your local Leader for information and support. They will be happy to simplify matters for you.

In the first three to five days after birth, if you experience nipple soreness beyond a slight tenderness when your baby latches on, it may be a sign that something isn’t right with the baby latch, position, or suck. An adjustment to the latch or positioning can help your baby be more comfortable. When you have mastered the “dance” of breastfeeding, sore or cracked nipples are allowed to heal.

If nipple pain worsens after the early days of breastfeeding your nipple pain may be due to other causes like thrush, bacterial infection, or tongue-tie. Contact an LLLeader for help if you need further assistance to improve your sore nipples. See information on sore nipples for more information.

Learn to recognize your baby’s early feeding cues so you have time to get in a good position before he becomes desperately hungry. Early cues include your baby opening their mouth, moving their head side to side – also known as the rooting reflex or sucking on hands and fingers. Don’t wait for baby to cry to let you know they are hungry. Crying is a very late hunger cue.

Basic Steps for Positioning

We will discuss several different positions. If you have pain or feel uncomfortable, try a different position. Adjusting the position can significantly improve breastfeeding pain.
Some general tips are:

Position yourself comfortably with back support, pillows supporting your arms and your baby, and your feet supported by a footrest or a large book.
Position your baby close to you, with their hips flexed, so that they do not have to turn their head to reach your breast. Their mouth and nose should be facing your nipple. Their body should be so close that they is touching you. If possible, ask a helper to hand you your baby once you are comfortable.
Support your breast so it is not pressing on your baby’s chin. Your baby’s chin should touch your breast, then the baby’s nose.
Attach or latch your baby onto your breast. Encourage your baby to open their mouth wide and pull your baby close by supporting their back (rather than the back of their head) so that your baby’s chin touches your breast first. His nose will be touching your breast. Your hand forms a “second neck” for your baby.
Enjoy! If you are feeling pain, detach your baby gently and try again.

These steps may need to be repeated frequently during the early weeks. You and your baby will find a technique that works for you after some practice.

Going Beyond the Basics

As you and your baby become more experienced at breastfeeding, you will find that breastfeeding positions can be altered in many ways, even from feeding to feeding. As long as you are comfortable and your baby is nursing successfully, use what works for you. Try experimenting with the four positions below.

Remember, in any of these positions, it is usually important to bring your baby to your nipple height.

Leaning over your baby can often cause backaches, neck/shoulder strain or sore nipples.

Laid-back Breastfeeding or Biological Nurturing

Laid-back breastfeeding, or Biological Nurturing, means getting comfortable with your baby and encouraging you and your baby’s natural breastfeeding instincts.

Dress yourself and your baby as you choose. You and your baby skin-to-skin is good option too.
Position yourself comfortably in bed, on the couch, or in a recliner with back support, and pillows to also support your head, shoulders, arms. Lean back, with your pillows for support. When you comfortably lean back, and put your baby on your chest, gravity will keep your baby in position with their body molded to yours.
Let your baby’s cheek rest somewhere near your bare breast. Rub your nipple on your baby’s upper lip to encourage them to open wide. Bring your baby close. Have their chin touch your breast first, and then their nose will touch your breast.
Position your baby close to you, with hips flexed, so that they do not have to turn their head to reach your breast. Your baby’s feet need to be supported by your body so they don’t dangle in the air.
Use one hand to hold your breast as needed and the other hand to support baby’s thigh or bottom.
If you feel pain, detach your baby gently by using your finger to touch the corner of your baby’s mouth and try again.
Relax and enjoy each other.

Cradle Position

The cradle position is most commonly used after the first few weeks. The cross-cradle position (see below) gives you more control.

To nurse your baby while cradling or holding them across your lap, your baby should be lying on their side, resting on their shoulder and hip with their mouth level with your nipple. The whole front of their body should touch the front of your body.
Use pillows to lift your baby and support your elbows to bring your baby up to nipple height, especially during the first few weeks.
Support your breast with either the “U” hold” or “C” hold as described in the “Breast Support Techniques” section below.
Your baby’s head will be on your forearm and their back will be along your inner arm and palm. When you look down, you should see his side.
Your baby’s mouth should be covering at least a half inch of the dark area around your nipple. Make sure your baby’s ear, shoulder and hips are in a straight line. As a newborn, your baby’s head and bottom should be level with each other.

Cross-cradle Position

During the early weeks, many mothers find a variation of the cradle position, called the cross-cradle position to be useful.

To nurse your baby in this position, your baby is supported on a pillow across your lap to help raise them to your nipple level. Pillows should also support both elbows so your arms don’t hold the weight of your baby; they will tire before the feeding is finished.
If you are preparing to breastfeed on the left breast, your left hand supports that breast in a “U” hold. If you are breastfeeding on the opposite breast, reverse hand used. (See the “Breast Support Techniques” section of this FAQ for a description of this hold.)
Support your baby with the fingers of your right hand.
Do this by gently placing your hand behind your baby’s ears and neck with your thumb and index finger behind each ear. Your baby’s neck rests in the web between the thumb, index finger and palm of your hand, forming a “second neck” for baby. The palm of your hand is placed between your baby’s shoulder blades.
As you prepare to latch your baby on to you, be sure their mouth is very close to your nipple from the start.
When your baby opens their mouth wide, you push with the palm of your hand from between the shoulder blades. Their mouth will be covering at least a half-inch from the base of your nipple.

Clutch or Football/Rugby Position

This is a good position if you have had a Cesarean birth, as it keeps the baby away from the incision. Most newborns are very comfortable in this position. It also helps if you have a forceful milk ejection reflex (let down) because your baby can handle the flow more easily.

In the clutch position you support your baby’s head in your hand and their back along your arm beside you. You support your breast with a “C” hold. (See “Breast Support Techniques” section of this FAQ for a description of this hold.) Your baby is facing you, with their mouth at nipple height. Your baby’s legs and feet are tucked under your arm with their hips flexed and their legs resting along your back so the soles of their feet are pointed toward the ceiling. (This keeps your baby from being able to push against your chair.) Pillows help bring your baby to your level.

Side-lying Position

For some people, this position works best after the early days of breastfeeding. The other positions may be easier to learn first. Practicing this position during the daytime can be very helpful.

You may find lying down to nurse is a comfortable position, especially at night. Both you and your baby lie on your sides facing each other. You can use pillows behind your back and behind or between your knees to help get comfortable. A pillow or rolled blanket behind your baby’s back will keep them from rolling away from you. Your baby can be cradled in your arm with their back along your forearm. Having your baby’s hips flexed and their ear, shoulder and hip in one line helps your baby get milk more easily.

Breast Support Techniques

As you hold your baby in any of the above positions, you may need to support your breast with your free hand. This removes the weight of your breast from your baby’s chin, allowing them to breastfeed more effectively.

“C” hold–See the cradle hold illustration above. Support your breast with your thumb on top, away from your areola (the darker skin surrounding the nipple) and the fingers underneath. Your fingers should also be well back from your baby’s mouth. This hold is helpful when breastfeeding in the clutch or football position as well as the cradle position.

“U” hold–Place your fingers flat on your ribcage under your breast with your index finger in the crease under your breast. Drop your elbow so that your breast is supported between your thumb and index finger. Your thumb will be on the outer area of your breast and your fingers will be on the inner area. This hold is helpful when breastfeeding in the cradle and cross-cradle positions.

Is My Baby Latched on Well?

When latching on your baby, use your nipple to tickle the center of your baby’s bottom lip. This will encourage your baby to open their mouth wide (like they are yawning). Aim your nipple slightly towards the roof of their mouth, bringing your baby to you, chin first.

Good latch-on checkpoints for your baby include:

Your baby’s nose is nearly touching your breast, that is, no further away than a credit card edge
Your baby’s lips are flanged
At least ½ inch of your breast around the base of your nipple is in your baby’s mouth.

If the latch is uncomfortable or painful, gently place your finger in your baby’s mouth, between his gums, to detach him and try again.

A baby who is offered the breast will suck without swallowing as they position the nipple in their mouth and tells your breast they are ready for the milk to let down. When your baby begins to receive milk, you will see their jaw working all the way back to their ear. your baby’s temples will wiggle. You will also hear them swallowing, quickly at first, then more slowly, as their appetite is satisfied.