Positioning and Attachment
By Jennifer Clark, IBCLC. Revised November 2021.
No matter what the latch LOOKS like ask yourself two questions…
1. Is it comfortable?
2. Is there good milk transfer?
When a baby latches nipples should not be pinched, sore, cracked or bleeding. They should also not be white or blanched. These are all signs that your babies latch maybe shallow. It is important to differentiate between initial discomfort on latching, sometimes this can be normal in the first few weeks after birth (due to hormones) but should go after the first 30 seconds. Also, some report discomfort (tingling, tightness in the breast) on let-down but again this should go and not last a full feed. When your baby comes off the breast your nipple should come out round and may appear elongated after a feed.
How to try and get a deep latch
POSITIONING- It can be easier to get a deep latch in a laid back or rugby hold position. Start baby so nose is in line with the nipple. A lot of the time parents start baby in a mouth to nipple position, however, baby needs to be able to tilt the head back and open mouth while to get a deep latch. Ensure you hold baby’s shoulders to allow them to do this and not their head. Moving a baby’s legs further down or around your body (depending on position) can help.
If the chin hits the breast first baby should open mouth wide so you can move them swiftly onto the breast. If you’re trying a laid-back position baby will root and self-attach without much help from the birthing parent.
Here is a great video on positioning your baby
Latching a newborn - YouTube
EXAGGERATE THE LATCH- Hold your breast so that your nipple points up towards the baby’s nose. This means that when the baby does a wide-open mouth the nipple goes up and back to the soft palate in the mouth. If the nipple sits on the hard palate, it can cause pain and pinching of the nipple.
Here is a great video on exaggerating your latch
How to latch a baby using the exaggerated latch technique. - YouTube
A baby with their mouth to nipple.
A baby with their nose in line with nipple
These images show a baby in the cradle position (left) and rugby position (right) and using breast shaping to exaggerate the latch, Nipple UP the nose.
SHAPING THE BREAST can help babies get a bigger mouthful of breast tissue. Whatever position they are in shaping the breast like a sandwich and pointing the nipple up towards the nose. Some babies may need you to hold this position until they're feeding well.
Holding your breast like a burger can help. The orientation is important. Imagine you have a big burger and you’re trying to fit it in your mouth. This helps baby get a big mouthful of breast tissue which helps baby remove milk more easily. You should see less areola as you practice this.
The left picture shows the U hold for a baby in cradle position
The right picture shows the C hold for a baby in rugby or koala hold.
If you cannot get a comfortable latch with these changes, please ask for support. If your baby has a tongue tie (restricted lingual frenulum) exaggerating the latch can help also until you have been seen. If feeding suddenly becomes painful after previously bring comfortable please ask for support.
Is there effective milk transfer? Is your baby getting enough milk?
Good swallowing in a feed (Suck swallow ratio of 1:1 or 1:2). Babies suck very quickly at the start of a feed to help release oxytocin from the mother. This then results in a “letdown” of milk. Most babies will have a suck to swallow ratio/pattern of 1:1 or 2:1. After the letdown of milk this may slow until the subsequent letdown of milk. Most babies will feed through at least two letdowns before releasing the breast and coming off content. See How do I know my baby is getting enough milk? - YouTube and How to recognise when a baby is drinking well - YouTube for videos of this.
Baby is content and happy after a feed. We don’t expect all babies to come off the breast and go straight down for a sleep but to be happy and not showing feeding cues (sucking hands, rooting for the breast etc) immediately after a good feed. Babies like to be held close and stay with their birthing parent. Baby wearing in the day can help.
Baby feeds regularly, around 8-12 feeds in 24 hours. Most babies will show feeding cues such as rooting for the breast and sucking their hands, usually with newborns just them being awake means they are getting ready for a feed. Watch your baby and not the clock, avoid scheduling feeds as this is detrimental for milk supply as well as your babies happiness! Sometimes your baby may go 30 minutes between a feed and sometimes 2-3 hours.
Good nappy output (5 or more heavy wet nappies a day, at least two yellow poos a day, around the size of a £2 coin before 6 weeks) This is by day 4. In the first 5 days babies nappy output increases from 1-2 wet nappies up until more than 5 heavy wet nappies a day. Poo will change from black meconium to yellow stools. In the first 6 weeks your baby should poo at least twice a day. After 6 weeks breastmilk composition starts to change and poos can become less frequent (sometimes up to every 10 days). If they are soft and yellow this is ok (as well as regular wet nappies). It is rare for exclusively breastfed babies to become constipated.
Good weight gain (around 30g/day depending on age). This may not always be in a smooth line but should to some degree follow your babies percentile chart (find this in the red book). This link shows average weight gain for babies
From left to right
Picture 1 - a baby following their percentile
Picture 2 - A baby who has had a big weight loss initially and slowly dropping more percentiles.
Picture 3 - A baby that is off the chart of percentiles
If you are worried about how your babies weight chart is looking, if they have dropped over two percentiles or they are not gaining weight as well as we would expect, reach out for support. The earlier you access the support, the easier it can be to resolve any problems.