Positioning

When teaching positioning techniques, much of the instruction involves avoiding interfering with the infant’s own feeding reflexes.  In order to position and feed baby in a cradle hold (horizontally across mom’s chest) or football hold (upright, in front of mom’s breast) it is important to allow the breast lie in its natural position.  It is common for an inexperienced breastfeeding mom to hold her baby in her arms and then try to bring her breast to the baby.  This can result in hunching over, and lifting the breast or moving it to the right or left, out of its natural position.  When the breast is held out of position and baby latches, the mom usually has trouble maintaining the same position of the breast throughout the feed and it drags out of baby’s mouth, causing pain and possibly nipple damage and a poor latch.

It is helpful to place the infant in front of the breast with his/her nose in front of mom’s nipple and with his/her entire body facing mom.  When then infant’s mouth is in front of the nipple, he/she may have a difficult time latching onto enough of the breast to feed effectively and may latch on with a flexed neck, which negatively affects swallowing and mobility of the lower jaw.  When the infant’s nose is at the nipple, he/she is in a position to latch asymmetrically which is associated with less pain for mom and easier milk transfer.

If the mom is supporting or shaping her breast to assist baby in latching, it is helpful to hold it in a way that is oriented to baby’s position.  For example, a, “scissors,” grasp, which shapes the breast by compressing above and below the areola, can work for a baby in an upright position (like a football hold) but it can cause trouble for a baby in a horizontal position such as a cradle hold.

One explanation uses the, “sandwich,” analogy.  When taking a bite of a large sandwich, first the head leans back a little, the mouth opens wide and the bottom of the sandwich is placed inside the lower lip.  The rest of the sandwich is pushed in under the upper lip.  If an infant is placed in a position, in which his/her nose is level with the nipple, the infant is oriented to allow his/her mouth to open wide and take in a large amount of mother’s breast to be compressed by the infant’s lower jaw.  It is this part of the mouth that compresses the breast, in order to remove milk.  In the scissors hold, the breast is compressed into a shape that is wider, horizontally.  If a baby tries to latch onto this breast when the baby is horizontal, the widest part of his/her mouth is vertical.  The result would be as if turning a sandwich on its edge and trying to take a bite.

Another hand position involves cupping the hand under the breast (fingers and thumbs at the sides) and works best if baby is horizontal, such as in the cradle hold.  Of course, if mom and baby are side-lying, such as when both mom and baby are lying down on a bed, then the orientation changes again and a scissors position (or thumb on top and fingers on bottom) would work.

In any position, it is important for the infant’s body to be facing mom and for the infant to open wide before latching.  It is also important for the infant’s chin to be touching the mother’s breast before latching and for his/her nose to be slightly away from the breast.  If the infant’s nose is touching the breast, the mother should avoid holding her breast away from the infant’s nose.  Instead, the mother can pull the infant’s body in closer to her body.  This usually results in creating space between the infant’s nose and the mother’s breast.

© Laura Spitzfaden 2010

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