In How to breastfeed

Positioning and attachment, including hands-off approach

Positioning refers to how the baby is held/positioned at the breast. Attachment refers to the amount of breast tissue in the baby’s mouth during a breastfeed. Health workers can assist in preventing or managing many early breastfeeding problems by discussing the importance of correct positioning and attachment with the new parents.

Positioning and attachment, including hands-off approach

This webpage is currently being reviewed and some outdated content has been removed. Please refer to Raising Children Breastfeeding videos and Raising Children Breastfeeding positions in pictures in the interim.

Positioning

There are many different options for positioning both mother and baby while breastfeeding, including lying and sitting. Encourage mothers to experiment until they find a feeding position that is comfortable and works well for them and their baby. As they get more used to breastfeeding it becomes easier to feed in different positions.

Regardless of the mother’s choice of breastfeeding position, ensure the baby is positioned at the breast to allow efficient milk transfer. The baby is positioned correctly when held close to the mother’s breast with:

Whole body turned towards the mother
Trunk and head aligned
Mouth at nipple level
Head slightly tilted back with support from across back and shoulders, not the head.

Attachment

If the mother experiences continued pain during a breastfeed, this may mean the baby is not attached correctly. Look for, or discuss, signs of effective attachment with the breastfeeding parents:

The baby has a large mouthful of breast, not just the nipple.
The baby’s chin is against the breast, and cheeks are not sucking in.
The mother can see and hear the baby swallowing.
Baby and mother will be able to see each other if the baby is positioned well.
The nipples are slightly longer after feeding, not flattened, white or ridged.

If there are no signs of effective attachment, encourage the mother to detach and re-attach by sliding a clean finger into the corner of the baby’s mouth between the gums. This will break the suction and the baby will release the breast. The breast can then be removed from the baby’s mouth and the mother can try re-attaching the baby again.

Hands-off approach

Encourage the mother and baby to breastfeed independently with minimal intervention, while still receiving optimal care and assistance. Rather than ‘doing’ the attachment for the mother, encourage, support and facilitate the mother and baby to attach independently:

Encourage the mother to observe what her infant is doing at the breast
Describe infant nutritive and non-nutritive sucking
Discuss what is ‘normal’ for a breastfeeding infant (attachment, signs that the baby is getting enough milk)
Use teaching aids such as videos and posters
- Demonstrate attachment and hand expressing using cloth breast and doll
- Teach the mother to recognise the baby’s feeding cues.