Poor positioning at the breast

Why is poor positioning a problem?

Poor positioning and unsupportive holds can cause many problems for mothers and babies. Some mothers bend forward to allow the breast to reach the baby, causing neck and back pain, or they may lift the baby to the breast without support, causing wrist, arm, and shoulder pain. Poor positioning may mean the baby’s mouth is not lined up properly with the nipple, causing nipple pain and damage. Babies held in a poor position may have difficulty breathing, may be more likely to choke, may have trouble latching, or may tire quickly. These issues can result in a baby not getting enough milk, especially if the baby is premature, a sleepy newborn, or a sick baby. 

A) Describing positioning

This baby is breastfeeding in the cross-cradle hold. His body is turned and not lined up with his head and his arm is in front of his chest.

A breastfeeding position decscribes the relationship between the baby’s and mother's bodies. This is different from a breastfeeding hold which is the technique used by the mother to position the baby while breastfeeding.

Positioning is especially important in the first days and weeks after delivery. Good positioning allows for comfortable and effective breastfeeding. Poor positioning needs to be recognized and addressed. 

B) Poor positioning of the mother

Mothers who are poorly positioned may: 

  • Bend forward or twist their bodies to allow the breast to reach the baby.
  • Lift the baby to the breast without support under the arm.
  • Perch on the toes instead of keeping the feet flat.
  • Struggle to stay in the same seated or lying down position. 

C) Poor positioning of the baby

This baby is breastfeeding in the cross-cradle hold. His arm is in front of his chest, keeping his body slightly turned away from the breast.

The most common positioning problems we see are when babies:

  • Do not have their ear, shoulder, and hip in a straight line. 
  • Do not have a gap between the ear and shoulder.
  • Have their neck bent so that their chin is resting on their chest, instead of in the sniffing position.
  • Have their arm in front of their chest, instead of circling the breast.

Other positioning problems can happen when babies: 

  • Have their nose buried in the breast. 
  • Are not supported and as a result, pull away from the breast. 
  • Are not lined up with the nipple as a result of bringing the breast to the baby instead of the baby to the breast.

D) Problems caused by poor positioning

1) Effect of poor positioning on the mother: 

Mothers may struggle to hold themselves or their babies in uncomfortable positions. They may feel tense and develop body pain in one or more areas (Charette 2019). 

Poor positioning can also mean the baby’s mouth is not lined up with the nipple or is too far from it, causing pain and damage. The baby may:

  • Stretch the whole nipple, causing pain and damage to the sides or bottom.
  • Pull the nipple to one side, causing pain and damage to one of the sides or the bottom (Douglas 2017).
  • Not bring the nipple deep inside the mouth causing compression pain and damage to the face.
  • Need to use more suction to stay latched.

Babies may breastfeed with one arm in front of the chest instead of circling the breast. This can result in baby's body being twisted or too far from the mother's body. In addition, older babies can use the arm to quickly push away from the mother while still latched and cause nipple pain (nip-lash).  

2) Effect of poor positioning on the baby: 

The baby may be more likely to choke if the head is not in the sniffing position but rather is twisted or bent. While choking is normal in many breastfeeding babies, it is not enjoyable for them and it is reasonable to try and minimize it.

The baby’s breathing while breastfeeding can be affected if the nose is covered.

Babies in a poor position often need to use more suction to stay latched. Premature, sleepy newborn, or sick babies may have trouble creating and maintaining adequate amounts of suction. This causes latching problems and can result in poor milk removal from the breast and in the baby not getting enough milk.

References

Charette C, Théroux L. Musculoskeletal Impairment: Causes of Pain with Breastfeeding Insight into 11 Cases. Breastfeed Med. 2019;14(8):603-608. 

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