Using the sandwich technique

How do I use the sandwich technique

This technique can be used with either the cross-cradle hold or the under-arm hold. In both cases, one hand is behind the baby’s neck and the thumb and pointer finger of the other hand are used to squeeze the breast while pushing the skin gently toward the nipple. This flattens the breast a little and makes it easier for the baby to latch. It is very important that the thumb on the breast is lined up with the baby’s nose and not the baby's ear. The sandwich technique should be used only if it is useful and for as long as it helps. 

A) The sandwich technique

The sandwich technique with the baby in the cross-cradle hold breastfeeding on the right breast. The mother's thumb lines up with the baby's nose. She uses her thumb and pointer finger to slightly flatten the breast and to push the skin of the breast toward the areola.

The sandwich technique softens the tissue behind the nipple (the nipple root) and makes it softer and stretchier, which protects the nipple from injury and makes staying latched and breastfeeding easier for premature, sleepy newborn, or sick babies.

An experienced breastfeeding specialist can be helpful when you are learning the sandwich technique.

If you find the sandwich technique difficult or not helpful, consider breastfeeding in the laid-back hold. When the mother leans back, the breast tissue falls on the chest instead of pushing on the nipple root, thereby softening the root. 

B) Using the sandwich technique

1) Breastfeeding with the sandwich technique

The sandwich technique can be combined with either the cross-cradle or under-arm hold. The position of the hand holding the breast is different between the two holds.

a) To begin the sandwich technique with a cross-cradle hold using the right breast:

  1. Place the baby in the cross-cradle hold in front of the right breast with your left hand behind the baby’s neck and upper back.
  2. Use a breastfeeding pillow, if helpful to lift and support the baby.
  3. The baby’s body should not be twisted and the baby’s ear, shoulder, and hip should be in a straight line.
  4. The baby’s mouth should be directly in front of the right nipple.
  5. Align the pad of your right thumb on your breast with the baby’s nose and the pad of your right pointer (index) finger on your breast with the baby’s chin.
  6. You should see that your hand is making a “U” and your thumb and index finger are each about 5 cm (2 in) from the nipple.
  7. Squeeze the breast firmly between your finger pads, pushing the skin of the breast gently toward the nipple so that the breast is flattened a bit like a sandwich.
  8. The baby’s arms should circle the breast with the lower arm under your breast. If the lower arm gets in the way, you can use your right ring and pinky fingers to hold the arm down.
  9. Latch the baby by tapping the baby’s top lip with your nipple and then bringing the baby’s mouth onto the breast.
  10. Once any nipple pain has settled and the baby has latched and is feeding effectively, you may release the breast very slowly as long as:
    1. The pain does not increase.
    2. The baby is able to continue breastfeeding effectively.
  11. If the breast pulls away from the baby’s mouth once you release the sandwich, the baby needs to be gently moved so that the mouth is once again lined up with the nipple.

b) To begin the sandwich technique with an under-arm hold using the right breast:

  1. Place the baby in the under-arm hold beside the right breast with your right hand behind the baby’s neck and upper back.
  2. See steps 2, 3, and 4 above.
  3. Align the pad of your left thumb on your breast with the baby’s nose and the pad of your left pointer finger on your breast with the baby’s chin.
  4. You should see that your left hand is making a “C” and your thumb and index finger are each about 5 cm (2 in) from the nipple.
  5. See steps 7 above.
  6. The baby’s arms should circle the breast. If the baby’s right arm gets in the way, you can use your left ring and pinky fingers to hold the arm down.
  7. See steps 9 to 11 above.

2) At the end of the feed

Once the baby lets go of the breast, the nipple should stay right in front of the baby’s mouth.

If the nipple does move away from the baby’s mouth, the baby probably has been tugging on the nipple, which can cause pain and make it harder for the baby to breastfeed. Adjust your positioning at the next feed to prevent this from happening.

C) Tips for using the sandwich technique

The following apply to the hand that is holding the breast (not the baby):

  • The thumb should be lined up with the baby’s nose and not the ear.
  • Move your hand back towards the chest if your fingers or hand are touching the baby.

Mothers with larger breasts may need to hold the breast a little further away from the baby to soften the nipple root.

D) Using the sandwich technique for part or all of the feed

1) For nipple pain

If you are using the sandwich technique to control pain:

  1. Keep squeezing the breast between the pads of your finger and thumb to control the pain.
  2. Squeeze a little harder if you feel a lot of pain.
  3. If the pain settles after latching the baby, you can very slowly release the breast while monitoring your pain.
  4. If the pain increases with release, reapply the pressure.

2) For babies who need support while breastfeeding

If you are using the sandwich technique to help the baby stay latched and breastfeed:

  1. Latch the baby using the sandwich technique.
  2. Once the baby is breastfeeding effectively, try letting go of the breast very slowly.
  3. If the baby cannot stay latched without it or cannot breastfeed effectively without it, continue to use the sandwich technique throughout the feed.

E) When to stop using the sandwich technique

Mothers should use the sandwich technique for as long as it is helpful.

Nipple pain that starts soon after the birth of the baby generally settles within a few weeks, at which time the sandwich technique should be stopped.

Babies with latching or breastfeeding challenges may need days, weeks, or months to learn to breastfeed. The nature of the baby’s breastfeeding challenge will influence how long the sandwich technique is helpful.

Mothers who develop a plugged duct should stop using the sandwich technique.