Under-arm (clutch) hold

What is the under-arm hold?

In the under-arm hold, the mother is seated and holding the baby beside her chest, usually with a pillow or armrest to provide extra support. The legs and feet are behind the mother’s body. The mother holds the baby’s neck and shoulders with her hand and aligns the baby’s mouth directly in front of the nipple on the side where she is holding the baby. The baby can be on its side (a vertical hold), its back (a horizontal hold), or somewhere in between. It’s important to have the baby at the right height and not too far in front of the nipple. This hold is good for mothers who have larger breasts or painful nipples or tummies and for sleepy, premature, or weak babies. It’s not so good for mothers with smaller breasts or for babies who are prone to choking or are older.

A) Describing the under-arm hold

This baby is breastfeeding in the under-arm hold. Her hands circle the breast. Her head is supported by the mother's hand and both are supported by a pillow.

The under-arm (football or clutch) hold is similar to the cross-cradle hold in that the mother supports the baby’s neck and shoulders with her hand, but unlike the cross-cradle hold the mother and baby are not tummy-to-tummy.

The baby is held beside the mother and can rest on its side, back, or in a position between. The baby’s legs and feet are behind the mother’s body.

A breastfeeding pillow is generally used when using the under-arm hold as it can make this hold more comfortable and provide extra support for the mother’s arm and for the baby’s body and legs. A folded-up blanket or soft chair armrest are alternatives.

The under-arm hold is often used to fix breastfeeding problems or breastfeed two babies at once and is compatible with the sandwich technique. It is also helpful if the mother has larger breasts

B) Using the under-arm hold

1) To adopt the under-arm hold at the right breast:

  1. Sit in a comfortable position with good back support and your feet flat on the floor.
  2. Consider placing a support (breastfeeding or regular pillow, blanket, or wide soft chair armrest) on your right side.
  3. Place the baby beside you on your right with the baby’s head slightly in front of you. The baby can be on its side (vertical under-arm hold), on its back (horizontal under-arm hold), or in between.
  4. Support the baby’s neck by placing:
    1. Your right index (pointer) finger pad behind the baby’s right ear.
    2. Your right thumb pad behind the left ear.
    3. The palm and the rest of your fingers should curl behind the baby’s neck and shoulders.
  5. Align the baby’s mouth directly in front of the right nipple by moving the baby’s body.
  6. If using the sandwich technique, grasp the breast in the sandwich technique with the left hand. The thumb should align with the baby’s nose.
  7. If not using the sandwich technique, simply hold the breast lightly with the left hand.
  8. If you are struggling to see the nipple because you have a larger breast, you may raise it by tipping the breast upward with your hand or by placing a rolled face cloth under the breast.
  9. Use the left hand to gently move the breast so that the nipple taps the middle of the top lip.
  10. Once the baby’s mouth opens, push the baby towards the nipple (chin first) with the right hand to latch the baby.

C) Under-arm hold options

These twins are breastfeeding in the vertical under-arm hold. The baby at the top of the page is in the horizontal under-arm.

1) The vertical and horizontal under-arm hold

The under-arm hold has two variations: vertical and horizontal.

In the vertical hold, the baby is placed on its side on the pillow. The baby curls its body around the mother’s side. The baby’s mouth is in a vertical position on the breast.

In the horizontal hold, the baby is placed on its back on the pillow with the baby’s mouth in a horizontal position on the breast. The breast may rest on the baby’s chest and tummy.

Finally, the baby may be held in between the vertical and horizontal holds, at an angle at the mother’s side, so that the baby’s mouth is somewhere between vertical and horizontal on the breast.

These holds are useful if you have nipple pain or damage, because they allow you to choose the direction that is the least painful to latch the baby.

The under-arm hold is also compatible with the sandwich technique, but you must ensure that the thumb holding the breast aligns with the baby’s nose.

2) The run-off under-arm hold

Mothers who wish to continue using the under-arm hold as the baby grows may find that the baby is too big to tuck in beside them.

One option is to have the baby’s body rest on a couch (sofa) or bed surface beside the mother.

3) Dropping the baby’s bum

Breastfeeding a baby who is held horizontally in the under-arm hold can increase choking. To reduce choking, the baby’s bum can be lowered so that the baby is more upright, in more of a sitting position. The mouth should remain aligned with the nipple.

D) Common problems with the under-arm hold

There are several common problems with the under-arm hold:  

1) The hand under the baby is not supported

If you have the whole weight of the baby’s head and body on your supporting hand and arm, you can become tired. This can result in the baby’s head falling below the nipple and the baby pulling down on the nipple causing pain and even damage.

Resolve this by using a breastfeeding or regular pillow to provide extra support under the hand that is holding the baby’s neck. If the pillow is too low, it can be raised using a folded blanket or towel put under the baby or the pillow.

Placing a rolled towel under the wrist can reduce arm and hand strain. To save time and effort, you can keep the towel rolled by securing it with elastic bands or string. 

2) The baby’s mouth is too far in front of the nipple

If the baby’s body is too far in front of you, the baby will have to bend its neck to reach the nipple and latch. This can make it more difficult for the baby to swallow and increase the chance of choking. If the baby’s chin is touching its chest, that may be a sign that this is happening. The head should be in the sniffing position.

Resolve this by moving the baby slightly farther behind you. If there isn’t space in your chair to move the baby back, move your trunk forward instead by placing a pillow behind your back but not behind the baby’s legs. You may also bend the baby’s legs at the hips so the feet are up and closer to your shoulder.

This is often a problem with mothers who are breastfeeding in bed and using the under-arm hold right after giving birth.

3) The baby’s body is too high for the nipple

If the baby’s mouth is above the nipple, the pillow may be too thick or the armrest too high.  

Resolve this by adjusting the pillow or using a thinner pillow. Alternatively, you can place the baby under the breast in a horizontal under-arm hold and let the breast rest on the baby’s chest and abdomen.

4) One of the baby’s arms is in front of the baby’s chest instead of encircling the breast

This causes the baby to be further away from the breast and nipple. It is also less comfortable for the baby than having the arms encircle the breast.

Resolve this by moving the baby’s arm to the correct position.

5) The baby is too long

As babies grow, they may be too long to tuck in beside the mother.  One option is to have the baby’s body rest on a couch (sofa) or bed surface beside the mother (the run-off under-arm hold).

E) Situations in which the under-arm hold is effective

The under-arm hold is well suited to mothers:

  • With average size breasts.
  • With longer or larger breasts, because there is often more room at the mother’s side and under her breast than on her lap.
  • With painful or damaged nipples, because this hold can be combined with the sandwich technique.
  • With a tender or larger tummy, because the baby is not held against the tummy.
  • Who are in a a semi-reclined position, such as in a hospital bed, as it is easier to see the nipple when leaning back than in a cradle or cross-cradle hold.
  • Who are breastfeeding twins and wish to breastfeed both at the same time.

Research has shown that the under-arm hold uses less muscle activity compared to the cradle and cross-cradle holds (Ezeukwu 2020; Petronilla 2021).

Babies who are premature, sleepy newborn, or sick do well in the under-arm hold because it gives the baby extra support and the mother is better able to see the baby’s face and watch signs of stress.

F) Situations in which the under-arm hold is less effective

The under-arm hold can increase the chance of choking when mothers have a large milk supply. 

The under-arm hold is less suited to mothers with short breasts as the baby has to be raised quite high to reach the nipple.

Babies who are older or bigger may have difficulty tucking under the mother’s arm and their legs may push against the back of the chair. It may be possible to adjust this position to accommodate a bigger baby.

References

Ezeukwu OA, Ojukwu CP, Okemuo AJ, et al. Biomechanical analysis of the three recommended breastfeeding positions. Work. 2020;66(1):183-191
 
Petronilla OC, Antoninius EO, Faith AC, et al. Evaluation of trunk muscle activities in response to three breastfeeding positions utilised by women. J Back Musculoskelet Rehabil. 2021 Apr 26. doi: 10.3233/BMR-200018