Attachment to the breast

Why attachment is important

A baby who attaches well to the breast can help prevent many breastfeeding problems. The well-attached baby causes no nipple pain and drains the breast well. This helps ensure a good milk supply so the baby grows well.

Sore, grazed or cracked nipples usually mean your baby is not attached properly and has damaged your nipples. A poorly attached baby is not usually taking enough milk. This can lead to a blocked duct or mastitis.

Breastfeeding — natural but also learned

Breastfeeding, although natural, is also a learned skill. This is especially true in modern westernised culture.

All baby mammals have natural instincts which enable them to find their mother’s breast from birth with little or no help from anyone. These instinctive behaviours include the following:

  • sticking tongue out
  • turning head from side to side
  • wriggling
  • finding and grasping the nipple
  • latching-on to the breast
  • suckling.

These instinctive behaviours are seen as early as the first 1–2 hours after birth and continue for at least 3 months after birth. So, even if a mother’s (and her baby’s) instincts are affected by drugs used in labour or by hospital policies and procedures, these instincts will be there once they are together. A mother can be sure that she doesn’t have to know it all and that her baby is born hardwired to breastfeed.

Baby led attachment

‘Baby-led attachment’ (BLA) is often the term used to describe the process of a baby seeking out his mother’s breast. BLA offers your baby the most natural introduction to breastfeeding. It is particularly helpful for babies who are reluctant starters. Here is a step-by-step guide to BLA. 

    

Start with a calm baby. A calm baby is more likely to be able to follow through on his instincts than a baby who is upset. His tongue will be down and forward which is where it needs to be to help achieve good attachment to the breast.

Get to know your baby’s feeding cues. Crying is a late feeding cue so it is important to recognise earlier feeding cues such as:

  • turning head from side to side
  • sticking tongue out
  • wriggling
  • hands to mouth.

If a baby is upset, try the following to calm your baby:

  • skin-to-skin contact
  • stroking your baby’s back in one direction
  • talking to your baby
  • gentle rocking movements
  • letting him suck on your clean finger.

Skin-to-skin contact. Some mothers find being completely skin-to-skin with their baby helpful, ie not wearing a bra and baby in just a nappy. A mother’s body can help to regulate her baby’s temperature by changing her own chest temperature. Skin-to-skin contact also helps to regulate a baby’s blood sugar levels and breathing and stabilise his heart rate. However, skin-to-skin is not essential at feeding time if the mother feels more comfortable with both of them lightly dressed, as long as the breast is available to the baby.

Positioning. A mother can hold her baby to her body in the way that feels right for her. Many mothers choose to hold their baby upright on their chest and between their breasts. Many mothers also find that a semi-reclined position works well. In a semi-reclined position, it is easier for a baby to make his own way to his mother’s breasts, gently supported by his mother. It can also help to minimise nipple trauma, as it reduces the drag on a mother’s nipple that may occur when a mother is sitting upright.

When your baby is ready to feed, he will start to lift and bob his head around. Some babies will bob their way down to a breast, others will gently glide towards a breast while others will quite dramatically throw themselves towards a breast. All these movements have a definite purpose — to find the breast!

As your baby moves closer to your breast and nuzzles towards your nipple, he may bring his hand(s) to his mouth and begin to feel around with his fists and move his head from side to side. Don’t worry if he sucks his fist. He will soon figure out that is not the breast. Some babies will suck their fist to calm themselves. It’s all part of the process. Don’t hurry him. Let him do it in his own time.

When your baby finds your breast, he will bring his tongue forward and may lick at the breast. He may press into your breast with his fists and may even move his feet up and down to rub the top of your womb (for the very early feeds), this helps to get the hormone oxytocin to be released which helps to get your breastmilk flowing).

When your baby finds just the right spot, he will dig his chin into your breast, reach up with an open mouth, attach to your breast and begin sucking. Let your baby lead the way as much as possible. However, if not in a reclining position, some mothers find it helpful to pull their baby’s bottom closer in to their body, or to provide some firm support to their baby’s neck or shoulders while avoiding pressure on their baby’s head. In a reclining position, gravity will act on the baby’s body, making these actions by the mother unnecessary. A baby needs to have his head free to be able to position his head to latch on effectively.

A baby who has had many chances to seek out his mother’s breast using his instincts usually quickly becomes skilful at breastfeeding, no matter the position his mother chooses. After all, it is only the baby who can open his mouth wide, attach and begin suckling.

The cross-cradle hold

When you have visitors or are out in public, you may like to use the cross-cradle or cradle hold (see photo below). Many of the points listed below apply to any way you feed your baby. Remember, there is no one right way for every mother and baby. The right way is what works for you and your baby.

Steps to attach your baby in the cross-cradle hold

  • Sit comfortably with your back and feet supported.
  • Unwrap your baby and hold him close, along your forearm.
  • Support your baby's neck and shoulder blade with your hand, so that your baby is able to move his head into the right position to attach well. Don’t hold his head.
  • Turn him onto his side with his chest towards you, head tilted slightly back, at the same level as your breast. His nose will be level with your nipple.
  • Tuck your baby’s feet around your side and his lower arm near your waist.
  • Gently brush your baby's mouth with the underside of your areola. Your baby should open his mouth wide when you do this. You may find holding your breast like you would a sandwich allows him to take in more of your breast and makes it easier for him to attach. When your baby opens his mouth wide and his tongue comes forward over his lower gum, bring him quickly to the breast with your nipple aimed at the roof of his mouth. His first point of contact will be his lower jaw or chin, on your areola well down from the nipple.
  • As his mouth closes over the breast he should take in a large mouthful of breast.
  • If you are engorged, expressing to soften around the areola may allow him to attach more easily.

To check that baby is attached well, look for these signs:

  • Chin is pressed into the breast and nose is clear or only just touching the breast.
  • Lips are flanged out, not sucked in.
  • Tongue is forward over the lower gum (may be difficult to see — don’t pull him away to check or you might detach him).
  • Your baby has much of the areola in his mouth, more so on the 'chin side'.
  • There is no pain (new mums may feel a stretching sensation as the nipple adjusts to being drawn out).
  • You may notice your baby's whole jaw moving as he sucks and even his ears wiggling. He should not be sucking in air or slipping off the breast. His cheeks should not hollow as he sucks.

Other breastfeeding positions

Cradle hold

Underarm (football) hold

Lying down

If it hurts

  • Take your baby off the breast. Insert a clean little finger in the corner of his mouth to break the suction.
  • Nipples that are creased, ridged or squashed, blistered, cracked or bleeding mean the baby is not properly attached. He does not have the nipple far enough back in his mouth and it is being squashed against his hard palate.
  • Wait for the baby to open his mouth wide and then reattach.
  • Sometimes a small change in the baby's position can help. For example, hugging the lower half of your baby’s body in, as this helps to allow your baby’s chin to further press into your breast. Ensure that there is no bunched clothing between you or your baby’s arm is getting in the way.
  • Chest to chest and chin to breast is a quick way of describing good positioning. His whole body should be very close to yours, like you are ‘wearing’ him.

Who to contact

If you have any concerns about attaching your baby, please contact the Breastfeeding Helpline on 1800 mum 2 mum (1800 686 268) to speak to a counsellor. More detailed information is also available in the ABA booklets Breast and nipple care and Breastfeeding: an introduction ABA booklet which includes information on BLA.

Useful websites

http://www.biologicalnurturing.com

ABA website links

Mothers Direct relevant products

© Australian Breastfeeding Association March 2012

The information on this website does not replace advice from your health care providers.