Some babies take to the breast first time. Others don’t.

If you have been using nipple shields (which are often advised for nipple soreness and engorgement when correct positioning might be useful, but takes longer), your baby has had bottles or simply does not know how to feed instinctively straight away, you may find yourself with the task of teaching your baby to latch on properly. This seems to be a rather rare expertise and not necessarily known by those who might be expected to have the knowledge. Many mothers who have contacted me have been told by midwives that their babies are latched on properly only to find that the pain they have been experiencing continues. If it hurts there is something wrong.

Suckling involves two actions on the part of the baby:

suction with lips and tongue to hold the nipple and areola in its mouth in the correct position

and milking the breast with the tongue and lower jaw to obtain the milk from the ducts where it is stored.

The breast has to be well into the baby’s mouth for the jaw to work and draw out the milk. If the nipple only is taken - which the mother may expect if she has only seen bottle feeding - it will hurt and the baby will not be satisfied. The breast has to be stimulated correctly for the milk to flow, otherwise it would come out when you didn’t want it to...

To begin with the baby needs to be held horizontally, body in line with the head thereby supporting the back of the neck, facing and close to the mother’s body, usually resting along the forearm. The back of the head must not be touched and left free to move so the baby knows it can breathe. Some mothers are told to push the baby onto the breast. This can end up with a distraught baby who wants to feed but is afraid that he won’t be able to breathe.

He needs to be held very close with the nipple pointing to the roof of his mouth, apparently pointing up his nose. Then he can take in the breast with a tip tilt head motion which is characteristic of latching onto the breast with a greater part of the lower breast being taken into the baby’s mouth.

As he opens his mouth, pull him swiftly slightly (about an inch) towards you so he gets the breast fully into his mouth. Sometimes mothers are taught to hold the breast in a ‘scissor’ hold (first and second finger each side of the areola) to enable the baby to take the breast when it is tiny, or to support the breast or to enable the baby to breathe. Occasionally it is useful to assist the baby to latch on by lifting the breast up slightly from underneath. Consistent manipulation of the breast can cause blocked ducts and is unnecessary. The baby’s nose is designed so that he can breathe even with his face apparently buried in the breast as he feeds - little air gaps exist around the sides of his snub nose - and as long as he is able to freely move his head back, he will pull away to breathe when he needs to. Some mothers are quite upset when they tell me how they have been manhandled by midwives anxious to get the baby latched on. The trick is to wait and keep offering, making sure that he can reach, he will latch on in his own good time.

The changes in position that I suggest most frequently are

(i) Moving the baby across the mother’s body (from elbow towards centre) while in the crook of her arm and

(ii) Pulling the baby closer tucking his body right in close to hers.

For all of this to work and the baby to have a lengthy and satisfying feed can take some time - time that midwives are often not allocated and why I feel that breastfeeding counsellors would be a useful resource within the maternity services.

Many nipples appear flat and if the breast is full the newborn may have difficulty latching on. New babies have such tiny mouths. A glass of iced water held onto the skin at the side of the breast can sometimes cause the skin to feel harder with the cold and enable the baby to latch on. You have to be quick while the effect lasts. Expressing a small amount of milk to soften the breast can also help. Once the breasts have softened after the initial rush of milk and extra blood supply there is usually not so much difficulty in latching on. Babies grow so quickly that the size of their mouth changes and they find the breast easier to grasp. It takes practice. Mothers feel pressurized to get it right quickly or give formula. The determined ones try again once they get home and often this is the time that I come into contact with them.

Many more would be breastfeeding if this help were available sooner. Mothers I speak to say that they just wish someone had said: “It might take an hour and a half” like I did and at least they would know what they had to do. I believe it takes a young baby about 100 times to learn something new, so each attempt brings you closer to getting your baby latched on. He also gets tired during the process so it quite usual for the baby to have little cat naps during the time you are getting him to latch on properly. Falling asleep at the breast is often seen as a problem, but it is normal, and the baby will either keep nursing gently in its sleep - which is fine - or wake and try again shortly. All the time spent at the breast stimulates supply and every suck by the baby produces milk; towards the end of the feed this is the richest milk producing the most growth and orders the milk supply increase for tomorrow. Remember the only way that the breast knows that more milk needs to be made is by the baby asking for more than it had today.

When you are being supported during this period, make sure common sense prevails. Your baby is not going to starve in the time it takes to learn to feed from the breast and cries of “But he’s hungry ” do not help you to successfully learn to breastfeed and suggest that breastmilk is not as satisfying for your baby as formula, which is not true.

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