Laid-back (biological or semi-reclined) hold

What is the laid-back breastfeeding hold?

With the laid-back hold, the mother is partly reclined and the baby lies face down on her tummy. There is some evidence this hold supports a baby’s instincts, can help premature babies breastfeed, and generally benefits newborns and their mothers. It works well for various breast sizes, for mothers with a tender or large abdomen, and for mothers with very firm breasts. It’s also good for premature babies, older babies, and babies who choke frequently. It is not compatible with the sandwich technique.

A) Describing the laid-back hold

The laid-back hold.

In the laid-back (biological or semi-reclined) hold, the mother lies back at an angle and the baby’s body is placed parallel and the baby’s tummy and mother’s tummy are in close contact (tummy-to-tummy). The baby rests slightly in the curve of the mother’s arm and the mouth is square in front of the nipple

The laid-back hold allows babies to latch by themselves, and newborns are naturally in this position when latching themselves after the breast crawl.

Newborn babies respond well to this hold, and there is some indication it supports their natural reflexes and instincts (Colson 2008; Douglas 2017). This hold may offer similar benefits to premature babies (Park 2018).

In the laid-back hold, the breast tissues will sit on the mother’s chest, rather than hang in the mother’s breast. This can soften the nipple root and make latching and breastfeeding easier and protect the nipple (Wang 2021). This effect is similar to that of the sandwich technique.

B) Using the laid-back hold

To adopt the laid-back hold at the right breast:

  • Lie back on an incline. Ensure you are well supported or you won’t be able to stay in this position for long.
  • Place the baby face down on your abdomen with the baby’s mouth aligned with your nipple. The baby may slide sideways into the curve of your right arm. This is fine.
  • The baby may also be positioned diagonally or horizontally across your chest.
  • Babies are encouraged to latch by themselves in this hold.

Another option is to latch the baby while sitting and then lie back with the baby at the breast.

You may feel more comfortable with a pillow, rolled towel, or travel neck pillow behind your neck. This will raise your head and allow you to watch the baby.

C) Common problems with the laid-back hold

While this hold can help prevent nipple pain and damage, mothers who have already developed these may find that they prefer to have more control of the baby’s head, latching, and breastfeeding. The laid-back hold does not give mothers a lot of control and cannot be easily combined with the sandwich technique.

The baby’s lower arm (left arm if breastfeeding from the right breast) may be under the breast instead of circling it. This can cause the baby to be pushed out of the tummy-to-tummy position. When the baby is properly held, the baby’s arms should encircle the breast.

Resolve this by moving the baby’s lower arm under the breast so the arms encircle the breast.

D) Situations in which the laid-back hold is effective

The laid-back hold is well suited to mothers:

  • Who have small, average, or large breasts.
  • With a tender or larger tummy, since the baby can be positioned in the curve of the arm, away from the tummy.
  • With a very firm nipple root, since it is often softer in this position, making it easier for the baby to latch and preventing and limiting nipple pain and damage (Thompson 2016).
  • Are breastfeeding twins and wish to breastfeed both at the same time.

The laid-back hold is well suited to babies who:

  • Are premature, sleepy newborn, or sick babies, since it may support the baby’s natural reflexes to feed.
  • Choke frequently at the breast, because this hold minimizes the amount of milk that can run back into the baby’s throat. 
  • Are older babies, because they can easily snuggle into the mother’s body.

E) Situations in which the laid-back hold is less effective

The laid-back hold is less suited to mothers who:

  • Wish to use the sandwich technique.
  • Are away from home and without extra supports such as pillows, and couches (sofa).
  • Wish to closely watch the baby's behaviour at the breast.

References

Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev. 2008 Jul;84(7):441-9
 
Douglas P, Keogh R. Gestalt Breastfeeding: Helping Mothers and Infants Optimize Positional Stability and Intraoral Breast Tissue Volume for Effective, Pain-Free Milk Transfer. J Hum Lact. 2017 Aug;33(3):509-518

Park J, Pados BF, Thoyre SM. Systematic Review: What Is the Evidence for the Side-Lying Position for Feeding Preterm Infants? Adv Neonatal Care. 2018 Aug;18(4):285-294
 
Thompson R, Kruske S, Barclay L, et al. Potential predictors of nipple trauma from an in-home breastfeeding programme: A cross-sectional study. Women Birth. 2016 Aug;29(4):336-44

Wang Z, Liu Q, Min L, et al. The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis. BMC Pregnancy Childbirth. 2021 Mar 24;21(1):248