Successful breastfeeding takes time, patience and practice. Correct positioning and attachment are essential.
It is normal for nipples to be tender in the first 7–10 days, while breastfeeding is established. The area in and around the nipple is full of nerve endings which stimulate the brain to let-down the milk.
Sore nipples that continue into the breastfeed are not normal and usually means the baby is incorrectly positioned or latched.
If you’re worried or experiencing continual pain, seek help from your lead maternity carer or your local La Leche League.
Hold the baby close
This may mean having to remove some blankets, or bulky clothing. (Don’t worry about them getting cold – this won’t happen if they’re held close to your body.)
Tummy to tummy and nose opposite nipple
If you can see your baby’s tummy button, they’re not turned close enough to latch well. Babies should be breastfed ‘tummy to tummy’.
Support the baby with their nose opposite the nipple – smelling the milk will help the baby to do all the right things with their mouth to achieve a latch.
It is often easier to start breastfeeding by holding the baby in the cross-cradle position. This means the baby’s head is supported with your hand at the base of their neck.
For example, if feeding your baby on the left breast, hold them with your right arm, supporting their body with your right hand at the base of their neck. Use your left-hand thumb to gently pull the nipple upwards so it is point toward the baby’s nose.
If you have larger breasts, you can support your breast with your left hand – just make sure your fingers are well away from the areola. The baby might not be able to latch if there’s a finger in a way.
Baby’s natural head tilt
The position of your hand is important as the baby needs to be able to put their head back slightly.
Babies do this little head tilt by themselves as it helps them come to the breast with the chin first – rather than being squashed into the breast with the nose and chin together.
Make sure your arm or hand is not behind the baby’s head, or they might not be able to do it.
Adjusting to a cradle hold
Once baby is latched well, you can adjust your position to a cradle hold, which might be more comfortable.
Release your hold on your breast (unless it is very heavy and full, in which case you may need to support it during the feed – see the underarm/rugby hold) and move your arm gently around the baby.
Using a lying-down position or the underarm or rugby hold can be useful if you’ve undergone a cesarean.
The underarm or rugby hold can also be useful if your breasts are heavy, as the weight is partially supported by the baby.
When you’re more comfortable with breastfeeding you can move from the cross-cradle to a cradle position right from the beginning of a feed.
Approaching the breast
- Bring baby gently towards the nipple and touch their top lip with the nipple, then move them slightly away again gently.
- Repeat these movements quietly and gently until baby opens their mouth wide, or run the nipple very gently along the baby’s top lip (not the bottom lip or baby may latch suddenly on to the nipple and squash it).
- Your baby has to have a wide-open mouth and their tongue forward to latch correctly. It is not possible for them to latch unless these things happen.
- Don’t rush baby. Don’t try and pull them on or try to push the nipple into the baby’s mouth without this very wide mouth happening.
- If your baby isn’t bringing their tongue forward when their mouth is wide enough for a latch,try hand expressing a little milk into their mouth to encourage the tongue to come forward.
- When your baby opens wide and brings their tongue forward, they may latch by themselves, or you may have to quickly bring baby to the breast when they are ready – this has to be fast or they may close their mouth again.
- Don’t worry if the wide mouth is missed a few times – you’re both working it out together and it takes practice.
Taking enough breast tissue into the mouth
You may be told that a baby has to take as much of the areola (darker area around the nipple) into their mouth as possible to latch properly. This isn’t true.
Here are some tips to make sure your baby has latched on to enough areola:
- Your baby’s nose should be level with the nipple.
- The baby needs to grasp more of the areola (darker area around the nipple) under their bottom lip. To make sure this happens, the nipple should point upwards toward the roof of their mouth, rather than straight forward.
- You may see areola above the baby’s top lip – this is normal.
Don’t worry if it doesn’t work the first time
- Go back to the beginning and try again if it doesn’t work the first time.
- If you’re still not sure what to do, ask your lead maternity carer for help.
- Check out this useful checklist of latching points from La Leche League – A Latching-on Checklist (PDF, 116KB)
If baby is attached correctly
- Their chin will be touching the breast but their nose should be reasonably clear.
- Their bottom lip will be flanged outwards and not turned inwards.
- They’ll be sucking quite quickly, but once the milk starts to flow they’ll change to rhythmic longer sucks with some short pauses. You’ll also start to hear them swallowing – this will happen more as your milk comes in and flows more.
- The baby’s cheeks should stay rounded when sucking.
If baby is not attached correctly
- Their checks may be dimpled – this usually means there’s a problem with their latch.
- You may hear funny little clicking noises during sucking – this may mean baby needs to be taking more breast tissue into the mouth.
How long on each breast?
Different individuals find different ways to breastfeed, but a general rule of thumb is to:
- Feed from one breast.
- Feed from the other breast if baby is still hungry.
- Remember to start the next feed on the breast that you last fed from.
Generally, in the early days of breastfeeding you can aim to feed from both breasts at least eight times in any given 24-hour period. However there are many variations in breasts, milk supply and circumstances.
Reference: Ministry of Health NZ