This is a fantastic mini-library of resources covering basic positioning and attachment articles, animations and videos. This helpful information is helpful for mums and those helping breastfeeding families. Thanks La Leche League of Broad Ripple, Indianapolis :) This is Jack Newman on latching. I think the explanations are a bit over whelming at times, over-complicating the process, but the graphics are extremely helpful and illustrate an asymmetrical latch, a really good thing to try if you or your baby are having trouble.
This is a very good animation of a baby being positioned at the breast to ensure an effective latch:
Biological Nurturing is a fantastically simple way of relaxing with your baby while feeding them, and a surprisingly successful way of encouraging a baby to latch who hasn't previously.
Lots of women find the few hours and days post labour to be a complete shock. Many have no idea that the changes that take place in that transition between baby in and baby out will affect them so profoundly: from being so sore that even thinking about going for a wee will make you cry, to being so exhausted that the thought of sitting up to breastfeed your baby is simply out of the question, to experiencing the hormonal fallout so acutely that even dropping your toothbrush down the loo accidentally will make you weep uncontrollably for ten minutes until someone comes to your rescue. On the plus side, some things can improve immediately your baby is out, like indigestion, nausea or a random aversion to cups of tea.
So, to the breastfeeding bit. Lots of babies, if given the chance, and if not suffering from the effects of maternal pain relief from the labour or any other mitigating factor, will actually crawl up their mother's tummy and latch on themselves. It is the way nature intended things to go yet like many things in today's modern world, sometimes we try to rush it. So if and when you are exhausted, it is perfectly possible to simply lie back and let your baby do the rest. Like this lady. Your baby is very likely to latch on within an hour, maybe 90 minutes. But there is no hurry - allow your baby time to find your nipple, and take the time to inspect and get to know your baby.
Your midwife or obstetrician should know about this way of getting a baby to latch. If they don't, which is depressingly common, feel free to speak up. Saying words like 'Unicef' and 'Birth Crawl' and 'Baby-friendly Initiative' can help. This should get them to support your choice of strategy. And it is Your Choice - you are not a patient when you have given birth - you are a mother with her baby, and providing there is no medical emergency of any sort, your health care providers should abide by whatever you say. Even when there is a medical issue, they should still inform you of all the facts and information you need to make an informed decision. It can be a good idea to brief your birth partner too so that he or she can do a good job of insisting on what you want, or helping you insist, particularly if you are shattered. You can go into the hospital with definite intentions and information about what it might be like. These mums have been through it and have some great tips. It doesn't matter what type of birth you have had, most women are able to lie back and take the weight of the baby on their chest.
If your baby latches at this time, great. If not, don't panic, he or she might just need to sleep a while and is likely to wake up and want to feed later particularly if kept skin to skin next to mum's chest or tummy. When your baby does wake up, again, lie back, try and relax and let your baby do what nature intended. If your baby still does not latch on, it does not mean they never will. It might be that they are groggy from the medication, or they may be unable to latch properly due to a physical issue such as tongue tie. Some women have found expressing some of their colostrum onto your finger and giving it to their baby to suck a good way to get them interested in feeding. Reading this article by world breastfeeding expert, Jack Newman, before the birth will help you be confident that you know what to do should your baby decide that latching on is for losers. He has some great practical tips.
It is important to say at this stage that when your baby is first born, their tummy is about the size of a small marble and doesn't need much to fill it. The small quantities of colostrum in your breasts are perfect for your baby and breastfeeding your baby while there isn't gallons of milk there is a great way for him to practice coordinating the sucking, breathing and swallowing.
The chin is pretty important in latching your baby on. Getting the chin to the breast first will help the baby get a good mouthful of breast, with more of breast in her mouth on the chin side than on the top lip side. You can often see more areola (the pinky brown bit surrounding the actual nipple) by the baby's top lip than by her chin as the nipple by her chin should be in her mouth as this is how she can compress the milk sinuses and get lots of milk.
A baby can feed for a short time with a good latch and good drinking, and be happy for a few hours before she needs more. If your baby is spending hours at the breast, it might be worth working on the latch to help the baby get more milk in a shorter amount of time so you can both take a break!
This Jack Newman video is quite a good demonstration of what I am talking about.
This is arguably one of the most important aspects of establishing breastfeeding. If your baby is latched on well all (or at least most - it can be hard at first!) of the time, breastfeeding is unlikely to be painful for you and it will be satisfying for her as she will be able to get milk easily - and along with connection with mum, this is what every tiny baby wants: milk. A 'good latch' will also keep your supply going effectively.
It appears that the best way to latch your baby on initially is by using the birth crawl or 'biological nurturing' approach in the hour or two after birth. (See Basics - The First Days for a link to the birth crawl video). After that it is up to you whether you wish to continue with the biological nurturing style of latching on (See Useful Information for a link to a biological nurturing explanation) or you wish to pursue other ways of latching your baby on so you can breastfeed any time, anywhere, as comfortably as possible.
The cradle hold is the most commonly taught way of latching your baby on. Not always the most comfortable incidentally - it can tire your shoulders, until later when perhaps you are stronger - but useful if you wish to enjoy breastfeeding while out, or discreetly with other people around. For the cradle hold position, start off by getting as comfortable as possible yourself. Some people find having cushions behind your back and under your arms can support you and take the weight of your baby, particularly early on when you are recovering from the birth and later when you are just plain exhausted! Some people find it useful to have a cushion on your lap to support your baby's weight and a few books on the floor to put your feet on so your legs are also supporting the weight of the baby. Whatever position works so that you are not straining to hold a position in order to feed your baby - you might be there some time! It can be a good idea to hold the baby firmly and confidently at the base of the skull or back of the shoulders so that you are supporting the weight of her head. You can hold her like this so that she feels comforted and reassured by your touch.
At this point, touching your nipple to her top lip may make her open her mouth wide and lift her head up to come up and over the top of the nipple, so that there is more of the whole nipple in the bottom gum side of her mouth and her top jaw has just gone sort of up and over - you will probably be able to see more areola this side. Don't be afraid to hold her head and shoulders slightly away from your breast for a little bit while keeping the rest of her close to you with your elbow. This is all part of the process of her learning that getting a good mouthful of breast enables her to transfer milk effectively which in turn prevents you suffering any nipple trauma. It may be worth making her wait to enable this learning to take place. Anyway, once she has her mouth wide open, quickly bring her to the breast, chin first so that she can get her gums underneath the milk sinuses (just behind your nipple - these will squirt milk into her mouth if she compresses them effectively). Her top lip will then come up and over the nipple to compress the other side of the milk sinuses. You want to aim for an asymmetrical latch - her bottom lip and gum should cover more of the nipple than her top one - most of the areola on the side where her top lip is will probably be visible and her chin should be massaging the breast as she sucks. Once a baby is latched on effectively, they will often start with quite fast sucking with a few swallows, depending on how much milk has collected in the milk ducts (like the pipes in your breast that channel the milk down to the nipple and out), and then progress to larger gulps as the milk is let down from deeper inside the breast. He or she will probably 'finish' that side with lots of sucks and the odd swallow as the milk flow slows. A very young baby, and some older ones!, will fall asleep at this point, which is when it is a good time (although not imperative) to change sides and start the whole process again. Sometimes a baby wants the second side, sometimes they are quite satisfied with one side. It is a good idea to be led by your baby.Having said all of that, like most things where breastfeeding is concerned if your baby appears to be doing none of these things, or didn't like one of these methods or techniques for latching a baby on to the breast, but is thriving on your milk, that is really all that matters.
Skin to skin in the first hour or two after birth is crucial to the success of breastfeeding. Many babies fall asleep exhausted after this time and then it can be difficult to get the breastfeeding relationship going. Not impossible, but more difficult. If the baby feeds well in the first hour or two, they will likely get a good dose of colostrum, the high protein orangeade - colour stuff that you may or may not have seen escaping while you were pregnant! This is packed full of antibodies and is a mild laxative to help your baby clear its bowels of meconium.
This first feed will get the whole thing going as it were, encouraging your milk production and giving the baby the comfort it is searching for when it comes out of its nice warm safe home where it has spent the last nine months. It is a good idea not to limit the baby's time at the breast at this stage. Dress that baby in a nappy, cover you both with a soft blanket, and allow the baby to relax and suckle and practice. It also allows you to practice breastfeeding and get to know your baby. It is, for some women, one of the most incredible bonding moments. For others, a relief that they are safe and sound and feeding well. And for others a tired blur!
If you are seperated from your baby directly after the labour you can have skin to skin with your baby at any time. Even when you are home, it can help with a baby having trouble latching on. It encourages the right hormones and is incredibly comforting to your baby to be safe and warm next to mum. With an ear on your chest, your baby will be able to hear your heartbeat, a sound that has been present in its life since it could hear!
At this stage, I should mention the cleverness of your breasts. They are actually able to fluctuate their temperature by two degrees either way to heat your baby up or cool it down depending on what is needed! How amazing is that! And if you have twins - one on each breast - each breast will fluctuate in temperature independently according to what the baby needs - GASP!
How many times have you had your baby's latch checked and it's been decided its fine? Often the first thing midwives do in hospital is to help latch the baby on, check it and pronounce it a good latch or otherwise. However, countless women online write posts to say that they have had the latch checked many many times and been told it is fine. But there might be problems present: the mother has sore nipples, or even cracks, the baby is slow to gain weight, and perhaps wants to feed every hour, for an hour, 24 hours a day! Or sometimes the baby falls asleep soon after feeding and then as soon as it is moved wakes up and wants to feed again! In many of these cases, the baby is not latched on properly at all, probably gets tired from all the inefficient suckling so sleeps to conserve energy, and wants to feed all the time to get the milk it needs.
So what can you do to make sure your baby is drinking well from the breast? The first thing is to watch your baby, not the clock. Sure, you want your baby to get a good bellyfull in a relatively short time so they can fall asleep in that milk drunk way and use all that milk to grow and develop, but using the clock, rather than your baby, as a measurement of whether he or she is drinking well is just not going to give you an accurate assessment. In this culture, we are often scared of spoiling the baby, or allowing the baby to use the breast 'like a dummy' - a dummy is a fake breast - not the other way around! So we try to limit the time at the breast, whereas women from other cultures, unconstrained by modern life perhaps, wouldn't think of limiting a young baby's time at the breast.
Anyway, I digress. Your baby still needs to be able to drink well, regardless of whether he or she hangs around after the main course for a long and luxurious five course dinner. So how to know your baby is drinking well. Look for the pause. When the baby is latched on, and sucking and swallowing, if your baby is drinking lots of milk, there will likely be a pause when the baby's mouth opens to its widest. This is when the baby's mouth fills with milk. Then they close their mouth and swallow. This video by my favourite breastfeeding oracle, Jack Newman, demonstrates it better than I can probably explain it.