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Breastfeeding: The Basics of Positioning

Supporting baby and breast

Breastfeeding: The Basics of Positioning Many women who begin breastfeeding are so preoccupied with having their baby grasp their breast that they skip right over the fundamentals of getting themselves and their babies into proper position for nursing. Your body position might not seem relevant until you consider that you will spend many hours breastfeeding each day for many months. Positioning yourself properly will reduce the likelihood of any physical discomfort while nursing and make it easier for your baby to breastfeed. Correct positioning of your baby will improve her attachment to your breast and increase her intake of milk. It's definitely worth spending a little time getting it right!

Getting Comfortable
The first breastfeeding may occur while you're reclining or sitting in your hospital bed or sitting in a chair in your room. The reclining position will be discussed a little later. If you sit up in bed, elevate the head of your bed as much as possible. You will probably need to tuck some pillows behind you to keep your back straight. If you sit up in a chair, select one with ample back and arm support and an appropriate height. It shouldn't be so low that your knees point up nor so high that your feet can't reach the ground. If necessary, tuck one or more pillows behind your back to help you sit upright. A rocker sounds enticing but it's preferable not to have movement while you and your baby are learning.

A pillow placed on your lap will help elevate your baby to the level of your breast. If no pillow is available, crossing your leg on the side you are nursing will bring your baby closer to your breast. A lap pillow is essential for women who deliver by C-section to keep the baby's weight from pressing against their incision. A footstool beneath your feet will also decrease the distance between your lap and your breast and make your back more comfortable. These simple measures can reduce neck, shoulder, and back strain. Some women purchase and use a special nursing pillow to make breastfeeding more comfortable and may even bring their pillow on outings.

Sitting upright is important, both for your comfort and to help your baby attach to your breast correctly. Leaning forward or backward changes the position of your breasts in relation to the baby and makes it more difficult for your baby to grasp the breast correctly. When you breastfeed, you always want to bring the baby to your breast, not your breast to the baby. When your breast has to be pulled to reach your baby, it is more easily dislodged from the infant's mouth during feeding. If your breasts are very large, you may want to roll up a diaper or receiving blanket and put it under your breast to elevate it.

Positioning Your Baby
No matter which breastfeeding position you use, a few basic principles apply. Your baby should be well supported throughout the feeding to help her relax and to provide her with a sense of security. You can use pillows, cushions, or your arm to maintain good support for her head, neck, shoulders, back, and bottom. Your baby's head, neck, back, and hips should remain in alignment. Her body should not be flexed or curved when positioning her to feed. When first learning to nurse, you'll want to keep her hands out of the way so they don't wind up in her mouth or next to your nipple. You can do this by swaddling your baby in a blanket. Or, you may be able to hold her arms against her body as you position her to nurse.

Supporting Your Breast
During pregnancy, most women experience remarkable breast enlargement as a result of the development of the milk glands and ducts. When abundant milk production begins, the breasts get even heavier. A newborn infant can't be expected to keep the breast correctly positioned in her mouth during nursing unless you support your heavy breast from beneath. Use the hand opposite from your arm that is supporting the baby to cup your breast so you can present the nipple to your baby. Place four fingers underneath your breast and your thumb on top-the C-hold-to gently support your breast. The placement of your fingers on your breast is very important. They should be well behind the areola, far back from the nipple, so that they don't get in the way of the baby's mouth. Some women successfully use a "scissor" hold, or V-hold, to support the breast between their index and middle fingers. However, it is difficult with this hold to splay the fingers far enough apart to keep them behind the areola. The C-hold not only provides better breast support, but it makes it easier for the baby to grasp sufficient breast without impediment. Eventually, most babies learn to breastfeed without requiring the breast to be supported throughout the feeding. In the beginning, however, breast support will be a big help to your baby.

Several popular positionsSpecific Nursing Positions
You can choose from several popular breastfeeding positions and will probably find that certain ones work better under certain circumstances. Because the maximum pressure on the nipple and areola is different for each position, varying the position you use can help prevent nipple soreness. Make an effort to learn at least two positions before you leave the hospital.

Cradle Hold
The traditional nursing position used most often and depicted in historical artwork is known as the cradle hold. The baby is supported with your arm beneath her back and with her head resting in the crook of your elbow or on your forearm. Your hand can cup the baby's bottom or thigh, and you may be able to hold her uppermost arm against her body using your thumb. With your upper arm held against your side, rotate your forearm so your baby's whole body turns toward you. A common error is to lay the baby on her back and stimulate her cheek with your nipple so her head will turn toward the breast. This technique is highly unsuitable-you wouldn't want to drink with your head turned to one side! Instead, your baby should be rotated to face your breast so that the two of you are chest-to-chest. Her mouth should be lined up with your nipple so she can attach readily. Your baby's lower arm can be tucked around your waist or under your breast.

Cross-Cradle Hold. The cross-cradle hold is similar to the cradle hold, except your arms are switched in their roles. With the cross-cradle hold, the baby is supported by the arm and hand opposite the breast being used, while the breast is supported by the hand on the same side. This position gives the mother more control of the baby's head, which rests between her thumb and fingers instead of on her arm. Rotate your baby's body on your arm so her chest and tummy are facing you. The cross-cradle hold is an excellent position for babies having trouble latching on and for small babies. Your hand supporting the baby's head can quickly guide the infant to your breast.

Football Hold
The football hold, also known as the clutch hold, is used to position the baby to nurse on the same side as the supporting arm. The position is a popular choice for mothers who have had a cesarean birth, as it keeps the baby's weight off the mother's incision. Begin by sitting your baby up at your side, facing you with her head near your breast. Tuck her body under your arm against your side, like a football, with her feet pointing toward your back. If you are seated in a chair, the baby's body can be flexed at the hips, with her bottom at the back of the chair and her legs pointed up. Her shoulders, neck, and head are supported by your hand and fingers, while her upper back rests against your forearm. Typically a pillow is placed beneath the arm supporting the baby to elevate her to the level of the breast and to provide comfortable support for the mother's elbow. The football hold is another popular position for small babies or those having trouble latching on. It also works well for women with large breasts or flat nipples. The position allows a mother to see her nipple and the baby's mouth and to control the baby's head. It is important not to apply too much pressure to the baby's head, however, as this can cause the infant to arch her head against your hand.

Reclining Position
It is not necessary to get into a sitting position in order to nurse your baby. Women who have a cesarean birth often prefer to nurse while lying down to avoid pressure against their incision. Other women may not feel well enough to sit upright for long. At home, you may want to nurse your baby while lying in bed at night or while napping during the day. To nurse while lying down, roll onto one side and have a helper place several pillows against your back. You'll probably want a pillow under your head, and some women like to have a pillow placed between their knees. Try to keep your back and hips in a straight line. Place your lower arm around your baby and draw her close to you so that your bodies are touching. Your baby should be on her side facing your breast, with her mouth lined up with the nipple. Use your opposite hand to support your breast.

It is actually possible to nurse from either breast in the reclining position without turning over. Place the baby on the bed next to you to nurse from the lower breast. Or, elevate the baby on a pillow to bring him to the level of the upper breast. You will want to have several other pillows handy to help you get into optimal position. Placing a pillow against the baby's back will keep him from rolling over if you want to remove your lower arm and put it under your head.