Positioning and Attachment
For the first 3-4 months your baby breastfeeds using instinctive reflexes. These reflexes work best when the baby receives the right physical contact and direction from the mother. The baby needs to be in full contact with mother's body and breasts at all times when feeding.
When a hungry baby is placed firmly on the mother's body/chest, the baby should lift their head and the chin and mouth will search for the nipple, instinctively centering on the nipple and opening mouth widely to allow a good mouthful of breast tissue in the mouth.
This process should be broken down into simple steps to ensure correct positioning and attachment at each feed.
- Sit in a comfortable position where the body is open and supported with a straight back and open shoulders. A small pillow in your lower back will help you to sit straight. This posture lifts your breasts and flattens your tummy, creating an ideal position for the baby's open body to lay close to you.
- Unwrap the baby, supporting the baby's shoulder blades with your hand and relaxed fingers. The base or nape of the baby's neck will rest between your thumb and forefinger.
- Turn baby's whole body to face you and snuggle baby in close to your breast. If the baby can get their arms or hands in front of their body, they are not close enough!
- The baby will begin to feel and smell the way to your nipple, their chin and mouth will lead forward and their head will naturally tilt back.
- Keep your nipple above the baby's top lip and the breast contacting the chin and lips.
- Be patient and wait for baby to open their mouth up wide with the tongue down. The further the baby's bottom lip is from the nipple the bigger the mouthful of breast the baby will take.
- When the mouth is wide, quickly hug the baby onto the breast. The baby's chin will sink into the breast and your nipple will brush under the baby's top lip.
- The nipple will roll to the baby of the baby's mouth where it cannot be compressed, pinched or damaged and the baby can form a good latch and feed well from the breast
- support infant
- chest to chest
- chin to breast
- wide open mouth
- correct tongue position
- hug baby to breast
- watch sucking rhythm
Video of early initiation of breastfeeding by Dr Jane Morton
Sore or tender nipples can be normal in the first weeks of breastfeeding. It is a new sensation to have your baby feed from your breasts this hard or this frequently. Years ago, women were told to 'toughen' their nipples up with steel wool and sit in the sun topless in order to prepare their nipples for breastfeeding! Thank god those days are gone! Nipples are highly vascular and relatively tough and can handle a little bit of trauma. Unfortunately, if bad attachment and positioning isn't corrected, then damage will occur and reoccurs with each feed. Hence the importance to correct this early on to eliminate the chance of any further problems.
In some instances the damage to the nipples is so severe or mismanaged that the mother cannot even bare to have her baby go near her breasts and wear clothing/breast pads, let alone feed. However, if you can tolerate the initial attachment discomfort (e.g. 30-60 seconds) and then it settles, then keeping baby on the breast is the best option. Please seek help from a Lactation Consultant if you plan on resting your nipples so that a plan to correct the attachment and get back to breastfeeding can be made before too long.
If Sore Nipples continues beyond the first 2-3 weeks, this could mean there is another reason for it other than incorrect attachment. Problems such as:
- bacterial infection
- tongue tie or other infant oral anatomy problems
- incorrect/frequent pumping
- vigorous hand expressing
- nipple shield use
Please seek help/advice if you have ongoing nipple damage beyond the first 2 weeks.
Nipple care can be managed by expressing a little breast milk out after a feed and patting it into the nipple to air dry. Application of a Lanolin nipple cream can be added for extra protection. Changing breast pads frequently is also very important to ensure the growth of bacteria or thrush cannot enter the damaged nipples. It is also important to know that a little bit of blood from your nipple ingested by the baby is ok and will not harm them. There are several nipple creams and breast pads on the market, finding one that is affordable and suitable for you is encouraged. I believe a natural 100% lanolin nipple cream is the best providing a healing and protective barrier. Some nipple preparations have perfumes and extra additives that are not suitable or recommended for breastfeeding.