Latch and Positioning

Your baby has instincts and reflexes that help him to latch onto your breast and feed.  You also have instincts for helping your baby to breastfeed.  Even so, sometimes breastfeeding can be difficult in the beginning.  The following suggestions may help you and your baby to breastfeed more easily and comfortably.

Stay in skin-to-skin contact, as much as possible, until your baby is breastfeeding easily.  Skin-to-skin contact promotes stable temperature, heart rate, breathing and blood sugar.  This allows your baby to be in the most receptive state for learning to breastfeed.  Babies in skin-to-skin contact with mom are more likely to latch and breastfeed well, right from the start.

You can use a laid-back breastfeeding position www.biologicalnurturing.com.  This position involves lying back in a comfortable position while allowing baby to lie against your body with his head just above and between your breasts.  Gravity and contact with your body stimulates baby’s inborn feeding reflexes and allows him to find his own way to the breast.  It also brings baby’s tongue down and his lower jaw forward and helps him to achieve a deeper latch.  In this position, help your baby to do what he is trying to do but let him do much of the work to get to your breast.  This position allows both you and your baby to rely on instinct rather than following prescribed steps for latching.

Be sure that your areolas are very soft.  Milk flow is slower and latching is difficult for your baby when your areolas are firm, due to engorgement or edema.  Engorgement and edema can also flatten your nipples, making them harder for your baby to grasp.  Moms who have had any IV fluids are at special risk for excess fluid in the breast and areola.  The use of reverse pressure softening RPS* (developed by K. Jean Cotterman RNC-E, IBCLC) can be very helpful in assisting baby to latch and encouraging milk to flow.  RPS also stimulates the milk ejection reflex which can be useful if mom must express milk by hand or by pump.

Be sure that baby is held very close to your body.  There should be no gaps between you and your baby.  When latching, baby’s chest should be in full contact with your ribs and/or lower side of the breast from which he is feeding.  If his hands are in the way, he is not being held closely enough.  Leaning back can help to open your lap and allows baby to be held as vertically as possible.  Baby’s body is tucked under your opposite breast or draped along your torso and snuggled in very close.  Baby’s arms can hug your breast.  Lead with baby’s chin pressed on your breast and with lower lip touching the outside edge of your areola and point his nose to your nipple, wait for a large gape and then help baby to latch by hugging his shoulders toward your body.  If baby needs head and neck support, your thumb and fingers can hold baby’s head just behind the ears.  Do not push on baby’s head when latching and do allow his head to extend slightly.

Online latch GIF:

http://users.iptelecom.net.ua/~vylkas/kinolatch.html

Nipple Tilt  You can also try pressing on your areola with the side of your finger or thumb above your nipple and parallel to baby’s lips to tilt nipple upward and to “catch” baby’s lower lip with the underside of your breast, then let the nipple follow or push it into his mouth.  Be sure that baby is latched asymmetrically with more areola covered by the lower jaw than the upper and be sure that lower and upper lips are turned outward.  Baby’s chin should be buried in your breast with his nose barely touching or not touching your breast.  When your nipple is released by baby, it should be in a round, regular shape.  It should not be pinched, flattened, creased or bruised.

Breast Sandwich  You can also increase the depth of baby’s latch by using the, “breast sandwich” technique of compressing breast with fingers on one side of the breast, well back from the areola and thumb on the other side near the areola.  Your fingers are placed on the side of baby’s lower jaw and the opposite hand from the breast is holding baby (cross cradle).  Be sure that the compression is parallel to baby’s lips.  Bring baby to the breast leading with the chin, nose to nipple and latch with the lower jaw first and then push the nipple into baby’s mouth.

If you have flat or inverted nipples you might, but not necessarily have more difficulty latching.  If your baby is having difficulty latching, avoid putting your finger, a pacifier or a bottle nipple into baby’s mouth.  Do not bottle-feed or finger-feed.  Hand express colostrum and feed with a spoon or cup.  Be sure to use RPS, before latching, in order to make areolas as soft as possible.

One technique that may help a baby latch onto flat or inverted nipples is to use a thumb and forefinger to pinch your areola on opposite sides of the nipple and draw this areolar tissue around the nipple to the side of the nipple.  Pull this skin outward and bend nipple upward (similar to the nipple tilt described earlier) let baby’s chin touch the breast and his/her lips touch the outside edge of your areola.  When baby opens wide, let nipple flip into (or push it into) baby’s mouth, while you hug baby’s shoulders close to your body.

Craniosacral Therapy is helpful to many infants who are having difficulty latching.  This is a gentle manipulation of the plates of the skull and lower spine.  During birth cranial sutures can impinge on cranial nerves, which can restrict baby’s tongue movement.  Some babies improve their latch dramatically with just one visit to a Craniosacral Therapist.

Some babies who are having difficulty latching deeply and transferring milk are tongue-tied.  Some tongue-ties are not obvious and baby may not have the classic heart shaped tongue.  Research shows that a baby with any residual lingual (under the tongue) frenulum, even if it can only be felt and not seen, who is having trouble transferring milk and/or whose mom is suffering from painful feedings or nipple damage, not remedied by positional changes, should be considered to be tongue-tied and offered a frenotomy as soon as possible to protect the breastfeeding relationship.  It is the functional ability of the tongue, not the look of the frenulum that determines if a baby should be treated.

Breastfeeding Should Be Fun and Enjoyable

www.lunalactation.com/KnoxTT.pdf

www.aap.org/breastfeeding/files/pdf/bbm-8-27%20Newsletter.pdf

Labial (upper lip) ties are associated with painful latch, sucking calluses and a gap of the front teeth.

http://www.kiddsteeth.com/maxillaryfrenum_and_nursingfinal.pdf

The next link shows a latching technique, designed to achieve a deep latch when baby has an upper lip tie.

http://thefunnyshapedwoman.blogspot.com/2011/03/introducing-maxillary-labial-frenulum.html

Often a tongue-tied baby will also have a high or narrow palate as it is the free movement of the tongue while baby is in utero, that shapes the palate.  A high or narrow palate can also independently affect milk transfer.

*See RPS handout by K. Jean Cotterman

©2011 Laura Spitzfaden IBCLC Feed the Baby LLC

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