Techniques Beyond the Basic Four Holds
By Becky Lane
Whether you have already had a baby or are anxiously awaiting your firstborn, if you are breastfeeding or plan on doing so, you’ve probably heard of the standard breastfeeding positions: the cradle hold, the cross cradle hold, the football hold, the side-lying position. But there’s a few more breastfeeding positions you might not have heard about, and these can be just as effective, if not more so, than the standard four.
The Prone Position
The Australian hold, the instinctive hold, the skin-to-skin position, the self-attachment position, uphill feeding, posture feeding – these are all terms that refer to one basic kind of nursing style – a prone position where Mom lies flat or nearly flat on her back (on a couch, on a bed, in a reclining chair) with Baby lying flat on his tummy on top of Mom. This position allows Baby to self-attach easily at the breast.
Sherri Garber Mendelson, an international board certified lactation consultant (IBCLC) with Providence Holy Cross Medical Center, Mission Hills, Calif., says she and her colleagues recommend this breastfeeding position extensively, especially for healthy newborns. “I like the face-down position because the baby seems to latch more effectively in the early days and empty the breasts better,” Garber Mendelson says.
There are several variations on this nursing style. Mom can position Baby parallel to her body, with the baby’s feet facing the same direction as hers, or perpendicular to her body, with Baby’s body lying across Mom’s chest. Some sources even suggest positioning Baby over the shoulder, with his feet lying by Mom’s head, his body supported by a pillow.
“Mom can lean back to help her baby handle milk flow in almost any position,” says Catherine Watson Genna, an IBCLC in private practice in New York City.
If you’re worried about your baby being able to breathe while lying face-down on top of you, don’t be. “Being prone is fine, as long as Baby is lying on Mom and no one is holding his head down,” Watson Genna says. “Babies have very good antigravity reflexes. When they are lying on their bellies on Mom, they can lift up their heads well. This is part of their normal ‘getting on the breast themselves’ behaviors.”
Garber Mendelson says that she, too, has never had any problems with her clients using this position with their babies.
Who It’s Good For: Handling milk flow is one benefit of the prone breastfeeding position, which makes it a good choice for moms with an overactive letdown, says Bonnie Henson, IBCLC, clinical operations manager of lactation support services for Miller Children’s Hospital in Long Beach, Calif. (How do you know if you have an overactive letdown? Read the sidebar at the end of this article for more information.) By using the force of gravity, Moms can slow the flow of milk into their baby’s mouth, especially during letdown, which lessens the chance of Baby choking or pulling off the breast.
You can use this prone position with any age baby, but Garber Mendelson says it is particularly useful for moms of immediate newborns.
Henson agrees. “Moms are usually reclined [after birth] and Baby is placed skin to skin with Mother and the baby instinctively moves to Mother’s breast and begins suckling,” she says.
“I have also used this reclined position for infants who keep their tongue pulled up and far back in their mouth,” Henson says. “In this reclined position it is almost impossible to keep your tongue back in the mouth.”
Who It’s Not Good For: Garber Mendelson says she would not recommend this position for some infants with physical limitations. “Infants with conditions such as torticollis (tight neck muscles) or shoulder/arm birth injuries might not do well with this position,” she says.
The Straddle Position
The straddle position (also referred to by some as an alternate form of the Australian hold) consists of Mom in a sitting position with Baby facing Mom, straddling the leg on the same side as the nursing breast.
“Your baby is held vertically and straddles your thigh, facing you,” Garber Mendelson says. “Your knee supports your baby on his or her bottom, while one hand is low on the baby’s head to give control as you bring your baby to the breast to latch. It may work best to have your baby sitting slightly ‘side-saddle.’ The other hand (on the same side as the breast being used) supports the breast to help the baby form a good, deep latch on the areola.”
Henson suggests using pillows under your infant if he is not tall enough to reach the breast.
Who It’s Good For: Watson Genna says she recommends this position sometimes if a baby has a very small lower jaw. “Mom can lean back and Baby can get his chin closer to the breast sometimes,” she says.
She also says this position can work well for babies with torticollis. “If a baby has a neck condition called torticollis (a shortened muscle on one side of the neck that causes the baby to turn his head mostly to one side), Mom can sometimes straddle the baby on one leg and feed from the opposite breast so he can keep his head turned to his favorite side,” she says. “Of course help from a physical therapist is very important to help the baby regain full use of the neck muscles as quickly as possible.”
Henson says this is another good position for moms with an overactive letdown or forceful milk ejection. “Because Baby is sitting up, gravity helps the milk find its way down Baby’s throat,” she says. “Also because Baby’s mouth is level with your breast, the milk does not come gushing down as quickly. The baby will have to work to pull milk from the breast.”
Who It’s Not Good For: “A baby that I would not recommend the sitting position [for] would be a baby that has very low muscle tone, as these babies need a great deal of support,” Henson says.
Why Haven’t I Heard of These Positions Before?
If you’re scratching your head wondering why you’ve never heard of these breastfeeding positions before, you’re not alone. None of the breastfeeding mothers I know had ever heard of them either.
However, “The reclined position is becoming more popular as we begin as a country to encourage skin-to-skin contact in the early days of the infant’s life,” Henson says.
My second child was 4 weeks old when I discovered the prone position. My lactation consultant introduced me to this hold when I had problems feeding my child due to an overactive letdown. It literally saved our nursing relationship. As soon as I tried it, we had no more issues, and it felt like the most natural position in the world. I wondered why I had been struggling all those weeks to fit my nursing style into one of the other more well-known positions.
Watson Genna says that a breastfeeding mother shouldn’t be concerned with following textbook breastfeeding positions. She should do what feels right for her and her baby. “Most mothers and babies don’t need any special positions at all,” she says. “If Mom leans back and snuggles Baby to her body, the baby can do the rest and find the breast.”
Garber Mendelson agrees. “The most important concept here is that the mother should feel empowered to try positions that feel comfortable to her and lead to successful breastfeeding for her baby,” she says. “In my experience, most women help their baby into positions that are hybrids of multiple positions.”
Signs of Overactive Letdown
If you’re having problems getting your newborn to nurse well after he’s latched on, you might have an overactive letdown. How can you tell? IBCLCs Sherri Garber Mendelson and Bonnie Henson provide the following lists of signs and symptoms:
Baby’s Symptoms (may have one or more):
- Arches away from breast soon after letdown or pulls off frequently during feeding.
- Appears to choke with letdown of milk.
- Nurses minimally or not at all on second breast.
- Develops colic. “The symptoms appear to be related to the baby getting too much milk too fast and the high concentration of lactose (milk sugar) in foremilk,” Henson says.
- Gains weight quickly (1-2 pounds a week), or is over birth weight at 2 weeks.
- Spits up frequently (often appears to be large amounts).
- Burps “like an adult” or passes a large amount of gas.
- Tentative diagnosis of gastric reflux.
- Grunts frequently between feedings.
- Abdomen appears full and distended especially after feedings.
- Wants to suck hands or pacifier frequently after feedings.
- Has a stuffy nose after feedings.
- Early or frequent ear infections.
- Has many (10-15) wet diapers per day.
- Crushes nipple during feeding.
Mother’s Symptoms (may have one or more):
- Milk squirts out of breast even after Baby disengages soon after letdown.
- Persistent sore nipples, often with a linear crack across the nipple face.
- Nipple comes out of Baby’s mouth pinched, not round.
- May feel that you have too much milk.
- May feel that you do not have enough milk because Baby appears to be “always hungry, not satisfied.”
- May have pain deep in the breast between feedings.
- Painful letdowns that sting or burn.
- History of repeated plugged ducts and/or mastitis (breast infection).
According to the article “Overactive Let-Down: Consequences and Treatments” by Mary Jozwiak on La Leche League International’s Web site (http://www.llli.org/), several methods can be effective in handling overactive letdown:
- Try one of the breastfeeding positions mentioned in this article.
- Gently take Baby off the breast during letdown and catch the forceful spray of milk in a clean cloth; then put Baby back on the breast to finish nursing after letdown has occurred.
- Have Baby nurse only on one breast at each feeding (or for every feeding in a two- to four-hour period for extreme cases). This allows the baby to get more of the thick, rich hindmilk with each feeding.
If you still experience problems nursing, seek advice from your doctor or an experienced lactation consultant.
