Positioning & attaching/latching the baby at the breast
Correctly positioning the baby at the breast and recognising a good latch attachment were acknowledged by many of the women who spoke to us as being the most crucial factors in getting breastfeeding off to a good, painless and trouble-free start. For some women the baby attached straight after birth (see 'The first breastfeed') and never looked back but for others it wasn't quite so easy and mother and baby had to learn together. Some women needed help from health professionals (such as midwives, lactation consultants and health visitors) and experienced breastfeeders (such as breastfeeding counsellors, La Leche League Leaders, family members and friends) in the hospital and when they first came home (see 'Support from Hospital Staff' and 'Getting Support for Breastfeeding'). The help generally consisted of getting the baby to attach to the breast and trying a variety of positions, both for the baby at the breast and for the mother, until both parties were comfortable. This was particularly important if the mother had undergone a caesarean section (see also 'Emotional and psychological aspects of breastfeeding').
She describes ways of checking that her baby was correctly attached.
Dont do it for me. Can you help me do it myself, please? she said.
Some women found it extremely difficult and took a long time to achieve and recognise good attachment while others thought that the written and oral descriptions of it made it sound far more complicated than it actually was.
Not attaching her first baby on properly led to later problems. She learned how to do it and had...
When I was pregnant I didn't really know anything about breastfeeding at all, I didn't get any information, it was just something that I had in my head, that I really wanted to do, and when she was born I, well I had said to my husband that I wanted to do it and I said I would give it a try and see how you would get on, and when she was born well of course I tried it, so well of course I thought it would be easy but whenever I started to do it I found it wasn't just as easy. It was actually quite difficult because obviously she wasn't, I wasn't latching her on properly, I thought it was just a normal thing to do, but whenever I was putting her on obviously I wasn't putting her on properly, she wasn't what they call 'latching on' so this is where the problems really started and then I actually took mastitis as well with the engorgement, so I had to, well I got quite a lot of help from the midwife, she doesn't live really far away and it was, she actually gave me her contact number so I was able to contact her. So, well I was in the hospital I think for about a week, and well they did try their best, I was fine whenever I was in the hospital but whenever I came back out and home, things were different. Things were different at home because that's really whenever the problems started with cracked nipples, and the engorgement, so I had to get help from the midwife. She was really helpful she would've came down and she would've tried to latch on but at this stage I had the cracked nipples so it was quite difficult and I was trying to, to wash the nipple with my own milk, they described to me to wash the nipple with your own milk which I did do, and it, it did help but it just took a while for it to clear up and again Kamillosan cream, I tried that as well, you didn't really have to wash it off because you would've just latched the baby on with it still on. So it was the latching on it was really the problem, every time I was trying to get my daughter on, it was a real, it, I could feel myself tight, my jaws, my mouth it felt as if it was just going all dry, and it was really the latching on that was really the difficult part, that was the, that was the part I found most hurt, I really dreaded to think of every feed time, 'Oh here it goes again', the pain, but she did tell me right enough to take painkillers to try and get rid of the pain, which I did do, I wouldn't really be a tablet person but I did try this for the pain because I had it in the back of my mind, 'Don't give up, keep, keep at it', so I did and.
How long do you think that took to get over the engorgement and the sore nipples, are we talking days, weeks, months?
No, we're talking weeks, I'm sure it was about two, three weeks before the nipple really started to clear up so the midwife that did come and help me she did advise me about times and a place where breastfeeding was taking place so I did decide to go, and there I met other mums who breastfed and, a midwife and a health visitor who was able to advise me as well at this stage, you know, I was beginning to get more information about latching on and, and all the rest of it so this is really where I got the information about latching on, that's really where I first began to think, “Oh there y'are, it's, there's more to it than just putting the baby on”, you must make sure that the mouth's open wide, and that they take the full nipple not just, you know, round the, the brown area that they take the full thing' so that's really where I got the information I was able to find help, she was able to tell me what I was doing wrong, I was really more or less putting my daughter on without really making sure that her mouth was open. They keep tell, they kept showing me, really by them own mouth experience how you, that the baby's mouth should actually be opened so this is really where I le
Finding the correct position took a lot of trial and error and the help of a lactation consultant...
Well, she [mother] used to come down and have the baby off me if she was a bit grisly and that would help if I was tired if she'd been up feeding a lot, and just support really. Sometimes she used to, be a, well because she hadn't done it herself she was like, “Give her the bottle” and it's like, “No I want to do this” so sometimes she couldn't understand but then she came over with me to see the lactation nurse so she was coming with me for like quite a few months, she used to come over and she used to watch then what the position that I was in and then, when we'd come back home she'd stay a little while just to make sure it was, I was in the right position and that helped a lot as well, and finding the right furniture to feed, me feed, that was the hardest thing getting the right like chair to sit on and the right, just to make sure you're in the right position. So the baby used to feed fine over in the hospital but when I used to come back from that clinic then it was finding the right positioning back at home and trying to get the same height chair and, and that, and I did try feeding on the side and so it was trying to find the right height for something to put on 'cause our bed is very low so I was too low, so it was just asking people if they had things that I could use [laughs] so.
So what sort of, what sort of chair did you find that you needed in the end and what sort of things did you use?
I used my mum's, one of my mum's dining room chairs because it was lower than mine, and my sister's bedside cabinet to put the pillows on and had her on that for a little while, but we couldn't get her to feed that very well that way though so in the end I feed, I still feed her like it now, I lie back and have her on my stomach and she looks for it herself and she feeds that way and that's the only way that we could get her to feed properly then it was the best attachment that we could get, and we couldn't get her to feed on, laid on the bed, or sideways feeding or forward, that was the only way we could get her to latch on properly, we're still doing that now nine months old so.
Lying on top of you…
…on your tummy…
On my tummy.
Yeah, she lies with her belly onto mine and then she just, so puts herself on now, I used to have to direct her a little bit when she was bit younger but now she just puts herself on, and she's comfortable that way and she feeds quite, we was finding her falling asleep if I was feeding her the other way so she wouldn't actually open her mouth wide enough to latch on properly, but by doing it that way she's, she came on then. We'd do it and she'd look for it more and her mouth would open up wider as well.
So was that just a matter of trial and error…
…trying lots of different positions?
Yeah, that was the last resort really, the lactation nurse said that was the last resort so that, “I tried it with some mum's before so let's give it a go with you” and we tried it the once and we haven't looked back, we just kept doing it that way.
So did you know straight away that first time when she latched on that it?
Yeah because she was, she wa
Her baby was born by caesarean section and she was shown a couple of different breastfeeding...
I don't, not, not to me they the midwife was good and she showed me a couple of alternatives, she showed me the rugby hold which is when you put the baby round the side and it latches on so you, you're not having a baby lying across your stomach. I think maybe because Sophie's quite light and things I didn't find it, you know, a pressure really so I've, tend, I've used it a couple of times but I tended just to use the, traditional hold? I don't know what you call it, just the one where you, lying across?
The cradle hold.
Yeah the cradle hold. Just more often, just because I found that works okay for, for us but that's the only thing I found it difficult a couple of times I couldn't put her back, I lifted her out and probably a couple of times when I shouldn't have because I did feel the pain, but when you've got a crying baby you just, your immediate reaction is to sit up and, and get them. But again being in hospital for the extra couple of days meant the midwife would actually come and place her back in, in her little cot because I struggled to sit up and do that but, other than that I haven't found any difference. And actually I was talking to a friend today who also had a caesarean and she feels the same, a bit like a milk cow of just continual, continual feeding but hasn't had any sort of adverse affect on her, her sort of bonding or wanting to feed, her ability to feed, so from that point no it's not been any, any different really.
Sometimes the baby preferred one side over the other. Sometimes the mother required special provisions, such as an upright chair or lots of pillows or purpose-built cushions. Several women used nipple shields to help them with getting the baby latched-on in the early days. They used them, both with and against health professional advice, for a variety of reasons such as inverted nipples, sore nipples or as a confidence booster.*
After her caesarean section, the midwives showed her lots of different positions but that...
Because I had the caesarean, the problem was I think, was that we weren't able to feed sitting up, so a lot of the feeding was had to be done lying down, and I don't think I was ever taught how to do that properly [Pause]. Sorry do you want to?
So let's just.
Talk about those problems…
…how they started? Well I think I first realised that I was having problems was when my nipples started to get sore and this was possibly around day four after the birth, and then I came home from hospital.
So your milk had come in by then?
Yeah. And I suppose again I didn't really understand what was a good latch, was it, was he suckling well? I just didn't understand these things were explained to me but some, for some reason it just wasn't going in my head. So they started to get really sore, a number of midwives that came through to see me were showing me different positions, how to feed, I mean by that time I could sit on the sofa etcetera, but he just seemed to be, every time he was latching on it was so painful, and I suppose by day six it was excruciatingly painful that I'd started to dread each feed. Every time he cried I used to think, 'Oh my goodness, oh no he's going to want to be on me again and it's so painful'.
And was that pain right through the feed?
Oh yes absolutely from the moment he clamped on, I understood that people said, “Oh it might be a little bit painful to start with 'cause they're a bit sore and you haven't breastfed before so, you know, it will go” but it never went within the feed it just was dreadful to be quite honest and I knew then that I've, if I was going to continue I had to seek help.
Okay, and so the midwives showed you lots of different positions? Anything else in the hospital, that may or may not have helped?
My problem was and I know a lot people won't want to acknowledge it, my problem was is that I didn't feel that all the midwives were singing from the same song sheet. A lot of them had different positioning, different theories, different attitudes, and it's very difficult I think then to know which is the right thing to do, what is the best advice to follow to be quite honest.
How did you cope with that, maybe conflicting advice?
When you get lots of different advice sometimes you think, 'Well I'll try them all and then the best one for me I'll stick with', but of course once it's breastfeeding, it's very difficult because you constantly try one idea like a rugby ball position, or trying him under you, trying lying down, and you just think, 'Well this is so confusing, I'm getting confused, he must be getting confused, he's not latching on right' and because of the nature of needing to feed a child they're not happy they need to latch on and it should be the most comforting thing for them and it wasn't like that so, it's very difficult to then know which is the best thing to do. It's very hard.
So you went regularly to the hospital, daily…
Daily sometimes, yeah.
…to get help? What sort of things was that counsellor doing?
She was, the breastfeeding counsellor I went to see at the hospital who
She used nipple shields to help her babies attach to her inverted nipples. They didn't affect her...
Midwives were just not really interested at all, they'd come out for my normal visit and they just kept, said to me, “You've got to keep waking her up, you've got to keep pushing her, poking her”. But that's all well and good I mean trying to wake up a newborn baby, it's pretty hard work [laughs], 'cause they just go straight back to sleep again and that's what she was doing, she was getting so frustrated because she couldn't get on my breast, she was going back to sleep again. So finally a decent midwife came out to me, my actual midwife, when I came home, 'cause I went to my mum's for a few days and she said to me, “You're going to have to go on shields otherwise you're gonna have to give up” but I was devastated when she said I had to give up so I said, “I'll go on the shields”.
The nipple shields?
Yeah, nipple shields. So I went on nipple shields and it worked really, really well, I didn't have any pain yeah it worked really, really well and then I think it was she was about four weeks old and I started getting really hot heavy breasts and I remembered mastitis with my first, so I got in touch, touch with the local group which was Bosom Buddies and got in touch with a lady's name, breastfeeding counsellor, [lactation consultant], she was brilliant, she came out to see me, superb, and she said to me that nipple shields I shouldn't have been put on because they're not good at all, they actually diminish, they take away your milk supply and that I had to get off of them really quickly. So I was like, 'cause once you, unfortunately when you're, you get taught how to breastfeed with nipple shields on you get comfortable and when you have to take them away it's like a security blanket, your security blanket's been taken away, and [lactation consultant] basically said, “You've got to get rid of them, take a weekend and just say throw them in the bin and get rid” and I was like, I did it, I did it within a whole weekend and I was off…
Did you have any other tricks for getting her on an inverted nipple? Putting her on?
No [lactation consultant] said that it was just down to luck, you just have to hope and pray that she'll click, you'll both click together, it's a learning curve she said for both of us. And she was right, a weekend now and I managed to do it, it was really hard, I mean it took ages to and the patience was just.
Can we just explore the nipple shields thing a little more? What effect did they have on your inverted nipples?
They were really good actually they really brought my nipple out, it was superb, I thought because my nipples were really quite out after I had my first, my daughter, when I stopped using the shield my nipples were really out 'cause she, she drew them out, I didn't think I'd have a problem with baby, [2nd son]. But because he just was such a greedy baby he wasn't willing to wait for the milk he wanted it there and then, it, my boob just wasn't good enough for him he wanted to get on and just have it glug, glug, glug, glug. He used to, I mean it, it was really funny because when he latches on, when I had my shield you could hear him going glug, glug, glug, glug, it was really like, I want it there and then so without actually having the shield to get him on, it is really upsetting though because you think it's a problem with you and you can't do anything to fix that problem so it's really upsetting for you because you're just wondering, 'Well why? Surely nature should intervene, you know, and bring your nipple out' but it doesn't work that way unfortunately, so it is frustrating really.
Some women were more confident with their second baby and found attaching easier. However, several women emphasised the necessity of mother and baby learning together, especially with a second child when they had assumed that it would be easy because they already knew what to do. In reality, they had to go back to basics with the new baby. A few women even mentioned being surprised by the after-pains (caused by the contraction of the uterus after birth) when their baby attached.
She thought she would feed her second baby with ease but she had to learn to position her new...
Well this is it you think you know, you think if you've done the breastfeeding before and you just assume you'll pick up where you left off, and so having already breastfed one child I assumed that I would, you know, go to hospital, have a second baby and put the baby straight on and off we'd go. And whilst I was more confident the second time round it still wasn't as easy as I had anticipated I had expected it to be, as I say, I'd expected to feed her instantly and she would latch on, but what I was forgetting in the equation is that whilst I'd breastfed before she hadn't and that, the first time round both mother and child are learning to breastfeed, second time round whilst the mother may have confidence in it the child has never fed before so yeah had to really, then had to do a slight, take a step back and I had to reassess my positioning of her I was, I was holding her in a way that I'd, I would have held an older child to feed and actually what the health, the health visitor came round and said, 'No what you need to do is remember she's a smaller child I guess, smaller baby you need to lift her right up onto, and give her more assistance in feeding, you need to position her rather than her find the position' so yeah so that was something that slightly took, not, it was a lot easier feeding the second time round, but as I say, I hadn't expected to have that, just initial hitch where it's like, 'Oh ok'.
How long did it take you to get it right?
Probably three or four days to really, you know, get back into finding the right position and really getting her, held in closer and, it was getting used to, lifting the rest of her body I would say is the main thing and just getting her for the whole, the whole of her raised up. And then once obviously you've done it a few times you then, find a position that's natural to you and the health visitor had suggested trying different positions, maybe trying the, as she called it, 'The rugby ball' position sort of under, which I tried for a little while I, it didn't really work for me I know it works for some people, so I then changed it back again [laughs].
An important method of learning to hold the baby appropriately was observing other women breastfeeding.
She developed sore nipples from not having her baby correctly positioned. She learned by...
I am not sure, at first I am, I try to like the, may be I try to hold him, may be I don't hold him properly and I have a problem and I try to like the position to him because at first I use his hand to, not like in the back of me, right, may be like a hug me, or something like that.
You think his hands were getting in the way?
Yes I think it is a problem, or something like that, I don't know, like the properly how to hold him, after that, I see, I have to go one and a half month I go to like the vaccination, about BCG vaccination at the hospital, I observe.
Just keep talking.
Yes, I observe to the, I observe to another pregnant woman and I see she hug and she hold the baby in her hand, how she hold or something like that, and I try to hold him like her and I think it is good for me and everything maybe is going on is better.
So when you saw the other women feeding and you copied them?
You found it easier?
Yes, I think it is easier to like that hold him and like the to suck and like everything I think is good for me to observe and copy, copy her and something like that and after that it is good if I go to the like exercise class after delivery, everybody in the class breastfeeding, like one in ten have a bottle and I see everything is normal like normal, like the breastfeeding I see and observe every time I go, and I try to breastfeed like her, I think is okay, yes.
So was your baby latching on to the breast, could you feel him getting the milk?
Yes I, because I try to like the, get on the milk but I think, it not comfortable for when he suck and sometime I think it very hurt.
You were sore?
Yes, I have a problem with the nipple sore and some people, some friends go to my house and she tell me about the, like the nipple shield, or something like that, but I didn't use it, but I think it like plastic, it not normal, I think it a problem if I use it.
So what did you do for your sore nipples?
I'm change another more than side of nipple is sore, right, but I try to going on in breastfeeding.
So you kept on feeding even though your nipples were sore?
Were they sore right through the feed or just at the beginning when your baby latched on?
In the beginning, in like the two or three weeks after the delivery may be in third week after delivery have a sore.
And when you got your positioning correct and when you were putting the baby in the, to the breast in the correct position did that soreness go away?
Yes of course because everything, going on is better, and I think sore is going away and my son can like the wider open the mouth wider and keep it because my breast have a problem because I have like the brown area like wider, if you compare with another person and I have a small nipple, short nipple, yes short nipple.
And you think that was what was causing the problems with your babies?
Yes, because I should to like the position because I know the proper way to suck
She always took her daughter off and repositioned her if breastfeeding hurt. She wished she had...
And she did?
She did yeah, I never, I never had sore nipples because I never put up with her latching on wrongly, I used to take her straight off the minute it hurt, the minute it was uncomfortable I used to take her straight off and put on again, and so she's never really experienced what it's like to try and get milk out of a breast because she's latched on wrongly.
Was there a trick to taking her off?
Yeah I find if you lick your finger so it's wet and just slide it in, in your nipple, like just down the side of your breast, it breaks the suction, it's amazing how strongly they suck, if she misses the nipple completely she get, I get a love bite on my boob.
And it's really painful it's almost like a little hot burn on your skin and you just, it's, I was so surprised by how strong the suction was. I think things, if I'd have known what I know now then, I'd have had a really good nose, I'd have tried to find someone who was breastfeeding, and really looked closely at the baby and looked around their breast and looked underneath to see the baby's lip. And quite a new baby so, 'cause they, they tend to latch on differently to an older baby, like Grace will, has her own way of sucking now and it's, it's bigger and so it's less squashed up whereas a newborn baby does look a bit squashed sometimes as they latch on. So I think I would have tried to find someone and they do have, at our Breast Mates group the new mums are happy to let, like expectant mums have a good nose and I think, I would have asked someone to do that, to just have a look at what a normal latched on feeding would look like.
And what would a normal latched on feeding look like?
Well, their ears wiggle, and the bottom lip curls under and you can just about see it but not, it looks different to how you describe a bottom lip curled under, and, they just, the look like they're big long feeding strokes but also it doesn't hurt and that's the main thing, I think if it's hurting there's something wrong and there's so much help out there. If, I know people that don't come under the Sure Start programme that I go to that feeds my breast, that funds my breastfeeding support group. La Leche League's really good and I go there every now and again just to meet other mums but I don't use that as a support as much because I've got my weekly support, but they have people on the phone there if
*Footnote: Current research shows that the use of modern, thin, flexible, silicone nipple shields can be temporarily helpful for babies with attachment problems, mothers with inverted nipples or premature babies in the transition to full breastfeeding. However, their use is controversial.
Last updated November 2011