A baby who breastfeeds well cues (shows readiness) for feedings, is in a good feeding position, latches-on (attaches) deeply at the breast, and moves milk forward from the breast and into his or her mouth. It is also comfortable for the mother.
A baby has to wake up and let his or her mother know that he or she wants to eat. This is called showing feeding cues. A baby should show he or she is hungry 8 to 12 times in a 24-hour period. Watch your baby and begin breastfeeding when you see your baby:
Making sucking movements
Bobbing the head against the mattress or your neck or shoulder
Bringing hands to face or mouth
Crying is a late feeding cue. Many babies have difficulty latching once they become frustrated and begin to cry. Try to feed your baby before he or she cries. If your baby does cry and cannot latch on, calm your baby before trying again. Put your baby skin-to-skin away from the breast, let him or her suck on your finger, or have someone else hold the baby for a while so your baby can calm down. Then offer to nurse again.
It will be easier for your baby to latch-on if he or she is snugly in a good position for feeding. The most common feeding positions include the following:
Cradle. The baby is held in the crook or elbow area of the arm on same side as breast to be used for feeding. The mother supports breast with opposite hand. The baby's body is rolled in toward mother's body so they are belly-to-belly. You should not be able to see the baby's arm closest to your body.
Cross-cradle. The baby's head is supported by the hand opposite the breast to be used for feeding. The mother supports breast with hand. The baby is rolled in toward mother's body belly-to-belly. As in the cradle hold, you should not be able to see the baby's arm closest to your body.
Football or clutch. Baby's head is supported by the hand on the same side as breast to be used for feeding. The baby's body is supported on a pillow and tucked under the arm on the same side as breast to be used for feeding. Many women who have had a cesarean delivery prefer this position as it keeps pressure off a mother's belly.
Side-lying using modified cradle. In this position, the baby lies next to the mother with mother's and baby's bodies facing each other. If a pillow under your arm is uncomfortable, try placing your baby in the crook of your arm. This way, you will not be likely to roll over on the baby should you doze off. This position also keeps the baby's head at a good angle to bring baby and breast together, with the baby's head higher than his or her tummy, which can be helpful for babies who are more likely to spit up.
Laid-back breastfeeding. In this position, you are leaning back in a recliner or reclining in bed. Your baby is lying on his or her stomach on top of you. You can support the side of your baby's head if your baby cannot hold it him- or herself. In this position, both you and your baby can relax. You can allow your baby to explore your breast and latch on at his or her leisure.
For all positions, bring your baby to the breast—not the breast to the baby—by getting in a good position before you try to latch. It can help to sit in a roomy and comfortable chair or sofa. Some women find it comfortable to use a pillow on their lap to raise the baby to the breast. Your baby must be held in good alignment if he or she is to suck, swallow, and breathe during feedings. When in good alignment, you should be able to draw a straight line down your baby's body from earlobe to hip no matter which feeding position you use. For you, being in a comfortable position means that your feet are supported, your back is supported, you are sitting up straight and not leaning over your baby, and your shoulders are relaxed.
To help your baby achieve a deep latch, support your breast from underneath with your hand. A C-hold, with your thumb on top and your fingers underneath your breast—at least 1 1/2 to 2 inches behind the nipple—gives good support for the cradle or cross-cradle positions. A U-hold, in which you slide your hand so your thumb is on one side of the breast and your fingers on the other, is a variation of the C-hold often used when a baby is placed in the football (clutch) position for feeding. You may not have to continue to use a C or U hold if your breasts are smaller, but mothers with larger breasts often maintain the hold throughout the feeding.
Once you are both comfortable and your breast is supported, you are ready to help your baby latch. To help your baby latch-on correctly, use your nipple to stroke the baby from the nose to the lower lip in a downward motion and wait for him or her to open wide. Then bring the baby and your breast together in one swift motion. The baby should have a big mouthful of your breast, and his or her chin and nose should be touching your breast. Your baby's lips should be flanged outward like a trumpet or fish lips. The lips should not be pursed or rolled in. If you were to roll down your baby's lower lip, you should see baby's tongue gliding in front of the lower gum. The tongue should also "cup" your nipple and areola.
Do not press down near the areola with your thumb thinking this will help your baby breathe. This will pull your nipple from the back of your baby's mouth, where it needs to be. Babies' noses are designed to "smush" against their mother's breast as they feed. That is why their noses are flat—so they can latch-on deeply to the breast yet still be able to breathe. If you are concerned about your baby's ability to breathe, pull your baby's lower body in closer to you or lift your breast rather than pressing down on your breast.
It is called breastfeeding, not nipple-feeding, for a reason. If your baby's latch is shallow—not deep onto the areola, he or she may appear to be "hanging" on the nipple tip. When this happens, the baby will not be able to remove milk from your breast very well. This would decrease the amount of milk your baby drinks, so feedings may take over 45 minutes and your baby may not gain weight as he or she should. Also, your nipples are more likely to become very sore or cracked. If you are worried your baby does not have a deep latch, or you have sore or cracked nipples, try the different positions outlined above. If this doesn't work, promptly contact your healthcare provider or lactation consultant for help.
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