In any of the nursing positions, when the baby is well aligned you should be able to draw a straight line that connects the baby’s ear, shoulder, and hip on either side of the baby’s body.
Once you and your baby are in proper position, the next step is to guide him toward the breast so that he can latch on properly and nurse. Latching on effectively is crucial to breastfeeding successfully because it prevents sore nipples, ensures sufficient milk supply, and stimulates plentiful milk production. In most cases (other than in the reclining position), it will be necessary to support your breast, at least in the early days of breastfeeding, in order for your baby to attach properly. This is especially true as milk production increases your breasts’ size and weight.
Using your free hand, place four fingers under your breast and your thumb on top to present the nipple to your baby. (Your lactation specialist or nurse may refer to this as a C-hold, since your hand makes the shape of a letter C.) Make sure your fingers are well behind the areola (the darker-colored area around the nipple) so it doesn’t get in the way of your baby’s latching on to the breast. You can provide gentle compression of the breast with your fingers to make it easier for your baby to latch. Alternatively, you can place your fingers on your breast in a scissors or V-hold to guide the nipple, but only if your fingers are wide enough apart to expose the areola.
With the breast supported, stroke your baby’s lower lip with your nipple or bring his chin in to touch the breast closely. This causes him to open his mouth. (If his mouth stays closed, stroke his lip again, press gently down on his chin with your index finger, and open your own mouth, too, since he might imitate you.) When he opens wide—not just a little, but as though he’s giving a big yawn—quickly draw him closer and place his open mouth fully on your breast. This guiding movement should be quick but gentle. Remember that you should bring your baby to your breast, not push your breast into his mouth. If your baby’s head is pushed into the breast so hard that he cannot breathe, he may become agitated or frightened; he may arch his back and refuse to breastfeed.
If your baby is in proper nursing position, his jaws will come together on your areola and his lips will seal over your breast. His chin and possibly his nose will touch your breast. (He will be able to breathe, but if you are concerned about his breathing, try lifting your breast or changing the angle of his body slightly, pulling his bottom in more closely to your body.) Helping him to latch on in a slightly asymmetric fashion, so that a bit more of the areola is in his mouth on the lower-lip side and a bit less on the upper-lip side, will position the nipple so it points toward the roof of the baby’s mouth.
You may feel slight discomfort when he first latches on and perhaps even for the first few sucks, but once he begins to suckle steadily you should not feel pain. Pain beyond the first minute or so of nursing is a sign of improper latching on and should be immediately corrected through further practice or with the help of a pediatrician, family physician, nurse, or lactation specialist. When pain persists throughout nursing, detach the baby by inserting your finger in thecorner of his mouth to break the suction and relatch him, making sure that his mouth is wide open before latching.
Many new mothers assume that infants are born knowing instinctively how to attach themselves to the breast and that if you present your breast in the proper way he will know what to do. Certainly some babies are capable of self-attachment, with good technique. This is most likely to occur in the first hour after birth but can be repeated later on. (Researchers have studied infants who are able to maneuver themselves from the mother’s lower abdomen, where they were placed immediately after delivery, up to the nipple, where they self-attach and start suckling. This has been called the “breast crawl.” Videos of this are available on the Internet.)
Most newborns do easily learn to latch on to the breast and soon begin the deep, regular suckling and rhythmic swallowing that typify successful nursing. But not all babies know instinctively how to latch on. You may need to teach your baby until he experiences enough successful feedings to associate his feeding behaviors with the satiation of his hunger.
The key to successful latching on involves taking enough of the breast into the mouth so that the nipple is drawn to the back of the baby’s mouth and his gums and tongue are compressing the areola, covering about an inch or two of the areola from the base of the nipple. This suckling movement causes your baby’s jaw to move the milk from the breast while his tongue makes a wavelike motion underneath the nipple, causing your milk to flow out through the tiny holes in your nipple. To achieve this, your baby’s mouth must truly be open wide as he latches on. Many early nursing mistakes occur when the mother hasn’t waited until her baby’s jaws are about as wide as they can be before she pulls him to her breast. As a result, the baby sucks on the nipple only, a position that limits the amount of milk received and soon makes the nipple sore.
To help your baby take in a large mouthful, use your C-hold to gently compress your breast; this makes the areola narrower and the nipple stick out more so it is easier to grasp. As he latches on, his tongue should stick out a bit, cover his lower gum, and partially envelop the breast. His lips should turn outward and press against your breast.
Try, Try Again
If your infant doesn’t manage to latch on properly the first time, gently detach him by sliding your finger into his mouth and pressing down on your breast to break the suction. You’ll know your baby didn’t latch on properly if you see indentations in his cheeks when he suckles, hear clicking noises, or notice his lips curled inward. He may also move his head frequently or not do any swallowing.
Incorrect latching may also cause pain for you. Don’t try to just pull him off your breast, since this could cause nipple pain. Keep practicing this latch-on technique until you and your newborn have mastered it, and don’t hesitate to ask the hospital nurses and lactation specialists for help.