The Lactation Consult: Problem Solving, Teaching, and Support for the Breastfeeding Family

Maureen Hoag Dann; CPNP,IBCLC

Disclosures

J Pediatr Health Care. 2005;19(1):12-16. 

In This Article

Helping the Mother and Newborn Achieve a Good Latch

Many articles have been written and lectures given regarding the FIGURE 1.The football hold.Reprinted with permission from Spangler A.Amy Spangler's breast feeding:A parent's guide, 5th ed.AbbyDrue, Inc., 1992. best latch on technique. Undoubtedly there are merits in many techniques and drawbacks to some for individual mothers. The recommendations below are meant to provide a simple yet tried and true approach that is successful for many mothers.Remember, if the baby is swallowing milk and the mother is breast feeding comfortably, you have accomplished your goal.

The Football Hold. Reprinted with permission from Spangler A. Amy Spangler's breast feeding: A parent's guide , 5th ed. Abby Drue, Inc., 1992.

The football hold and modified cradle hold often are easiest for the struggling mother or baby. Below are descriptions of these holds. To avoid confusion, the feminine gender will refer to the mother; the male gender will refer to the infant. You may need to practice with a doll and memorize the basic steps to each technique before attempting to help a mother.

The football hold is often best for the mother and infant experiencing difficulty achieving an effective latch on. This position allows the mother to support both her infant's head and her breast simultaneously. It is easier for her to visualize the latch on process. The sleepy or disinterested infant may be more alert in this position. The football hold is often more comfortable for mothers who had a Cesarean section.

Assist the mother with the football hold as follows:

  1. Provide a comfortable armchair with pillows or a nursing pillow. Tuck the infant into a "V" position at his mother's side with his legs parallel to her back (see Figure 1).

  2. The infant's head should rest in the palm of his mother's hand. The infant's head rests in his mother's right hand when nursing at the right breast; his head rests in her left hand when feeding at the left breast. The mother's forearm supports her infant's neck and back.

  3. Have the mother support her breast with her free hand. See "The Moment of Latch On" below.

  4. Use multiple pillows if necessary to support the mother's hand and arm. The mother may remove the hand supporting her breast as long as she remains comfortable.

The modified cradle hold position works well when the mother prefers the cradle hold but has difficulty controlling the infant's head or supporting her breast for latch on. Women with larger breasts as well as those with shorter arms may feel more comfortable with a modified cradle hold.

  1. Position the infant on his side, stomach to stomach with his mother. The baby should be resting against the mother's upper abdomen, not lying low near her lap. Use a nursing pillow or multiple smaller pillows for comfort and support.

  2. If nursing at her right breast, have the mother support her infant by placing his head in the palm of her left hand. Her left forearm should support the baby's back and maintain the stomach to stomach position (see Figure 2).

  3. When nursing on her right breast, have the mother use herright hand to support her breast. Have her support her left breast with her left hand when feeding on the left breast. See "The Moment of Latch On" section that follows.

  4. Once the infant has latched on, the mother may remove the hand supporting her breast if she remains comfortable.

The Modified Cradle Hold. Reprinted with permission from Spangler A. Amy Spangler's breast feeding: A parent's guide , 5th ed. Abby Drue, Inc., 1992.

No matter how "perfect" the mother's positioning for breast feeding, the infant primarily is responsible for a good latch and effective nursing. The mother can be a critical facilitator by making the nipple and areola easily available to the infant, but in the end only the baby can latch and Breast feeding.

You may help the mother to facilitate a good latch by following these suggestions:

  1. Have the mother support her breast using a "C" hold. Be certain that her thumb and fingers are positioned well behind her areola (see Figure 3).

  2. The mother can lightly touch the tip of her nipple to the center of her infant's mouth. Have her squeeze a drop of milk onto the nipple tip if possible. It is best to avoid over stimulating the infant's mouth and to "invite" the infant to latch on.

  3. Wait until the infant opens yawn wide. His tongue should be down on the floor of his mouth. Note his lingual frenulum and see if the infant can extend the tip of his tongue past his lower lip. The tongue must be able to curl around the bottom of the areola in order to suck effectively and avoid pain for the mother.

  4. Point the nipple tip straight toward the back of the infant's throat (see Figure 4). Mothers often aim their nipple up so they can SEE the infant latch on around the nipple. Injured nipple tips occur when the roof of the infant's mouth bangs on the upturned nipple during feeding. Red, abraded, or scabbed nipple tips may suggest this problem.

  5. Confirm that the infant's lips are rolled out so that a thin lip line is visible around the entire areola at latch on. Sucking is less effective as well as painful when either lip is rolled inward.

The "C" Hold. Reprinted with permission from Spangler A. Amy Spangler's breast feeding: A parent's guide , 5th ed. Abby Drue, Inc., 1992.

The Latch On. Reprinted with permission from Spangler A. Amy Spangler's breast feeding: A parent's guide , 5th ed. Abby Drue, Inc., 1992.

Listen to confirm audible swallowing and ask the mother if she has any breast pain. Initial latch on pain should resolve quickly when the latch is correct. Even when a mother has visible damage to her nipples, latch on pain should ease significantly when the positioning and latch are correct.

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