FAQ 4: What are the various breastfeeding positioning?
The first step at the beginning of every nursing session is positioning.
Positioning essentially describes the body postures of the baby and the mother. Positioning is very important as it helps the baby get a good latch. Typically if the baby is unable to latch properly, both the position and the latch may need to be readjusted. Sometimes, breast also needs to be positioned in order to facilitate nursing. It is important to note that it is not always necessary. And, the need to do it goes on decreasing as the baby grows older.
Mother’s position: It is very important that the mother remains comfortable while breastfeeding, whether she's sitting up or lying down. Pillows can be used to support her back, arm and even the baby to sustain her at the breast level. It is essential to remember that the baby is supposed to be brought to the breast and not the other way around. So, a posture where the mother is leaning uncomfortably towards the baby or lying in a way where she's experiencing some amount of muscular tension is not desired. Leaning over the baby can cause backaches and/or neck/shoulder strain. And it can also make the latch less deep because gravity pulls the baby towards the tip.of the nipple and the weight of the breast push the baby down further. This may not be true in all cases, but it's certainly a concern for babies who are struggling with deep latch due to various reasons. In the early days, when both mother and baby are still adapting and getting used to breastfeeding, it helps for the mother to first be absolutely comfortable in her preferred nursing position, and then have her partner/help handover the baby to her. The breast can be supported in ‘C’ hold or 'U’ hold. The ‘scissor/cigarette’ hold is not recommended as it may impede the milk flow and create obstructions leading to engorgement and plugged ducts. The fingers in a scissor hold also come in the way of the baby's mouth, preventing a deep latch.
Baby's position: Just like the mother, the baby should also be comfortable while breastfeeding. Baby should be entirely turned towards the mother. A baby lying straight on the back with the only face turned towards the mother is not comfortable. Baby's chin should be touching the breast whereas the baby's head should bend slightly backwards in order to facilitate swallowing. Baby’s ears, shoulders, back, hips should all be aligned in a straight line. In the newborn days, it's always preferred that baby and mother have good skin to skin contact (belly to belly). Baby's neck, back and buttocks should be well supported.
Breast position: Breasts come in different sizes and shapes. For every baby, it's mostly only their mother's breast and nipple they are going to latch on. Therefore, every baby can potentially learn to adjust to the given conditions including the breast and nipple size and shape and nurse efficiently. Sometimes breast needs to be positioned in a certain manner so that baby can find it easier to latch. For very large breasts, a rolled-up baby blanket to support the breast works well. For large nipples, just gentle squeeze above the areola and helping baby latch (how we take a mouthful of a large burger by squeezing it gently - Think of holding the breast like a burger, moulding it with fingers parallel to baby's lips, but make sure that the fingers are placed at least two inches away from the areola so that the baby can get a good mouth full of the breast) does the trick. The gentle squeeze should be done perpendicular to the baby's mouth. It is important to understand that breast positioning is not necessary always. Also, as babies achieve greater head control as they grow bigger, they become very efficient at latching and need less and less assistance.
Above described positioning of the dyad enable a good latch and comfortable nursing sessions. It's very important because in the times of cluster feeding, nursing sessions may go on for hours together and a comfortable position prevents exhaustion and ensures willingness from both the parties to nurse as much as needed. This positioning should be followed consistently through different nursing positions viz. cradle, cross-cradle, football hold, side-lying etc.
There are various nursing positions. Mother can choose any of them as per her and her baby's comfort. These positions work as guidelines in the initial days when mother and baby both are getting accustomed to breastfeeding. It's important to remember though that, mother and baby are like pieces of a puzzle which fit each other perfectly. But each set of mother and baby are unique. Thus, what works for one, may not work for another. So, it's important to focus on mother-baby-duo specific needs, comfort level etc.
Since babies nurse very often, it is helpful when mothers think of creating a nest or a sanctuary, at least in the early days. Having a number of pillows handy, a book or a device, TV, water and some wholesome snacks can help the mother-baby dyad to settle in comfortably for those long hours. Breastfeeding is a learned skill for both the mother and baby. Experimenting with different positions can help you find your sweet spots. As the baby grows older, the entire paraphernalia is usually not required.
1. Biological nursing position: Also called as the 'natural breastfeeding position', this is the most natural position which encourages both mother and baby's natural instinct to breastfeed. (See image 1.1) The mother lies down on her back or lies comfortably in a reclining position. The baby is kept on the mother's belly, facing her. It is best if there's maximum skin to skin touch between mother and baby. In this position, the baby utilizes all five of her sensory organs to find and latch on to the mother's breast. When a newborn is kept on her mother's belly for the first time in this position, the baby uses her reflexes to move up to the mother's breasts and latches. Like all other mammals, human babies are capable to find their way to the mother's breasts. They use their sight to locate the darker portion on the mother's body (areola and nipple), their sense of smell to guide their way towards breasts (the mother's areola smell like an amniotic fluid at birth), they gain warmth and security from the touch of mother's body and they derive comfort from hearing the familiar sound of their mother's heartbeat. Babies are designed to move their hands and legs in upward to downward directions in order to facilitate movement towards the breasts. Once they find the breast, babies latch instinctively and taste the first food that nature intended for them. This entire process is called breast crawl. This position is helpful even later as it's very comfortable. It works best when the mother is struggling with latching. It's also called laid back position. It is very helpful when the mother has overactive (fast) letdown of milk, as in this position, the baby is able to control the flow better as milk flows against gravity and thus, the overactive letdown is neutralized while breastfeeding. A modified version of this position can be used for mothers having delivered through a C-section. However, the mother may not be able to support the baby and may need assistance from partner and/or others in this variation.
2. Cradle position: In this position, the mother sits with her back well supported. As the name suggests, the mother cradles the baby in her arms and brings her at nipple level. When the positioning criteria are met (as described in the first section), the baby is latched. In this position, the baby’s head rests on the mother's forearm, not at the elbow or wrist level, and her back will be along the mother's inner arm and palm. Baby is turned entirely toward the mother. Upon looking down, the mother can see the baby's side. This position works well once the baby is able to latch without any assistance.
3. Cross - cradle position: Also called a modified cradle position, this position gives the mother more control and is very commonly used in the initial days of breastfeeding to figure out the working latch. To nurse the baby in this position, the mother sits with her back well supported. Baby is kept on a pillow or pillows, depending on the requirement, across the mother's lap, turned entirely toward the mother and is brought to nipple level. When baby nurses from the left breast, the left breast can be supported by mother's left hand in a ‘U’ hold; (mother's fingers should always be parallel to baby's lips) while the baby is supported by mother's right hand. It's done by gently placing the right hand behind the baby’s ears and neck with thumb and index finger behind each ear. Essentially, the baby’s neck rests between the thumb, index finger and palm of mother's right hand, forming a “second neck” for baby. Avoid touching the baby's head as this can irritate the baby and baby will push ahead towards the breast first, resulting in a shallow latch. Mother's inner arm runs along and supports baby's back. If the baby is breastfeeding on the right breast, the mother supports her breast with her right hand and supports the baby with her left hand. It's important that the mother supports both her elbows with pillows too, so her arms don’t hold the weight of the baby; or else; they will tire before the feeding is finished. It is also important to keep all fingers (except thumb) together while supporting the baby's neck. When fingers are spread, they get tired easily as it's too much weight for them to handle individually for a duration of an entire nursing session. In this position too, upon looking down, the mother can see baby's side.
Once the baby is a little older and is able to maintain the latch without the mother having to support the breast, mothers can change into a cradle hold once the baby is latched and is drinking well. To do this release the hand holding breast and bring its arm under the baby's head while slowly letting go of the hand supporting the baby's neck.
4. Football position: This position is also called as ‘clutch hold’. Mother sits with her back well supported and holds the baby like a clutch. So, the baby’s head is in the mother's hand (palm) and her back is along the mother's arm beside her. Baby’s legs and feet are tucked under the mother's arm or on pillow, placed on the side. Here too, the mother creates the second neck for the baby like in the cross-cradle position, the baby is held with the right hand while she nurses from the right breast and breast is supported with a ‘C’ hold with the left hand. The hands supporting baby and breast are reversed when the baby is nursing from the left breast. Pillows are used to bring the baby to the right height. This position is very useful when the mother has undergone a C-section (so that there is no pressure on the incision). This position also works wonders when the baby refuses a particular breast. Football hold for twins works great when both babies want to nurse together.
5. Side-lying position: This position is potentially the most comfortable position for most mothers. It provides much-needed rest to the mother in times of cluster feeding, growth spurts and sleeps regressions. In this position, both mother and baby lie on their sides facing each other. Pillows can be used to support the mother's back, between her knees and below baby to bring a baby to the nipple level. A pillow or rolled blanket behind the baby’s back will keep her from rolling away. The baby can be cradled in the mother's arm with her back along the mother's forearm. The side-lying position is safe and can be used from day 1 itself. A popular belief is that breastfeeding in the lying down position can cause ear infections. This is not true. Even when the mother is sitting up to feed, the baby is in the same position as when side-lying and nursing. The myth about ear infection has come into existence due to mistaken transfer of bottle feeding-related information on to breastfeeding. When a baby drinks formula from a bottle while lying down flat, it can get into the Eustachian tubes and middle ear and cause an infection. However, firstly, it's important to remember here that formula and breast milk are not the same. Breast milk inhibits the formation of bacteria, while formula encourages bacteria. And secondly, breastfeeding and bottle feeding are not the same. Milk does not pool in the mouth when the baby is breastfeeding, as opposed to bottle feeding when milk/formula does pool in the baby's mouth. Similarly, another belief saying breastfeeding in the lying down position can cause the mother to roll over her baby or suffocate them is untrue as well.. Thus, it's a perfectly safe position as long as safe sleeping guidelines are followed - which involve - no smoking or alcohol consumption by parents, the bed should not be too soft, there shouldn't be toys on the bed, baby should not be heavily dressed, baby's face should not be covered, and baby should be put to sleep on her back. A mother that nurses lying down is more likely to nurse long term because it is less exhausting.
Easy Breastfeeding by Camilla Conti
Child care : 2nd edition, BPNI-Maharashtra state branch
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