By Dr Louise Santhanam, General Practitioner
Good positioning and attachment of the baby at the breast is critical to effective breastfeeding. This enables:
- Maternal comfort while feeding
- Development and maintenance of breastmilk supply
- Effective milk transfer and optimal infant growth
If breast problems, feeding difficulties or growth faltering occur, the breastfeeding ‘first principle’ is to review positioning and attachment as part of the diagnostic process. Refer the mother and baby for a breastfeeding assessment by an appropriately skilled practitioner, with observation of a full feed. See our page on ‘Breastfeeding Support‘ for more information. Familiarisation with the contact details for local infant feeding support colleagues is recommended.
Situations in which anatomical or functional problems are present (eg. tongue-tie, neuromuscular problems) may impair the ability to achieve effective attachment and milk transfer.
As breastfeeding is a learned behaviour for each individual mother-baby dyad, attention to correct positioning and attachment is essential in the early days and weeks. This can help to quickly achieve maternal comfort while feeding, facilitate the development of optimal milk supply and thus increase the potential for longer-term breastfeeding. The assistance of an experienced breastfeeding supporter who assesses positioning and attachment and can advise on alterations for improvement is often critical to breastfeeding continuation. The same principle applies if breastfeeding problems or difficulties with feeding or weight develop later down the line- a feeding assessment is an important part of investigating possible causes and any necessary adjustments can be made.
The following principles assist good positioning and attachment of the baby:
- Find a comfortable position in which to feed
- Hold the baby close, facing the breast with its shoulders and body in a straight line and its neck supported but the head free to extend
- Hold the baby with its nose opposite the nipple. The nipple can be brushed on the baby’s lips to encourage mouth-opening
- Wait for the baby to extend its neck and open its mouth wide
- When the mouth opens wide bring the baby to the breast with the chin touching the breast first, followed by the bottom lip and tongue near the outer edge of the areola
- The top lip should latch over the nipple as far as possible
- Less of the areola should be visible underneath the chin than above the nipple
It is important to note that babies breastfeed not nipple-feed. If the baby sucks on the nipple only this will cause pain, cracking and bleeding. If attachment at the breast is good the nipple comes into contact with the baby’s soft palate inside the mouth, and feeding should be comfortable for the mother.
How to Breastfeed- Getting a Good Attachment
The video below is a demonstration of good attachment at the breast (‘the latch’), including a visualisation of the anatomy inside the infant’s mouth:
Indicators of Good Attachment at the Breast
NICE Guideline CG37: Postnatal Care up to 8 Weeks after Birth defines the indicators of good breastfeeding attachment, positioning and successful feeding as follows:
Indicators of good attachment and positioning:
- Mouth wide open
- Less areola visible underneath the chin than above the nipple
- Chin touching the breast, lower lip rolled down, and nose free
- No pain
Indicators of successful feeding in babies:
- Audible and visible swallowing
- Sustained rhythmic suck
- Relaxed arms and hands
- Moist mouth
- Regular soaked/heavy nappies
Indicators of successful breastfeeding in women:
- Breast softening
- No compression of the nipple at the end of the feed
- Woman feels relaxed and sleepy
Additionally newborn stool pattern and changes can help to indicate if milk transfer is effective. NCT: What’s in a nappy?- How to know if your baby is feeding well Explains how the contents of the nappy can indicate if a baby is feeding effectively.
La Leche League GB: Positioning and Attachment Includes information on breastfeeding positions, including Biological Nurturing™ positions (‘laid-back’ breastfeeding).