Positioning and attachment (latching on)

Positioning and attachment is how you hold your baby at your breast so they can feed. Attachment is also sometimes known as 'latching on'.

Correct positioning and attachment is the most important thing for successful breastfeeding. When your baby is well positioned and attached, they will find it easier to feed well.

In the early days of breastfeeding, you may feel nipple tenderness or sensitivity as you get used to your baby attaching to your nipple. But it should not be painful.

How to attach your baby

There are 2 ways to attach your baby:

• baby-led approach
• mother-led approach

Baby-led approach

The baby-led approach lets your baby use their natural instinct to latch on.

How to do it:

1. Relax in the laid-back position.
2. Lay your baby tummy-down between your breasts, with easy access to the nipple.
3. Let them find your breast and attach on their own.

Mother-led approach

If the baby-led approach does not work for you, you can take a more active role in helping your baby to attach. This is called the mother-led approach.

Stage 1

Hold your baby close to you with their nose level with your nipple.

Stage 2

Let your baby’s head tip back so their top lip brushes against your nipple. This helps them open their mouth wide.

Stage 3

When your baby’s mouth is wide open, bring them to your breast.

Aim your nipple to the roof of their mouth.

In the correct position, your baby can suck, swallow and breathe comfortably. If they cannot breathe freely, they come off the breast.

Signs your baby is well attached include:

• their chin is pressed into your breast
• your nipple and most of the areola (the area around your nipple) is deep in your baby’s mouth
• more of your areola is visible above their top lip than below their bottom lip
• their cheeks appear fuller
• their nose is titled back and they can breathe easily

When they start feeding, they suck quickly at first. This is followed by longer sucks and you can hear them swallowing.

Breastfeeding positions

Before you start breastfeeding, find a comfortable position. Like any new skill, this takes practice. There are very few rules, but it is important that you and your baby are sitting or lying comfortably.

Try the following positions to see which works best for you and your baby.

Laid-back position

Laid-back is a fantastic breastfeeding position. It lets you relax while your baby is able to attach easily to your breast. This is very important in the early days when you are both getting used to breastfeeding.

Laid-back is a great position to try if you are having difficulties with breastfeeding.

5 tips to help you get your technique right:

1. The movement needed to get into this position is from your pelvis. Shift your hips forward in a chair or bed to create a semi-reclined position. Laying your baby down on your semi-reclined body ensures they connect with your body without any gaps.
2. Lay your baby on top of you with their tummy down and their cheek resting near your breast.
3. Allow your baby to self-attach. They will find the breast and attach themselves. You can also guide or help your baby to attach.
4. You can use your arms as guard rails to support your baby on top of your body.
5. You can also use pillows and cushions to provide support wherever you need it.

Cross-cradle position

Tips for getting your technique right:

• Hold your baby close and facing you. You may find a pillow on your lap helpful to support your baby.
• Gently support your baby’s neck, back and shoulders. This will allow them to tilt their head back easily.
• Do not hold or cover the back of your baby's head. This can result in them pushing back or arching, leading to a failed attachment to the breast. It is important to create space for your baby to tilt their head back for a successful attachment.
• Sometimes it helps to shape your breast, making sure your fingers and thumb are well back from the areola. This creates an oblong shape and allows your baby to attach easier to your breast.
• The palm of your other hand can support your baby’s back.

Koala-hold (straddle-hold) position

Koala-hold position is good for babies with:

• reflux
• an ear infection
• tongue-tie
• low muscle tone
• hip dysplasia
• oversupply of breast milk

This position is easier for babies who can sit without help. You can use this position with a newborn if you give your baby plenty of support.

To do koala-hold:

1. Your baby sits straddling your thigh or on your hip.
2. Their back and head is upright while breastfeeding.

Mother and baby face each other either upright or semi reclined.

Football hold position

This is a good position if you have had a caesarean birth. It helps to keep your baby away from the affected area.

To do football-hold:

1. Support your baby’s neck, back and shoulders with your hand and wrist.
2. Let your baby’s back lie along your arm. Your baby should be facing you with their nose near your nipple.
3. Support your breast with your other hand.
4. Guide your nipple towards the baby's mouth.
5. Your baby will then snuggle up close and begin to breastfeed.

Side-lying position

Side-lying involves lying down. It is good for night feeds

Tips for getting your technique right:

1. You and your baby lie down facing each other.
2. Make sure your neck and back are supported and comfortable. Your baby's chest should face your chest.
3. Take the arm that you're lying on and either place it under your head or use it to support your baby under their head or around their body.
4. You can use a pillow or rolled-up blanket behind your baby's back for support.
5. Your baby’s nose will be near the nipple and their chin in contact with the underside of the breast.
6. From there, your baby's gape reflex will be stimulated causing them to open their mouth wide and latch on to the nipple.
7. This helps ensure that the nipple is deep within your baby's mouth and reduces the likelihood of nipple pain or damage.

How to know your baby is attached correctly

Signs that your baby is attached correctly:

• Your baby should have a wide mouthful of breast in their mouth.
• Their chin should be touching your breast.
• You may notice their top and bottom lips curled out.
• Their cheeks should be full and rounded - you should not see the cheeks dimpling when your baby sucks.
• Their jaw should be moving, you may also see their ears twitch as they feed.
• They will start with short quick sucks, then change to long deep sucks with pauses to breathe.
• You should hear them swallowing as your breast milk volume increases.
• You should not hear smacking or clicking sounds.
• They should feed calmly and not move on and off the breast.
• Your baby finishes feeding and seems satisfied.
• You will feel comfortable during a feed and your nipples should not be sore.

How to support your baby

Try to:

• let your baby attach gently - you do not need to push your baby onto your breast
• keep your baby's hands free - they use these to locate and massage your breast

To make sure they stay attached, try not to touch their lips or the back of their head during feeding.