Getting breastfeeding started? How can you tell your baby is attached well? Here's a quick guide.
Breastfeeding is natural, but doesn't always come naturally. We grow up not seeing many, if any babies breastfeeding, and if we do they may well be covered up. So how do you, as a new mum or dad, know by looking. Well here are some tips from a experienced breastfeeding supporter.
1. It doesn't hurt
In the first couple of days (and for some women, up to 14 days), it may feel uncomfortable when they first go on as the nipple gets stretched, but this should last less than 10 seconds. If it hurts more than that it is not right - even if a midwife or health visitor says it looks like a good latch. Check the rest of the signs below and the common mistakes, and go and see a breastfeeding specialist - see list at the end.
2. Ear, shoulder, hip in a line
Your baby's head and body should be in a line. It is hard to drink over your shoulder, make sure their head and body is in a line. If their head is twisted they may take in a lot of air, and not a lot of milk.
3. Chin in, nose out
This means their head is tipped back a bit which is easier for drinking (think what you do when you drink). (Larger breasted women may find the nose is not free of the breast, but the chin should be pressing into the breast.) When you bring your baby to the breast make sure they are 'nose to nipple' before they open their mouth. This will make them tip their head back, and their chin will be the first part of their body to touch your breast. You may be able to see the chin moving up and down and their tongue massages the milk out of the breast.
4. Asymmetric (looks off centre)
There is more areola above the top lip than below (if visible). With bottle feeding the teat goes centrally into the mouth. With breastfeeding the nipple needs to go over the tongue to the back of the mouth. When putting them to the breast, nose to nipple, your baby will tip their head back (nipple will be aiming at their top lip), they will then open their mouth. Your nipple will go over their tongue to the soft palate. If they go on centrally your nipple may get stuck on their tongue and get pressed onto the roof of their mouth. Have a look at your nipple after. If it looks squashed, has a ridge, looks like the end of a lipstick, then the attachment needs some tweaking.
5. Nipple aiming at the crown of their head
When you look at your baby feeding, can you draw an imaginary line from your nipple to the crown of your baby's head? If it doesn't then it can be a sign to retry. When you put your baby to the breast they should be facing the nipple. Some nipples point straight out, some point sideways, some point down. Move your baby to face the nipple so they come straight at it, not from the side. Which is why I don't like the 'tummy to mummy' phrase: baby should be close to you but if your nipples hand down baby may be on their side more. Don't use a pillow until they are on. Pillows can make them too high.
6. Rounded cheeks
Your baby's cheeks may looked stretched, that's great - wide open mouth, but they shouldn't go in and out with the suck. If they do that means your baby hasn't got a mouth full of breast. More likely to get a mouth full of breast if go on off centre.
7. Sucking pattern
After the first three or four days you should notice your baby has a pattern to their sucking. They will start off with rapid sucks, as they drink the more watery milk that's been stored in the breast. This triggers the 'let down' reflex, which is the brain flicking the switch to make lots of milk - fast! And the oxytocin released makes the tiny slivers of muscle around each breastmilk cell contract and squeeze the milk out. (Some women feel this as a tingle, or a tugging sensation, others don't.) Then they will get into a rhythm of suck, suck, pause. Gradually over the feed the pauses will increase as the milk becomes more fatty and they start to fill up. Towards the end of the feed it may seem as if they are barely feeding because they are on the thick fat rich milk. (This will help them put on weight.) It's a bit like having a chocolate pudding with Jersey cream. They keep having another bit, and another bit. You may notice a fluttery feeling. This is their tongue flicking out the really thick creamy milk.
The nurturing finger
Your baby's hair is so soft it is easy to find yourself stroking their head as they feed, but it will push their head, so their chin goes onto their chest. This is really hard for your baby to get on the breast and to drink the milk.
Holding their head
As with the nurturing finger this pushes their head onto their chest. You try drinking like that; it's almost impossible. Holding their head, or pushing them on by pushing their head, can cause them to pull back, pushing against your hand, losing their attachment. Support them across the shoulders and around the neck.
Moving them over
You get them positioned beautifully. They were nose to nipple, they tipped their head back and opened their mouth and instead of them going in, you push them over so they go on centrally. Instead, hug them straight onto you.
Putting your breast into the baby's mouth
If you put your breast into your baby's mouth it doesn't encourage your baby to open their mouth wide. It also means as soon as you move their latch slips. Instead bring the baby to you.
If you think your baby's position could do with a tweak, put your little finger in at the side of their mouth to break the latch, and try again. In the first two weeks sometimes it can take twenty attempts each time but it is worth persevering, so your baby learns how to do it well, and so you don't get sore, or more sore. Here is a video showing you how to get the baby on.
If you still would like some help, see the list below.
It might not be you
Tried all these things and it's still not right? It might not be what you are doing, there may be other factors, such as tongue tie, or a high palate, or a neck tightness from birth or position in the womb (osteocraniopathy can help with this). Go and see a specialist - see the list below.
Where to get help
Ask your midwife or health visitor for the breastfeeding drop ins near you.
Here are some helplines, and some organisations have trained breastfeeding counsellors who can visit, or who run drop ins.
I hope you found this helpful. I trained as a breastfeeding supporter with the NHS, and ran the breastfeeding drop in at the Sure Start children's centre where I worked, where I helped hundreds of women, both at the drop in and at home visits. I now work as a doula (birth and postnatal) and provide breastfeeding support through this. I run antenatal breastfeeding workshops.
See my website for more details of my services.