Why attachment is important
A baby who attaches well to the breast can help prevent many breastfeeding problems. It’s more likely for breastfeeding to be comfortable and for the baby to be able to remove milk well from the breast. 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:
sticking tongue out
turning head from side to side
finding and grasping the nipple
latching-on to the breast
These instinctive behaviours are seen as early as the first 1–2 hours after birth and continue for at least 3 months after birth. Sometimes a mother’s (and her baby’s) instincts may be reduced by drugs used during the birth or by hospital procedures such as limited or delayed skin-to-skin time. However, this can be overcome by a mother and her baby spending as much time as possible together in skin-to-skin contact. 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’ is the term used to describe the process of a baby seeking out his mother’s breast. Baby-led attachment 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 baby-led attachment.
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
- putting hands to mouth.
If your baby is upset, try the following to calm him:
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. It is then 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 move his feet up and down. His movements help get the hormone oxytocin released in your brain, and in turn that helps get breastmilk flowing. Don’t worry that it takes time in the early days, he will get more efficient with practice.
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 sitting up, 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 pushing 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, especially in the early weeks, usually quickly becomes skillful 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.
There are various ways to position your baby for breastfeeding. There is no one right way for every mother and baby. The right way is what works for you and your baby. Here are some steps which may help when you take the lead and bring your baby to your breast:
Steps to attach your baby
Sit comfortably with your back and feet supported.
Unwrap your baby and hold him close so that his chest is touching your chest. Do not 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.
For some positions such as the cross crade hold (see photos below), you can support your baby's neck and shoulder blade with your hand. For other positions such as the cradle hold (see photos below) you can support your baby's head in the crook of your arm.
Gently brush your baby's mouth with the underside of your areola. Your baby should open his mouth wide when you do this. 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.
Lower lip flanged (turned out) over the breast. It is normal for the upper lip to rest in a neutral position at the breast.
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 (although it is common for new mums to feel nipple pain in the early weeks as the baby attaches but this pain stops as the milk starts to flow).
- 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.
Photos of various breastfeeding positions
Cross cradle hold
Underarm (football) hold
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 an ABA counsellor. More detailed information is also available in the ABA booklets Breastfeeding: breast and nipple care and Breastfeeding: an introduction.
ABA website links
My breastfeeding plan (useful plan to read prior to your baby being born)
© Australian Breastfeeding Association July 2017
The information on this website does not replace advice from your health care providers.