During the early weeks of breastfeeding while you and your baby are in the learning process, you will want to pay special attention to proper positioning and latch-on. Doing so will prevent or lessen nipple soreness and ensure that your baby receives adequate milk. Once nursing is well-established, close attention to these breastfeeding basics is not so crucial unless there is a problem.

When selecting a place to breastfeed, choose a chair that will allow you to sit as upright as possible, perhaps one with a straight back and arms. You may also find that pillows placed behind your back and under your arms give you more support. This is especially true if you are nursing while sitting up in bed.

Consider propping up your feet using either a nursing stool or a stack of books. Doing so elevates your lap; thus taking pressure off your back, shoulders, and arms. If you are sitting up in bed, place pillows under your knees.

When using the football or clutch hold, position the baby at your side with your forearm along his back and your hand cradling the back of his neck. You will want to place a pillow at your elbow where the baby's bottom will rest. Pull the baby in closely. Use the pillow under baby's bottom to support your arm as well. You may also find that a pillow or rolled up blanket/towel under your hand/wrist at the baby's head prevents you from tiring so easily.

Another position that allows for good head control like the football hold is the transitional hold or cross-cradle hold. With this position, lay the baby across the front of your body on his side as you would with the traditional cradle hold. Support your breast with the hand that is on the same side as the breast you will be offering the baby. With the opposite arm, reach around the back of the baby's back and cradle the baby's neck with your hand.

You will want to support your breast throughout the entire feeding for the first few weeks. If you are large breasted you may want to continue to do this for as long as you breastfeed. Larger breasted mothers often find that a rolled-up blanket or towel placed under their breasts makes latch-on easier for the baby as well. Support your breast using a C-hold (4 fingers underneath way back against the chest wall and thumb on top away from the areola).

Begin by hand expressing a little breastmilk onto your nipple. Line your baby up so that his nose is at the level of your nipple. Lightly tickle your baby's top lip with the tip of your nipple in an up and down motion. This will cause baby to tip his head slightly back making it more likely that the chin plants first and more of the lower breast tissue is taken into the mouth. WAIT for baby to open wide - as wide as he does when he yawns. For some babies this may take time, so be patient! Do not allow the baby to chew his way onto the nipple.

When the baby opens as wide as a yawn, QUICKLY boost him onto your breast. He should take an inch to an inch and a half of your breast tissue into his mouth. Once he is latched-on you can help him take more of your breast into his mouth by pulling down on his chin. He should be pulled in so close that his chin is touching your breast. His nose may also touch it. Do not be afraid that he cannot breathe in this position. Babies' nostrils flare, enabling them to breathe out of the corner of their noses during nursing. If the baby's nose seems to be blocked by your breast, change your positioning by pulling the baby's legs and body in closer or lift your breast a bit more rather than compressing the areola with your thumb. Doing so can inhibit the flow of your milk.

It is normal to experience some discomfort the first few seconds of nursing as your nipple tissue is stretched and elongated far back into your baby's mouth. This temporary tenderness usually diminishes once your milk lets down and completely disappears within a few days. Aside from this normal tenderness, breastfeeding should NOT hurt. Sore nipples usually indicate that the baby needs to take more of the breast tissue into his mouth where it cannot be gummed or chewed. If this initial discomfort does not subside within the first minute or so of a feeding, break the latch by inserting your finger in the corner of baby's mouth or by pulling down on baby's chin, and begin again. Do this as many times as you need to for the latch-on to feel comfortable. Allowing your baby to stay on the breast when he is not latched-on correctly will cause nipple soreness and possibly prevent your baby from receiving a sufficient amount of milk. Some babies will start out with a good, deep latch and then slip down onto the nipple as the feeding progresses. Be aware of this and break the suction and relatch your baby is needed.

• If using the cradle hold, cross cradle/transitional hold, or lying side-by-side, the baby should be facing you so that he does not have to turn his head. If using the football hold, the baby's mouth should be directly in front of or slightly below your nipple.

• The baby should take at least an inch of your areola into his mouth.

• The baby's chin and nose should be touching your breast.

• The baby's cheeks are nicely rounded when suckling.

• The baby's top and bottom lips should be flanged out - like a fish's lips or a rose bud. If they are not, use your finger to manually flip them out. If the baby sucks in either of his lips during the feeding it can cause nipple soreness.

• The baby's tongue is down, cupping your breast. If breastfeeding is going well and you are comfortable there is no reason to check the position of the tongue. If nursing is uncomfortable and the tongue cannot be seen, it may indicate that the baby is using it improperly. If this is a possibility, consult a lactation consultant or La Leche League leader in your area.

• Your nipple looks nicely rounded immediately after your baby releases it. There should not be any creasing. The nipple should not look pointed, mashed, or formed in any way.

• Your nipples are sore during the entire feeding or become sore as the feeding continues.

• You can hear clicking or smacking noises as the baby suckles.

• The baby is having trouble latching on and is coming off the breast repeatedly after only a few sucks.

• The baby falls asleep after only a VERY few minutes of nursing.

• The baby's cheeks are dimpling in with each suck.

• Your nipples look pointed, creased, mashed, etc. when released from your baby's mouth.

• The baby has too few wet diapers and stools (see "Is My Baby Getting Enough?").

• The baby acts hungry all the time by being constantly fussy and by constantly sucking on his hands.

• Feedings are routinely taking more than 30 minutes. While length of feeding may not indicate a problem at all, sometimes babies who routinely need this long or longer to feed are not latched deeply enough to transfer milk effectively.

Breastfeeding is not supposed to hurt! If after paying close attention to positioning and latch-on for 48 hours, your nipples are no better or are worse, you should consult a lactation consultant or La Leche League leader for one-on-one support. In the meantime, following the measures listed in "Treatment Measures for Sore, Cracked, and Bleeding Nipples" may make you more comfortable.

Written by Becky Flora, BSed, IBCLC

Last revision: February, 2, 2001

Sources:

• La Leche League's, "The Breastfeeding Answer Book" (1997) by Nancy Mohrbacher, IBCLC and Julie Stock, BA, IBCLC

• "Guide for the Breastfeeding Mother" (1996) by Edie Armstrong, BSN, IBCLC

More info at other sites:

Color images of correct latch-on fs