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Cordelia Uys article on breastfeeding with large breasts

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Cordelia Uys article on breastfeeding with large breasts

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Blocked nose: whatever position you use, if you find your baby's nose is buried into your breast, all you need to do is pull their bum into your body, and their nose will pivot away.

Nursing bras: A comfortable, supportive and properly fitted bra, that doesn't put pressure anywhere, is essential for all breastfeeding mothers, and even more so for those with larger breasts. It's recommended to avoid using an underwired nursing bra for the first 6 weeks, as mothers are particularly vulnerable to getting blocked ducts while their milk supply is being established. Molke make soft bras for large breasted women and are highly recommended by breastfeeding mothers due to the ease of access to the breast. Underwired bras are usually fine after that, as long as they're 100% comfortable. There are lots of milk ducts on the underside of your breasts, so you don't want anything constricting that area. If you can't find a well fitting nursing bra you can convert one of your own bras using a nursing bra conversion kit.

A breast 'sling': if you have particularly large breasts, and especially if your nipples point downwards, it can be extremely difficult to see what you're doing, and to fit your baby close enough to your body, when latching them. Creating a sling out of a long cotton scarf, tying it round your neck and then under your breast, so that the breast is lifted, can be very helpful. This doesn't tend to be necessary past the newborn stage.

Breastfeeding in public: feeding discreetly with large breasts can be tricky. I remember feeling very envious of my smaller-busted friends who could effortlessly latch their babies without needing a hand to support their breast, especially since the baby then completely covered any bare breast.

Discovering the 'one up, one down' method was a revelation. This involves wearing a long, stretchy vest under a looser outer top. The floatier and looser the outer top, the better. You get your baby in position, unclip your bra, pull down the part of the vest covering your breast, lift the outer top and quickly latch your baby. This means all the fiddly unclipping of your bra and manoeuvring of your baby is done under the outer top, and minimal time is spent with your breast on display. The stretchy vest covers not only the breast you're not feeding from, but also your stomach, which is a part of our body most of us would rather not have exposed.

The good news: as your baby gets older and larger, breastfeeding with larger breasts tends to get much easier.
Cordelia Uys is an NCT breastfeeding counsellor. She facilitates antenatal breastfeeding classes, introducing solids workshops and parenting classes. She also runs a private breastfeeding drop in with a team of IBCLC's and two cranial osteopaths. Cordelia is also the breastfeeding expert for a new mothers' wellbeing App Biamother. She is mother to three grown up boys, all of whom were breastfed.

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Breastfeeding with large breasts -Feed Eat Speak feeding blog

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Blocked nose: whatever position you use, if you find your baby's nose is buried into your breast, all you need to do is pull their bum into your body, and their nose will pivot away. Nursing bras: A comfortable, supportive and properly fitted bra, that doesn't put pressure anywhere, is essential for all breastfeeding mothers, and even more so for those with larger breasts.

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NHS leaflet with photos

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Skip to main content

Breastfeeding takes practice. It takes time to work out which feeding and burping positions feel best. There aren't 'correct' positions - it's about what feels most comfortable for you both, so try them all out to see which feels best. Remember to offer both breasts and switch breasts after each feed.

Hold your baby's whole body close with their nose level with your nipple.

2. Let your baby's head tip back a little so that their top lip can brush against your nipple. This should help your baby to make a wide, open mouth.

3. When your baby's mouth opens wide, their chin should be able to touch your breast first, with their head tipped back so that their tongue can reach as much breast as possible.

4. With your baby's chin firmly touching your breast and their nose clear, their mouth should be wide open. You should see much more of the darker nipple skin above your baby's top lip than below their bottom lip. Your baby's cheeks will look full and rounded as they feed.

The Breastfeeding Friend from Start4Life, available 24 / 7, has lots of useful information and expert advice to share with you.

Further help

For further help with latching on, watch our breastfeeding video:

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Breastfeeding takes practice. Have a look at our guide to latching on, breastfeeding positions and how to burp your baby

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Skip to main content Breastfeeding takes practice. It takes time to work out which feeding and burping positions feel best. There aren't 'correct' positions - it's about what feels most comfortable for you both, so try them all out to see which feels best. Remember to offer both breasts and switch breasts after each feed.

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Why it's important for the baby's chin to be tucked into the breast

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This method can help a baby who isn't getting a big enough mouthful of breast for some reason.

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How to latch a baby using the exaggerated latch technique.

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Shows lots of different positions to try

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This extra support under the chin can be useful for a baby who has low muscle tone

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Positions that help you work with your baby's innate feeding instincts

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How to find a position that works with your baby's natural instincts

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Get access to files anywhere through secure cloud storage and file backup for your photos, videos, files and more with Google Drive.

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Tips to help your baby open their mouth wider

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Tips to help your baby open their mouth wider

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How to tell a baby is well-latched and drinking well:

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How to tell a baby is well-latched and drinking well:

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Commentary by my friend and colleague Stacey Zimmels:

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Attaching Your Baby at the Breast – Breastfeeding Series

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Useful film on latching a baby in the cross cradle position

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Useful film on latching a baby in the cross cradle position

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Good attachment really is the key to successful breastfeeding. Use this guide to get it right from the start, but if you find you are still struggling - ask for help!

Before you start - Make sure your baby's head, neck and body are in a straight line - a baby cannot suckle or swallow easily if the neck is twisted. Good attachment is difficult for a baby to maintain if his body is twisted at the waist. The baby should be held so that the back of his shoulders is supported, and his head is free to tilt back. If you are unsure about the attachment of your baby, seek help from your midwife, health visitor or maternity support worker. You can also visit your local support group. Someone observing how your baby feeds can really help to get it right.

This is a link from our Breastfeeding by mums, for mums DVD which shows good attachment.

Below are still photos of attachment too.
1. The baby should face the breast with nose to nipple - this allows the baby to tilt his head back so that the nipple is aimed at the roof of the mouth. 2. When baby gapes wide open, press on the back of his shoulders to bring him in quickly - and you will need to move quickly! 3. Chin and tongue leading, head tilted back, the nipple goes into the back of the mouth as baby is brought towards the breast. 4. Attachment shouldn't be painful, baby should keep suckling and should let go on his own at the end of the feed. The nipple should look the same shape as before the feed.

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Good attachment really is the key to successful breastfeeding. Use this guide to get it right from the start, but if you find you are still struggling - ask for help! Before you start - Make sure your baby's head, neck and body are in a straight line - a baby cannot suckle or swallow ...

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How to get a deeper latch:

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· Ensure your baby is held close to your body and their body is in a straight line at the spine with their head free to tilt back.

· Position your baby with its nose in line with your nipple

· Wait until your baby roots and opens it's mouth really wide before gently guiding them to the breast to latch

· Remember that you are aiming for your baby to get a large mouthful of breast tissue into the mouth and not only the nipple

You may also need to use the exaggerated latch or flipple technique

1. Hold your breast and shape it so that your nipple is pointing up against your baby's nose.

2. Shape your breast like a hamburger in line with the baby's mouth. The orientation is important. When shaping your breast like a hamburger the piece that they take a bite from needs to match the alignment of your baby's mouth and lips. More information with infographics can be found here

3. Wait till your baby roots and opens it's mouth very wide. It helps if your baby can feel your breast with their lower lip or chin

4. At that moment guide your baby to the breast with your other hand

5. Your baby will take the breast into it's mouth leading with the chin. Your baby will take the underside of the breast tissue and latch with the nipple still pointing up to the roof of it's mouth

6. Once latched you should notice that your baby has a much bigger mouthful of breast tissue and that you can see much less of the breast and areola.

7. Initially you may worry that your baby can't breathe as you will notice their face is much deeper into the breast tissue, this is ok. Keep watching your baby while you get more confident seeing them feed in this way.

If you are still struggling with a shallow latch and/or suffering from nipple pain or damage then seek support from an IBCLC lactation consultation. To find an IBCLC near you click here.

Let me know your experiences of dealing with a shallow latch and how you overcame them. You can comment below.

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Getting your baby to latch more deeply when breastfeeding -Feed Eat Speak feeding blog

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· Ensure your baby is held close to your body and their body is in a straight line at the spine with their head free to tilt back.

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This can help if feeding is painful.

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Good drinking in cross cradle position: 

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Good drinking in cross cradle position: 

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Good drinking in laid back (baby led) position:

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Good drinking in laid back (baby led) position:

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Can I see Natural Breastfeeding positions in action?

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How to achieve an asymmetric latch:

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Here's one way to get a deeper, more comfortable latch.

Baby goes on your breast off-center, taking in more of your areola (colored circle around your nipple) with his lower jaw than his upper jaw. An off-center latch matters less in gravity-assisted positions (shown below), than when you sit up to breastfeed.

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Getting a Deeper Latch - Nancy Mohrbacher

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Here's one way to get a deeper, more comfortable latch. Baby goes on your breast off-center, taking in more of your areola (colored circle around your nipple) with his lower jaw than his upper jaw.

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Note: For clarity, we are referring to baby as "he" and mother as "she."

The First Week: Positioning and Latch

Breastfeeding is a gift only you can give your baby. A healthy, full term baby is likely to know instinctively what to do at the breast.

During the early weeks skin-to-skin contact helps your baby be connected to his instinctive breastfeeding skills and helps you and baby enjoy breastfeeding. Each mother discovers what works for her, and what works for one mother may not work for another. Mary Renfrew wrote in Journal of Human Lactation that learning to breastfeed is like mother and baby learning a dance. Use what works in these suggestions and tailor them for you and your baby. Trust that you know what works for you and your baby. You will know when the positioning is ideal for you, when you and your baby are comfortable. When positioning is right for you, your nipples stay healthy and your baby can feed most efficiently. Concern about sore nipples or breastfeeding comfortably is a common reason that mothers contact La Leche League. Improving positioning helps eliminate many cases of sore nipples.

You may have noticed this description is long. Be assured that many mothers have successfully accomplished breastfeeding their babies for centuries and you too will learn how to best position your baby. These suggestions are not meant to tell the mother that if she follows all the steps the position will be "right". The suggestions are meant to gives you ideas on how you and your baby can learn to breastfeed and enjoy the breastfeeding experience.

However, like other seemingly simple tasks, it takes a lot of words to describe what other mothers have found works well for them. LLL Leaders are experienced in guiding mothers through the positioning process. If you feel overwhelmed by preparing to breastfeed your baby, contact your local Leader for information and support. She will be happy to simplify matters for you.

In the first three to five days after birth, if you experience nipple soreness beyond a slight tenderness when your baby latches on, it may be a sign that something isn't right with the baby latch, position, or suck. An adjustment to the latch or positioning can help your baby be more comfortable. When you have mastered the "dance" of breastfeeding, sore or cracked nipples are allowed to heal.

If nipple pain worsens after the early days of breastfeeding your nipple pain may be due to other causes like thrush, bacterial infection, or tongue-tie. Contact a La Leche League Leader or lactation consultant for help if you need further assistance to improve your sore nipples. See information on sore nipples for more information.

Learn to recognize your baby's early feeding cues so you have time to get in a good position before he becomes desperately hungry. Early cues include opening his mouth, moving his head side to side - also known as rooting reflex or sucking on hands and fingers. Don't wait for baby to cry to let you know he is hungry. Crying is a very late hunger cue.

Basic Steps for Positioning

We will discuss several different positions. If you have pain or feel uncomfortable, try a different position. Adjusting the position can significantly improve breastfeeding pain.
Some general tips are:

1. Position yourself comfortablywith back support, pillows supporting your arms and your baby, and your feet supported by a footrest or a telephone book.

2. Position baby close to you, with his hips flexed, so that he does not have to turn his head to reach your breast. His mouth and nose should be facing your nipple. His body should be so close that he is touching you. If possible, ask your helper to hand you the baby once you are comfortable.

3. Support your breast so it is not pressing on your baby's chin. Your baby's chin should touch your breast, then the baby's nose.

4. Attach or latch baby onto your breast.Encourage him to open his mouth wide and pull him close by supporting his back (rather than the back of his head) so that his chin touches your breast first. His nose will be touching your breast. Your hand forms a "second neck" for your baby.

5. Enjoy!If you are feeling pain, detach baby gently and try again.

These steps may need to be repeated frequently during the early weeks. You and your baby will find a technique that works for you after some practice.

Going Beyond the Basics

As you and your baby become more experienced at breastfeeding, you will find that breastfeeding positions can be altered in many ways, even from feeding to feeding. As long as you are comfortable and baby is nursing successfully, use what works for you. Try experimenting with the four positions below.

Remember, in any of these positions, it is very important to bring the baby to your nipple height.

Leaning over your baby can cause backaches, neck/shoulder strain or sore nipples.

Laid-back Breastfeeding or Biological Nurturing

Laid-back breastfeeding, or Biological Nurturing, means getting comfortable with your baby and encouraging you and your baby's natural breastfeeding instincts.

Dress yourself and your baby as you choose. Mother and baby skin-to-skin is good option too.

Position yourself comfortably in bed, on the couch, or in a recliner with back support, and pillows to also support your head, shoulders, arms. Lean back, with your pillows for support. When you comfortably lean back, and put your baby on your chest, gravity will keep him in position with his body molded to yours.

Let your baby's cheek rest somewhere near your bare breast. Rub your nipple on baby's upper lip to encourage baby to open wide. Bring your baby close. Have his chin touch your breast first, and then his nose will touch your breast.

Position baby close to you, with hips flexed, so that he does not have to turn his head to reach your breast. Baby's feet need to be supported by your body so they don't dangle in the air.

Use one hand to hold your breast as needed and the other hand to support baby's thigh or bottom.

If you feel pain, detach baby gently by using your finger to touch the corner of baby's mouth and try again.

Relax and enjoy each other.

Cradle Position

The cradle position is most commonly used after the first few weeks. The cross-cradle position (see below) gives you more control.

To nurse your baby while cradling or holding him across your lap, he should be lying on his side, resting on his shoulder and hip with his mouth level with your nipple. His whole front of his body should touch the front of your body.

Use pillows to lift your baby and support your elbows to bring your baby up to nipple height, especially during the first few weeks.

Support your breast with either the "U" hold" or "C" hold as described in the "Breast Support Techniques" section below.

Your baby's head will be on your forearm and his back will be along your inner arm and palm. When you look down, you should see his side.

His mouth should be covering at least a half inch of the dark area around your nipple. Be sure his ear, shoulder and hips should be in a straight line. As a newborn, your baby's head and bottom should be level with each other.

Cross-cradle Position

During the early weeks, many mothers find a variation of the cradle position, called the cross-cradle position to be useful.

To nurse your baby in this position, your baby is supported on a pillow across your lap to help raise him to your nipple level. Pillows should also support both elbows so your arms don't hold the weight of the baby; they will tire before the feeding is finished.

If you are preparing to breastfeed on the left breast, your left hand supports that breast in a "U" hold. If you are breastfeeding on the opposite breast, reverse hand used. (See the "Breast Support Techniques" section of this FAQ for a description of this hold.)

Support your baby with the fingers of the right hand.

Do this by gently placing your hand behind your baby's ears and neck with your thumb and index finger behind each ear. Your baby's neck rests in the web between the thumb, index finger and palm of your hand, forming a "second neck" for baby. The palm of your hand is placed between his shoulder blades.

As you prepare to latch on your baby, be sure his mouth is very close to your nipple from the start.

When baby opens his mouth wide, you push with the palm of your hand from between the shoulder blades. His mouth will be covering at least a half-inch from the base of your nipple.

Clutch or Football Position

This is a good position for a mother who has had a Cesarean birth, as it keeps the baby away from the incision. Most newborns are very comfortable in this position. It also helps when a mother has a forceful milk ejection reflex (let down) because the baby can handle the flow more easily.

In the clutch position you support your baby's head in your hand and his back along your arm beside you. You support your breast with a "C" hold. (See "Breast Support Techniques" section of this FAQ for a description of this hold.) He is facing you, with his mouth at nipple height. Your baby's legs and feet are tucked under your arm with his hips flexed and his legs resting along the your back rest so the soles of his feet are pointed toward the ceiling. (This keeps him from being able to push against your chair.) Pillows help bring the baby to the correct height.

Side-lying Position

For some mothers, this position works best after the early days of breastfeeding. The other positions may be easier to learn first. Some mothers find that practicing with this position during the daytime is very helpful.

Many mothers find lying down to nurse a comfortable position, especially at night. Both mother and baby lie on their sides facing each other. You can use pillows behind your back and behind or between your knees to help get comfortable. A pillow or rolled blanket behind the baby's back will keep him from rolling away from you. The baby can be cradled in your arm with his back along your forearm. Having his hips flexed and his ear, shoulder and hip in one line helps your baby get milk more easily.

Breast Support Techniques

As you hold your baby in any of the above positions, you may need to support your breast with your free hand. This removes the weight of the breast from the baby's chin, allowing him to breastfeed more effectively.

"C" hold-See the cradle hold illustration above. Support your breast with your thumb on top, well back from your areola (the darker skin surrounding the nipple) and the fingers underneath. Your fingers should also be well back from your baby's mouth. This hold is helpful when breastfeeding in the clutch or football position as well as the cradle position.

"U" hold-Place your fingers flat on your ribcage under your breast with your index finger in the crease under your breast. Drop your elbow so that your breast is supported between your thumb and index finger. Your thumb will be on the outer area of your breast and your fingers will be on the inner area. This hold is helpful when breastfeeding in the cradle and cross-cradle positions.

Is My Baby Latched on Well?

When latching on your baby, use your nipple to tickle the center of your baby's bottom lip. This will encourage him to open his mouth wide (like he is yawning). Aim your nipple slightly towards the roof of his mouth, bringing baby to you, chin first.

Good latch-on checkpoints for your baby include:

His nose is nearly touching your breast, that is, no further away than a credit card edge

His lips are flanged

At least ½ inch of your breast around the base of your nipple is in his mouth.

If the latch is uncomfortable or painful, gently place your finger in the baby's mouth, between his gums, to detach him and try again.

A baby who is offered the breast will suck without swallowing as he positions the nipple in his mouth and tells your breast he is ready for the milk to let down. When he begins to receive milk, you will see his jaw working all the way back to his ear. His temples will wiggle. You will also hear him swallowing, quickly at first, then more slowly, as his appetite is satisfied.

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Positioning - La Leche League International

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Note: For clarity, we are referring to baby as "he" and mother as "she." The First Week: Positioning and Latch Breastfeeding is a gift only you can give your baby. A healthy, full term baby is likely to know instinctively what to do at the breast.

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Best Beginning graphic of a baby attaching on the breast

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Best Beginning graphic of a baby attaching on the breast

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Find out how to make sure your baby is attaching well at the breast.

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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5. Graphic of a baby attaching on the breast

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Find out how to make sure your baby is attaching well at the breast. Vimeo Video http://www.vimeo.com/11692547 The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole: From Bump to Breastfeeding 1.

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Global Health Media films on positions and attachment at the breast and much more: 

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Global Health Media films on positions and attachment at the breast and much more: 

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BUMP TO BREASTFEEDING FILM ON ATTACHMENT AND POSITIONING: 

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BUMP TO BREASTFEEDING FILM ON ATTACHMENT AND POSITIONING: 

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding.

Key to achieving the Baby Friendly standards is a workforce able to support mothers to breastfeed effectively. This video provides some guidance on this.

You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website.

Video not working? Contact us

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Positioning and attachment video - Baby Friendly Initiativ

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding. Watch to learn more.

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Here's a film of a baby drinking nicely at the breast. Look out for the deep jaw movement and swallows: 

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Here's a film of a baby drinking nicely at the breast. Look out for the deep jaw movement and swallows: 

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Note the position of the baby at the breast. Chin in the breast, nose not touching, baby covering more of the areola with the lower lip than the upper. An asymmetric latch.

The pause in the chin as the baby sucks means the baby just got a mouth full of milk. The longer the pause, the more milk he got.

A baby who drinks like this for 20 minutes straight (for example, we are not recommending feeding by the clock), might not take the other side, he would be full.

Timing feedings makes no sense.

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Note the position of the baby at the breast. Chin in the breast, nose not touching, baby covering more of the areola with the lower lip than the upper. An asymmetric latch. The pause in the chin as the baby sucks means the baby just got a mouth full of milk.

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Emma Pickett on the main principals of attachment and positioning:

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A dad at my breastfeeding support group this week had a bit of an epiphany. 'It's never felt like this before,' his wife had said. We'd spent just 3 or 4 minutes together. I'd mentioned one or two things about the way she was holding her baby. It was enough to make all the difference.

Just like in golf, he noted, with a tiny change to swing and position the game had been transformed.

As a lactation consultant, you study for hours and hours and pages and pages and pages. You know lots of things you may not talk about from month to month. But there are twenty or so things you say nearly every day.

So many mums have their experience transformed by a tweak. They are sore, dreading each feed, wondering how things will ever change and one comment - that may not even be 20 words long - can make all that go away in an instant.

It's one reason why even a rushed midwife or GP can turn breastfeeding around with the right training, even if they don't always have the time to devote to a long support session.

Here are a few of my favourite tweak considerations:
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1. Get a glass of water. Take a drink. Notice how you tip your head back and your chin comes away from your chest? Now try to take a drink with your chin pointing down towards your chest. Not so easy. Try and do that every time you drink, and I think you'll find you take less, give up sooner that you might otherwise and probably get a bit windy. So, tweak number one is hold your baby in a position where they can lift their chin away from their chest. If you are using a cradle hold or a cross-cradle hold, that means you might need to have them further away from the feeding breast's armpit and slid more across towards the non-feeding breast. We talk about 'nose to nipple' because that's encouraging the baby to reach towards the nipple with their head tilted back. If you are using a rugby hold, super important the baby isn't too far forward so they end up curling around the breast with their chin hunched towards their chest.

2. Don't hold the baby's head too high on the back of their head or push the baby's head towards the breast. Babies are clever at protecting their breathing (why we don't need to press our fingers into the breast near baby's nose). And nature has given them a reflex which means when someone pushes on their head, they'll be very unhappy about attaching in case they can't rescue themselves when breathing becomes restricted. They may even push back and shallow the latch and sometimes even refuse to feed entirely. So, support baby's head by holding around the base of the skull - supporting around their shoulders and chin and ears area - but no higher. Imagine Elvis towards the end of his career in Las Vegas with those diamond encrusted collars. You're holding your baby's Elvis collar and no higher. And even then, as gently as possible. Just enough to support baby's head without being too bossy or firm. You might even be using a position where this isn't a risk at all - you might be lying down or using a reclined position where your hand is nowhere near baby's head.

3. Beware the cushion myth. I am not kidding when I say that most people I meet using breastfeeding cushions are using them in a way that makes their life harder for themselves. The gap between your lap and the natural fall of your breast is probably very different from your mate's. It's going to depend on the length of your torso, the size of your breast, the way your breasts fall, the height of your lap which varies with your chair. It's also going to depend on the shape of your baby. So how on God's green Earth did we all get the message that the same size of breastfeeding pillow fits everyone?

Again and again and again, taller mums are slumping forward and hunching over their baby lying on their cushion. 'This cushion must be right. I just have to contort myself to get to it!'

And shorter women also think that the cushion is surely the answer, so they put baby on the cushion and umm, there's no space between their breast and the cushion for baby to fit. They often end up lifting their breast so baby can fit underneath. They might then have to hold their breast throughout the entire feed, compressing ducts and causing hand pain and usually not holding the breast in the same position the whole way through a feed so things wobble around.

Or folks might put the baby on the cushion and baby is a few centimetres too far away from them with sometimes not even the chin and chest making contact with mum at all.

Cushions can be handy to support mum's arms, but it doesn't normally work that the baby can't be held by mum and is entirely on the cushion.

What often works even better is no pillow at all and mum leaning back a bit. Check out: http://www.mothering.com/articles/natural-breastfeeding/

4. Baby needs to be clooose. If you can see the buttons down the front of baby's sleep suit, they are probably too far away. If baby's arm is trapped between you, they are being pushed too far away. If there's a big blob of your clothing and a breast pad between you, they are probably too far away. I once supported a mum who found night time feeds much more painful. She was sitting in the same chair to feed as she did in the day and was using exactly the same position but at night it was pinchy and uncomfortable. It turns out the difference was that the baby was wearing a sleeping bag at night. Just a few extra millimetres of padding meant that baby's chest and chin was a little bit further away from mum's body and the nipple wasn't going back far enough into baby's mouth. Baby's chin needs to be close into the breast. It's not going to work if the baby's chin isn't touching the breast at all. And the chin can't touch if the chest is too far away.

It's common for a mum to say, "Wow it doesn't hurt anymore!" followed by "I haven't been having them close enough!"

5. Mums are fiddling around and 'checking the latch'. It's completely understandable that when someone tells you the baby's mouth should be a certain way and the bottom lip should be flanged out like a fish lip, you think you are supposed to check! But the minute you push your baby's cheek out of the way and have a bit of a rummage, you've made some adjustments. Better to go with a look at the baby as they approach the breast and the mouthful you saw them take and how it feels. And how the nipple looks when it comes out of baby's mouth (might be elongated but shouldn't be squashed and flattened at the end.) If the baby is close enough, you usually can't see the lips at all. The rounded part of baby's cheek is in contact with the breast and the lips are hidden.

6. And while we are talking about lips, the top lip doesn't need to flange out and do the fish lip thing. It can rest in a neutral position. An excessively flanged top lip can even be the sign of a shallow latch. I've met several mums who have been told that the top lip should stick out and even flip it out themselves to make that happen. Curled in isn't ideal but it doesn't need to flip out.

7. Babies are sinking. Mums might start with baby on a squishy pillow and as the feed goes on, gravity does evil things and the baby starts to sink. The movement might be imperceptible but it's enough to pull the baby away from the breast. That pregnancy pillow filled with beans that the manufacturers claimed was super for breastfeeding? Meh. If it's bean-filled, it's likely to sink. That favourite feather filled bed pillow? Going to sink. Holding all the weight of your baby on your arms and hands and sitting bolt upright? You are going to sink. You are not designed to hold the weight of your baby in that position for minutes and minutes throughout the day. It's a big clue if you finish a feed rubbing your wrist and thinking, 'phew, glad that's over!' Gravity is your enemy. You need to find a position which you can sustain. That might be the right cushion for you (or more than one) or again, it might be about leaning back. Babies also latch better when they are anchored. If they feel themselves slipping, they may even clamp down and things can get even more sore.

8. What's the bottom cheek doing? Not many of us have nipples that come out from our body at precise right angles. So why do so many of us feed a baby as if that's true? The baby is precisely 'tummy to mummy' and lying on a breastfeeding cushion as if our nipples are pointing directly in front of us. In fact, most women have nipples that point slightly down (or off to one side and down). But we put baby into the 'right angle' position anyway. What ends up happening is that the top cheek (which mum can see in a cross-cradle or cradle position) is nice and close to the breast and rounded. However the bottom cheek can be centimetres away from mum's body with an unhelpful gap for air to get in and a shallowed latch. Get someone to check that the bottom cheek is touching the breast too. Look at your natural body shape. Your baby may need to look up towards your shoulder rather than at the back of the chair. You may be able to see both of their eyes.

9. Ear/ Shoulder/ hip in alignment. Get that glass of water again. Twist your neck and try to take a drink. It's rrrreally hard. And if what you were drinking was gradually getting thicker and fattier, again, you're likely to be taking in air and giving up sooner than you might. Baby can't lie on their back and twist their neck towards you to come to the breast. We want the ear and shoulder and hip to all be pointing in the same direction. Even a baby with a twisted torso and the twist is around the hips can run into problems.

10. Look at your body. Look, that mum over there in Costa seems to be able to drink her coffee (yes, you can drink coffee) and is just supporting her baby on one arm! How the heck! Can I do that? You know how hairdressers' clients turn up to their appointments with a celebrity photo and say, 'make me look like that!' That sometimes happens in breastfeeding too. 'Can I hold my baby like that mum I saw?'

Sometimes the answer is yes and sometimes it's no. Your humerus is the bone that goes between your shoulder and your elbow. Sometimes your humerus bone and the height of your breast isn't ideal for particular positions. Long humerus and high firm breast? You may not be able to do the cradle hold. I mean seriously - you may NEVER be able to do the cradle hold. The baby will be too low. Short humerus and long low breast? You may not be able to do the position that that woman in Costa can do and drink coffee. You might always need a hand to support the breast if you want to do the cradle hold.

It's not all about the pictures in that breastfeeding book or what your mates are able to do. It's about the shape of your body and the shape of your baby. Do you need to factor in wheelchair arms? Do you need to think about how your breast texture changes in the day? It's all very individual. Trying to make it work like everyone else does it can be unhelpful - which is why getting face-to-face help tailored to you can be so useful.

11. Give the baby more space for their tongue on the breast. You may have heard people talk about baby getting more of a mouthful of breast below the nipple than above. Or seeing some areola above the top lip and less (or none) below the bottom. If the baby has more space for their tongue on the breast, they have a chance of scooping more breast into their mouth and the latch being deeper. When the nipple is going in, picture it pointing towards the roof of baby's mouth rather than pointing down the back of their throat. Even just a little bit of re-angling can make things easier.

12. Don't make your baby eat cotton. Breastfeeding clothes also assume we're all the same. If you find them a faff - as you pull open a teeny slit to find your nipple hidden in there somewhere - I'm pretty sure your baby does too. If they ping back so the baby's nose and cheek comes back into contact with fabric again, maybe rethink. I've even seen babies with fabric in their mouths with a look of resignation that says, "This is the best I'm going to get". Cheap vest tops you can pull out of the way are very sensible. You can layer more than one so different bits are covered. And a bulldog clip is useful for securing fabric (not your chin holding your clothing and preventing it from flopping down onto baby's face).

As I say, some of that really isn't complicated. It's what we talk through on the breastfeeding helplines and what we point out every day in breastfeeding support groups. While at the same time NOT saying that it's 'normal' to be pain at 10 days or your nipples just need to get used to things. If you feel breastfeeding is just all too hard, remember you could be seconds away from fixing things.

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'Breastfeeding is just like golf! A tiny adjustment makes all the difference'

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A dad at my breastfeeding support group this week had a bit of an epiphany. 'It's never felt like this before,' his wife had said. We'd spent just 3 or 4 minutes together. I'd mentioned one or two things about the way she was holding her baby.

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Here's an NHS leaflet on attachment and positioning, with some good photos: 

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Here's an NHS leaflet on attachment and positioning, with some good photos: 

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Here is a 7 part series of videos on attachment and positioning made by Jessica Barton, an American IBCLC Lactation Consultant.  She covers all of the main breastfeeding positions and how to get your baby to latch in each one.  

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Here is a 7 part series of videos on attachment and positioning made by Jessica Barton, an American IBCLC Lactation Consultant.  She covers all of the main breastfeeding positions and how to get your baby to latch in each one.  

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Part 1: Baby-led:

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Improving Latch By Improving Positioning: Introduction and Laid Back Breastfeeding (Part 1 of 7)

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Improving Latch By Improving Positioning: Cross Cradle (Part 2 of 7)

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Improving Latch By Improving Positioning: Cradle Position (Part 3 of 7)

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Clutch Hold (also know as the Rugby hold)

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Clutch Hold (also know as the Rugby hold)

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Improving Latch By Improving Positioning: Clutch/Football Hold (Part 4 of 7)

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From SantaBarbaraLactation.com: This is the fourth in a series of videos describing how effective positioning promotes effective latching. In this video I describe the basics of latch and how to position a baby in the clutch or football position. The goal with any position is the get the nipple far back and to the roof of the baby's mouth.

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Improving Latch By Improving Positioning: Side Lying (Part 6 of 7)

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Here's a very helpful article on how to recognise effective breastfeeding. The top video clip shows a baby 'nibbling' at the breast, and the one below shows a baby who is well-latched and doing deep swallows:

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Here's a very helpful article on how to recognise effective breastfeeding. The top video clip shows a baby 'nibbling' at the breast, and the one below shows a baby who is well-latched and doing deep swallows:

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It was a new mum that first mentioned this to me, and as soon as she did it dawned on me that she was totally right. When supporting mums, lots of focus is on latch - because obviously the better the latch, often the less pain and the more effectively baby can feed; but all too often we meet a mum with a slow gaining baby who is always wanting to feed, or perhaps a mum with sore/cracked nipples sometimes resulting in a the shape of a lipstick! and then we hear "the midwife/health visitor has checked my latch and said it was fine...". Really if I had a pound for everytime I heard it, I would be writing this blog from Mauritius

This mum called me because she fell into all three of these categories - her baby was being supplemented with expressed breastmilk because of very slow gain, nipples were sore which the midwife had put down to baby spending long periods at the breast (with her supposed "perfect latch") and mum instinctively knew something wasn't right that was being missed. Almost as soon as I had stepped through the door mum posed the question that had been bothering her: "everyone keeps telling me everything is fine, but I really don't think she's actually having much milk, yet when I say she doesn't seem to swallow lots, they just keep saying latch looks fine - can it appear fine and yet baby still not take much milk?

And she's right- there's often little emphasis from mainstream sources on how to tell if baby is actually drinking lots of milk, either to mums or to health professionals; sure jaw moving and a swallow pattern generally gets some coverage - but does such basic information really help a new mum or busy health professional?

Whilst latch is a significant indicator, there are several problems with relying solely on it; firstly unless you are trained and experienced specifically in this area, identifying good latch from not so effective can be a tricky job. Babies can look well latched on and in fact be swallowing little, and others can start well and gradually close their mouth as the feed progresses.

Those helping in the early days often hand over to someone else for later care - so some never see the longterm outcome of their advice, never realise that latch they thought was "fine" really wasn't. Shoes are my favourite example - it's comparable to someone saying their shoes hurt, having whopping great heel blisters and then an experienced shoe fitter telling them that "sorry, but they appear to fit fine".

Secondly even if someone feels confident assessing latch, it's about more than just what is going on externally and is visible to the eye; as a very wise lady one told me - unless you have x-ray vision to see what is going on inside, it's impossible to state with any certainty things are "fine" - not when mum is presenting with all the signs something isn't right. Milk transfer is still the key - is the baby effectively milking the breast and drinking to satiation when they get there? or are they attempting the equivalent of drinking through a squished straw and running out of steam before they are truly finished, often never experiencing the "drunk" look babies get at the end of a feed, perhaps wanting to feed again an hour later?

Lastly latch can be subjective - some infants "appear" to be attached suboptimally, yet take lots of milk, fill nappies appropriately and are content and settled between feeds; if mum and baby are happy with time spent at the breast and baby is growing as expected - sometimes the phrase "if it aint broken, don't fix it" is worth remembering.

Back to the mum I started with; I observed a feed in her favourite position - mouth was wide and taking some breast tissue, rather than just the "nipple suckling" that causes hollow cheeks and seems to be the typical "bad latch" often recognised. However baby was not latched asymmetrically, and it became immediately apparent that whilst baby occasionally swallowed, little milk was being consumed; mum was totally right. Had the midwife been watching for milk transfer as well as latch, it would have been picked up a lot earlier than when I saw her at 6 weeks.

The first clip below shows "nibbling" or ineffective feeding: Baby is doing almost no drinking. A baby who breastfeeds only with this type of sucking could stay on the breast for hours and still not get enough milk. Something needs to be done here and if achieving a better latch, using compression doesn't help, the baby almost certainly needs to be supplemented (Newman).

Now compare this to the clip below, where baby is doing some really good drinking: The pauses are very long (this is the mouth filling); this baby could spend a very short period of time on the breast and still be getting plenty of milk (Newman)

N ote the difference in positioning in these clips. In the first baby is meeting the breast almost vertically - with nose, mouth and chin meeting the breast at the same time. As you can see the baby's nose sites very close to the breast, potentially making it difficult for him to feed well and breathe easily. In the second clip baby's head is flexed back and the chin meets the breast first, the nose is then well clear from the breast tissue. This asymmetric latch means more of the areola below the nipple than above is in baby's mouth - allowing him to milk the breast easily and consume lots of milk.

It's also not always a case of excellent or bad - there can be a whole host of "good" drinkers too, which is another great example of why timing feeds just doesn't work. A baby feeding as per the really good drinking clip is is likely to be satiated super fast, maybe as little as ten minutes - the next clip below shows a "good drinker" - still milking the breast effectively, but not quite as well as the "really good feeding" above (note the shorter pauses) so maybe he will take 20 minutes. The baby in the very first clip is likely never to be truly satiated and may hang around an age and then want to feed again perhaps only an hour later. Please note these times are only examples!

You can see more asymmetrical latch clips here.

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Effective breastfeeding - it's not all about the latch

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It was a new mum that first mentioned this to me, and as soon as she did it dawned on me that she was totally right.

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Here's a lovely clip of a baby doing Baby-led breastfeeding, also know as "Biological Nurturing”:

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Here's a lovely clip of a baby doing Baby-led breastfeeding, also know as "Biological Nurturing”:

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Here's kellymom.com's page on latching and positioning, showing an excellent animated diagram (in the top right-hand corner) of how to 'pivot’ a baby onto the breast:

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Here's kellymom.com's page on latching and positioning, showing an excellent animated diagram (in the top right-hand corner) of how to 'pivot’ a baby onto the breast:

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No matter what latch and positioning look like, the true measure is in the answers to these two questions:

Even if latch and positioning look perfect (and, yes, even if a lactation consultant told you they were fine), pain (particularly after the first two weeks) and/or ineffective milk transfer indicate that something needs to change, and the first suspect is ineffective latch/positioning.
If baby is transferring milk and gaining weight well, and mom is not hurting, then latch and positioning are - by definition - good, even if they look nothing like the "textbook" latch and positioning that you've seen in books.

"Rules and regulations have no place in the mother-baby relationship. Each mother and baby dyad is different and what works well for one mother and baby may not work well for another mother and baby. The important thing to do is to look at the mother and baby as individuals."- Andrea Eastman, MA, CCE, IBCLC in The Mother-Baby Dance

Following are some of my favorite resources on latch and positioning:

Newborn Hands: Why are they always in the way while breastfeeding? from the San Diego Breastfeeding Center

Latching handouts by Diane Wiessinger, MS, IBCLC

Breastfeeding: Off to the best start from the Unicef UK Baby Friendly Initiative
(Lovely latching pictures here, with simple directions. Open (download) the leaflet from the link.)

Deep Latch Technique from The Pump Station.
(Good latching pictures and directions.)

When Latching by Anne J. Barnes, has instructions with drawings
(The drawings and tips here are helpful.)

A Guide to Latching Your Baby by CW Genna

(with photos)

Breastfeeding Videos by Dr. Jack Newman

Animation illustrating assymetrical latch technique by Victoria Nesterova
(Nice animation - text is in Russian.)

The Mother-Baby Dance: Positioning and Latch-On by Andrea Eastman, MA, CCE, IBCLC
(This is a longish article written for breastfeeding counselors that has some nice descriptions of latching and positioning, along with info on why some things tend to work better than others.)

Is baby latching on and sucking efficiently? How to tell from AskDrSears.com
(A useful list.)

Help for various nursing positions

Some Ins and Outs of Laid-Back Breastfeeding from Breastfeeding USA

Laid back breastfeeding video from BiologicalNurturing.com

Videos: Natural Breastfeeding How-Tos

Lactation yoga, or side-lying nursing without getting up to switch sides by Eva Lyford, @

Nursing Laying Down (step-by-step description with photos) from Mother-to-Mother.com

More useful information

Latching: Thoughts on pushing baby's chin down when latching @

Baby Led Latching from Natural Mama NZ

When The Breastfeeding Baby Keeps Falling Asleep Before They're Full from Analytical Armadillo

Videos: Breastfeeding NZ - A Good Latch

When the Back of the Baby's Head is Held to Attach the Baby to the Breast by Robyn Noble DMLT, BAppSc(MedSc), IBCLC and Anne Bovey, BspThy

Breast Compression by Jack Newman, MD. The purpose of breast compression is to continue the flow of milk to the baby once the baby no longer drinks on his own, and thus keep him drinking milk. Breast compression simulates a letdown reflex and often stimulates a natural let-down reflex to occur. The technique may be useful for poor weight gain in the baby, colic in the breastfed baby, frequent feedings and/or long feedings, sore nipples in the mother, recurrent blocked ducts and/or mastitis, encouraging the baby who falls asleep quickly to continue drinking.

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Latching and Positioning Resources * KellyMom.com

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No matter what latch and positioning look like, the true measure is in the answers to these two questions: Is it effective? Is it comfortable? Even if latch and positioning look perfect (and, yes, even if a lactation consultant told you they were fine), pain and/or ineffective milk transfer indicate that there is a problem somewhere, and the first suspect is ineffective latch/positioning.