Assisting Breastfeeding/ Chestfeeding Clients with Latching on Newborns

Figuring out how to nurse a baby doesn’t have to leave parents so stressed out and exhausted.

Crystal Cooper, PhD., IBCLC

Why is breastfeeding/chestfeeding so difficult? We’ve come a long way in understanding how to help newborns latch onto the breast. We lost a lot of breastfeeding/chestfeeding knowledge when formula became popular and breastfeeding rates went down. In response, the idea that “breast is best” was promoted, but we then started teaching people how to breastfeed in the same way that we taught them to bottle feed. It turns out that this doesn’t work so well and has helped to spread the belief that breastfeeding/chestfeeding is hard and there are a lot of women/people who can’t do it.

Don’t get me wrong, it’s a challenge because of the barriers that exist in our society. It’s also true that breastfeeding/chestfeeding is a relationship between two people, and both of those people have unique body shapes and sizes. There is a learning curve involved, where both mom/parent and baby must get to know how their body and the other person’s body moves and responds, the way dancing partners do. There are also mothers/parents and infants who have issues that make it difficult or impossible to breastfeed/chestfeed that have nothing to do with positioning. The thing is, it’s far fewer people than you’d think because babies come equipped with ways to help them figure breastfeeding/chestfeeding out if we give them the opportunity.

 Infants are born with what are called primitive reflexes, which are automatic movements that they don’t have control over, and that assist them in being able to breastfeed/chestfeed. The reflexes are stimulated when there is pressure on certain areas, such as their palms, the soles of their feet, and their forearms. “The magic hour” where infants are placed tummy to tummy on top of their mother/lactating parent after birth, is an example of this. Within that time the infant actually crawls up to the breast and self-attaches. This ability is due to the primitive reflexes, like the stepping reflex, which causes the infant to “crawl” when the bottom of their feet touch the surface of the mother’s/lactating parent’s body. Other reflexes cause the baby to orient themselves by licking their hand and the mother/lactating parent’s body, and causing their mouth to open wide, and their head to bob in alignment with the body.

The Magic Hour

If you use the standard nursing holds with a newborn, those reflexes either don’t get stimulated, or they are stimulated but because of the position the infant is in, they make it seem as if they are fighting at the breast. Babies are like turtles in this way, where if you turn them over on their back their legs flail in the air, but if their feet are touching a surface they can walk

This baby is displaying what appears to be resistance at the breast. He is arching his back and pulling his head away while pushing his mother away with his hands. Some parents take this personally and think the baby is rejecting them, but in many cases, it happens because the baby’s reflexes are being stimulated in a way that makes latching in this position difficult. If he were laying on top of his reclined mother, the stimulated reflexes would help him to latch.

Have you ever noticed that one of the reasons that newborns can be hard to get latched on is because their hands are in the way? Their reflexes are being stimulated and are causing their arms to move and their hands to grasp in problematic ways. If you put the mother/lactating parent into a comfortable semi-reclined position, however, and place the baby tummy down on top of her/them, those active arms and grasping hands will help the baby find the breast, stabilize their body, and latch on.

Working against reflexes: In this position the baby’s body is facing upwards towards the ceiling instead of being fully turned in towards this mother’s body so that they are tummy against tummy. The hands are activated but are in the way of the baby getting a good latch when the mother/lactating parent is trying to wait for the baby to open wide and then pull them onto the breast.

The cradle and cross-cradle holds aren’t the only ones that work against the reflexes. The football hold also relies upon waiting for a wide open mouth and bringing the baby up onto the breast. Also, if you place a baby in a football hold to nurse, their legs need to go far behind the mother/lactating parent to latch correctly. However, this causes the bottom of their feet to touch the back of the couch or chair, stimulating their primitive reflexes and causing the baby to push off the surface scootching themselves forward and causing a bad latch.

 Another issue is that placing your hand on the back of an infant’s head while nursing will cause the infant to push back against your hand instead of moving forward towards the breast. When using the standard holds, moms/lactating parents, tend to believe they need to support the head.

Babies will push against your hand if you hold it while nursing them.

Sometimes moms/lactating parents will depress the breast to see if the baby has flanged lips, or to make sure they can breathe. This often causes some of the breast tissue to pull out of their mouth, disturbing the latch and potentially causing them pain.

The standard positions can also fail to stimulate an important primitive reflex. How many times have you tried to help a mother get her baby to open wide so that she can latch them only to wait and wait and wait for their mouth to gape? If you allow the baby to bob their head and find the breast on their own with little to no help in the laid-back position, you won’t have to wait for their mouth to open wide. That’s because it stimulates the rooting reflex, and the palmar and Babkin reflexes that connect the hands and mouth neurologically, causing the mouth to open when both palms experience pressure or touch. Gravity does the rest and keeps the mouth open wide enough to take a lot of breast tissue into the mouth to create the vacuum needed to extract milk without pain.

The primitive reflexes don’t last forever. At various points in early infancy, they become integrated. Some people will say they go away, but that isn’t quite accurate. The integration of the reflexes mean they go from being automatic and something the infant can’t control to no longer automatic and something they have control over. When the reflexes become integrated, or when the baby has had lots of practice latching in the laid-back position, they should be able to latch on just fine in any position.

Here is how you can help!

Wait for the Baby’s Hunger Cues:

New parents do best if they learn how to breastfeed/chestfeed without complicated step-by-step instructions and when nursing is as relaxing as possible. This means first and foremost that the baby is calm. When babies cry the tongue raises up and they can’t latch on until the tongue is lowered. Making sure the baby is calm means pointing out the infant’s cues that indicate they are hungry and encouraging clients to respond before the baby gets fussy. Crying is a late cue. Newborns will first root when they are hungry, opening their mouth and turning their head to the side, sticking out their tongue, and sucking on their fist or fingers.

This baby is showing hunger cues by opening his mouth, sticking out his tongue, and bringing his fists to his mouth.

Make Sure the Mom/Lactating Parent is Reclined and Comfortable:

Breastfeeding/chestfeeding can be stressful for moms/lactating parents. Laid back nursing can help take the stress out of it for them. In this position there is no need for them to put pillows under and around the baby, instead, their body is the pillow. Help the mother/lactating parent use pillows behind their own back and arms just to get themselves comfortable in a reclined position. They should not be sitting upright or lying flat.

Place the Baby Abdomen Down on Top of the Mother/Lactating Parent:

Once they are reclined and relaxed, place the baby abdomen down on top of their mother/lactating parent’s chest. Make sure they aren’t too far from the nipple, and that their hands are free and uncovered. Mittens and swaddling interfere with infant reflexes, which are touch based. The baby can be positioned either vertically, slanted, or horizontal.

In the laid-back position, the baby can be positioned vertically, horizontally, or at an angle.

Let the Baby Do the Work:

 Reassure the mother/lactating parent that the baby is not uncomfortable and doesn’t need their assistance as they bob their head around looking for the nipple. Moms/lactating parents often want to help the baby out, but as soon as they do so, they move their breast tissue in such a way that some of it is pulled out of the baby’s mouth. This is also the case if the mom/lactating parent uses their finger to depress the breast in front of the infant’s nose, or if they press down to peek at the baby’s lips to make sure they are flanged.

Reassure the mom/lactating parent that babies nostrils are placed in such a way that they breathe from the sides and won’t suffocate even when their nose is pressed up against the breast. Newborns can be noisy breathers, but if they can’t breathe, they will readjust themselves or pop off. Also, if their latch is not perfect in this position, they will adjust themselves. Gravity will make sure the mouth ends up open enough.

The focus should be on how the latch feels rather than how it looks or what the mechanics of latching are. If it is painful, the mom/lactating parent can make small adjustments without relatching until it no longer feels painful. Often the baby will adjust themselves in this position, making the latch comfortable before the mom/lactating parent needs to do anything. If latching proves to be painful or difficult despite these methods, be sure to refer the client to a lactation consultant.