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Breastfeeding: Helping Your Baby Attach Correctly

A baby is born with several reflex actions that help him learn to breastfeed. For example, an infant will automatically turn his head toward a stimulus that brushes against his cheek, a reaction known as the rooting reflex. He will open his mouth wide and put his tongue down and forward when the lips are touched. When a nipple touches the roof of the baby's mouth, it triggers rhythmical cycles of sucking in which the tongue compresses the nipple and areola. Despite all these built-in reflex actions, you should not expect your baby to latch on correctly to your nipple without some extra help on your part. Many mothers admit that they aren't sure how to breastfeed and that they were hoping the baby would know! They hold the baby in the vicinity of the breast and expect the infant to take over from there. You can be a great help to your baby by performing a few simple maneuvers.

Once you are positioned comfortably with your breast supported, and your baby is well supported and positioned with her mouth aligned with your breast, you are finally ready to help your baby latch on. Your baby's hands should be out of the way and her body pulled close to you so the breast is within easy reach. You don't want the breast pulling away from her as she tries to nurse.

Lightly touch your nipple against the midpoint of your baby's lower lip to stimulate her to open her mouth WIDE. Many women make the mistake of trying to push their nipple into their baby's mouth, just like we do with bottle-feeding. Instead of trying to insert your nipple, concentrate on bringing your baby to your breast. Lightly tickle her lip, and patiently wait until she opens very wide. Then quickly pull her toward you so she grasps your breast. A common error at this step is to attempt to latch a baby on when her mouth is not open wide enough. Usually this problem occurs because a mother is so anxious to get her baby attached that she doesn't take the time to keep tickling her baby's lower lip until she opens really wide, like a yawn. A baby who grasps the nipple without opening wide will end up grasping only the tip. Correct latch-on involves taking the entire nipple plus about one to one and a half inches of surrounding areola and breast. She must grasp sufficient areola and breast to allow her jaws to be positioned over the location of the dilated milk ducts. Since the size of the areola can vary tremendously from woman to woman, a baby may need to take it all into her mouth (if the areola is small) or may leave a margin visible beyond her lips (if the areola is large). What's important is that the baby takes the entire nipple and a large mouthful of breast. This will assure that the nipple is far back in the baby's mouth so that it won't experience any friction or pressure and, thus, won't get sore.

Latch-on can be made easier for some babies if the mother uses a C-hold and then gently compresses her fingers and thumb to make the areola more narrow. The fingers and thumb should be aligned with the baby's mouth by positioning them parallel to the infant's jaws before squeezing them together. The result is a more narrow and more protuberant areola area that may be easier for the infant to grasp properly.

When your baby is attached correctly, her jaws should be open wide, her lips flanged out, her nose resting against the upper breast, and her chin pressed against the underside of the breast. You should feel her jaws compressing the breast at a point well past the nipple. Her sucking should not be uncomfortable. The tip of her tongue might be visible between her lower lip and the breast as it lies over the lower gum. Even with her nose touching the breast, your baby can breathe comfortably because her nostrils are flared. If you attempt to press your breast away from your baby's nose, this can change the angle of the nipple in your baby's mouth, creating friction and soreness. If her breathing seems obstructed by your breast, try pulling her lower body closer to you.

Signs of Proper Technique
You can assume your baby is latched on correctly if you observe the following:

• Her mouth is open wide and her lips are flanged out.
• She has taken a good amount of the areola into her mouth.
• She sucks deeply and rhythmically, with several sucking bursts separated by pauses.
• You hear your baby swallow regularly (a soft "kaa, kaa, kaa" sound when the baby exhales).
• Your nipple is comfortable after the first few sucks.
• Her cheeks don't sink inward, and you don't hear any clicking sounds as she nurses.

Signs of Incorrect Technique
You should suspect that your baby is not attached to the breast properly if any of the following are present:

• She is grasping just your nipple and no surrounding areola.
• The baby's chin and nose are away from the breast.
• Her lips are curled in.
• She keeps falling off.
• She doesn't suck deeply and regularly (a rapid, light, sucking action-flutter sucking-is wrong).
• You seldom hear swallowing.
• Her cheeks are tugging inward or you hear clicking noises.

You also should assume that the latch-on is incorrect if you experience significant pain while nursing. Brief, slight nipple discomfort often is present during the first few sucks for the first couple of days, but thereafter breastfeeding should be comfortable. Significant pain usually means the baby is not grasping the surrounding areola properly. If she isn't latched on correctly, don't continue the feeding. Instead, remove her, correct your positioning, and latch her on all over again.

Removing Your Baby from the Breast
When a baby has fed well and is satisfied, he usually will stop sucking and come off the breast on his own. Do not attempt to remove your nursing baby from the breast by pulling him off. Breaking suction in this way is likely to cause trauma to your nipple and result in soreness. Instead, slide your finger into your baby's mouth and press down on the breast to break suction in order to remove your nipple.

When Breastfeeding Becomes Second Nature
All these details you're trying to learn make breastfeeding sound like a lot of fuss and bother. You might wonder if breastfeeding is going to be terribly restrictive, since it seems so very complicated. But remember, when you are busy learning the basics, everything seems painstaking and awkward. Before long, however, you'll be nursing without thinking about the fundamentals at all. A toddler learning to walk has to concentrate on every step. In a matter of weeks, the child becomes more surefooted, and before long, walking is second nature. Breastfeeding is like that. You and your baby have so much to learn in the first days that you wonder if you will ever go through the motions automatically. Before your baby is a month old, I predict you'll be breastfeeding while performing all kinds of activities: reading, talking on the phone, eating your lunch, comforting an older child, watching a soccer game, sitting at your computer terminal, or putting the dog out.