Breastfeeding holds and positioning the baby at the breast

How do I hold and position the baby at the breast?

Mothers need to find the breastfeeding hold that is most comfortable and effective for themselves and their baby and puts the baby in a good position at the breast. This is especially important in the first few weeks after delivery to prevent nipple pain and allow the baby to breastfeed effectively. The baby’s head should be looking straight ahead at the breast and tipped back slightly with the mouth in front of the nipple. To keep the baby in the right position and the mother comfortable, mother and baby may need extra support from a regular or breastfeeding pillow or footstool. It is also important to bring the baby to the breast, not the other way around. This helps maintain a good position. As the baby lets go of the breast at the end of a feeding, the nipple should stay right in front of the baby’s mouth; it should not move away from it.

A) Describing the breastfeeding position

A breastfeeding position describes the relationship between the baby’s and mother’s bodies.

How the baby is positioned at the breast is very important in the first weeks and months after delivery. Without good positioning, babies can struggle to breastfeed and mothers may not be comfortable. This is not calming for either the mother or the baby. Good positioning helps prevent early nipple pain and damage and allows the baby to breastfeed effectively. This is especially important for babies with feeding challenges, such as those who are prematuresleepy newborn, or sick babies. Poor positioning needs to be recognized and addressed.

Good positioning is less important as babies grow, because the nipples and breasts and the baby all adjust to breastfeeding. Mothers of babies older than a few months are less likely to become sore because of poor positioning. Other causes should be considered.

B) Describing breastfeeding holds

A breastfeeding hold is the technique used by the mother to position the baby while breastfeeding.

There are a number of breastfeeding holds. As each mother and baby is a little different, mothers need to find the hold that is most comfortable and effective for her and her baby. Mothers may use different holds over the course of one day and the choice of holds may change over time.

The cradle hold is the most popular hold over time. Mothers with larger breasts and mothers of twins tend to use the under-arm hold. Many mothers will use the side-lying or laid-back holds which allow them to rest while breastfeeding. The laid-back and cross-cradle holds can offer extra support to newborn babies and those with breastfeeding challenges. The vertical hold is less commonly chosen by mothers as it requires that babies support themselves sitting.

C) The mother’s position

The mother should be comfortable while breastfeeding. She should not be tense or struggle to hold the baby to her breast. Mothers may notice neck, back, arm, and wrist pain without proper positioning and support.

If she is sitting, her feet should be well supported. Some mothers benefit from a footstool. If she is lying, she can place extra pillows behind her back, between her legs, or under her knees, depending on the situation.

D) The baby’s position

The baby should be comfortable and have:

  • The head looking straight ahead at the breast and not turned to one side.
  • The head tipped back slightly in the sniffing position.
  • The mouth in front of the nipple.
  • The nose just grazing the breast or slightly buried in the breast but not blocked by it.
  • The ear, shoulder, and hip in a straight line.
  • A small gap between the ear and the shoulder.
  • Both arms and hands reaching outward and upward slightly and wrapping around the mother’s breast.
  • The bum supported.

A baby positioned correctly at the start of the feed may fall out of position during the feed. This can be caused by a lack of support or by the baby moving.

E) Bringing the baby to the breast and not the breast to the baby

Some mothers latch a baby by bringing the breast to the baby, using her hand. This can result in a baby being in a poor position at the breast as once released, the breast will fall back to its normal position, away from the baby, and the nipple will no longer be aligned with the baby’s mouth.

Mothers with larger breasts are more likely to have this problem because the breasts can be moved by hand more easily. The correct technique is to move the baby to the breast.

Occasionally, mothers with very large breasts are unable to bring the baby to the breast. They may have to hold the breast throughout the feed to keep the baby latched or to prevent nipple pain. This can be tiring and such mothers should consider other options.

This poor positioning can also result if the mother latched the baby with the sandwich technique but released the breast during the feed. If the breast moves after being released but the baby remains in the same place, the breast can fall and will pull away from the baby. Mothers should ensure that the baby moves with the nipple as the breast is released from the sandwich.

F) Supporting the baby’s head

Younger babies have a limited amount of strength to support the head on the body resulting in the neck being bent or twisted.

To minimize this, mothers should ensure that the baby's head and body are in a straight line and the baby's head is supported. 

In the cradle hold, the baby's head rests on the mother's forearm. To provide support and keep the neck straight in the cross-cradle and the under-arm holds, the mother’s hand is placed behind the neck and shoulders with the pads of the finger and thumb right behind the ears. In the laid-back hold, the baby's face and body rest on the mother's breast and arm. In the side-lying hold, the head and body are supported by the surface on which the baby is lying. 

Mothers should avoid pushing the back of the head.

A small number of very weak babies benefit from the mothers holding the baby’s face with their hand in the dancer-hand position.

G) Pillows

A breastfeeding pillow can make a hold more comfortable and keep the baby from breastfeeding in a poor position or shifting into one during the feed. Every mother and baby is unique and it is important to find a pillow that works for both. Some mothers use a pillow just until the baby grows enough that the feeds are short and pain-free. Other mothers continue to use a pillow as long as the baby is breastfeeding. These are both valid approaches.

H) The location of the nipple after breastfeeding

The mother and baby’s position at the end of the feed may be evaluated by looking at the alignment of the baby’s mouth with the nipple at the moment the baby comes off the breast.  

Ideally, the nipple should stay directly in front of the baby’s mouth. The nipple should not move more than one centimetre (one half inch) away from the mouth as the baby comes off. The nipple should point straight into the baby’s mouth.

If this is not happening, the baby has likely been pulling on the nipple, and the positioning should be addressed.