Getting your baby positioned and attached comfortably at the breast is an art—mothers often say it takes a little while for breastfeeding to feel entirely comfortable and natural, even if they’ve breastfed before. In the past girls grew up learning about breastfeeding by watching mothers in their families and communities. These days many of us become mothers having never seen a baby breastfeed. But breastfeeding has worked for mothers and babies for thousands of years and it can work for you too. Many babies can find their way to the breast by themselves, especially if they haven’t been too affected by birth interventions. Other mums and babies need a little longer to work it out with maybe some help from a skilled breastfeeding supporter such as an LLL Leader. When all is going well, specific holds and positions don’t really matter because you and your baby will work out what suits you best. However if you are finding it awkward, uncomfortable or downright painful then the following information is designed to help you think about where you can make adjustments and get breastfeeding working comfortably for you.
Good positioning and attachment is important for maintaining milk production. A baby who attaches deeply at the breast is able to remove milk effectively. This is important for maintaining milk production. Well-drained breasts make milk quickly. If there is any concern about how much milk you are making, working on improving positioning and attachment is an important first step.
There’s no ‘right’ or ‘wrong’. If you are comfortable, your baby is producing plenty of dirty nappies and is gaining weight after the first few days, then breastfeeding is going well for you. There are no rules—but there are a few principles that can help you work out what to do if things aren’t going well: see Latching on – getting a good attachment.
Positioning describes how you sit or lie and how you support your baby as he takes the breast. How you hold your baby can make a big difference to how well he can breastfeed. Even small adjustments can be significant.
Attachment describes the way he latches onto the breast.
If it hurts then make changes
If it doesn’t feel right to you, then it isn’t fine, whatever anyone says. Pain is your body’s way of letting you know something is wrong. Start by trying to improve positioning and attachment. A few quick adjustments to how you are sitting or lying or how your baby comes towards the breast may be all that are needed. Sometimes it can take a little longer. You may need to work with one or more skilled breastfeeding supporters over a period of time to get to the point where everything falls into place and breastfeeding starts feeling natural. Each mother and baby pair is different and what works well for one mother and baby may not work for you. This is one reason why you may hear different suggestions from different helpers. You are the best judge of what is helpful so don’t be afraid to use what feels right for you and discard the rest.
Your baby needs to be calm
You can offer the breast at any time when you are both calm. You may even find it easier if your baby isn’t obviously hungry. Feed your baby before he needs to cry. Early cues for wanting to eat include sucking his hand, smacking his lips, turning his head towards you, or fussing. He won’t latch well if he’s distressed. If your baby is upset take time to soothe him. Hold him upright against you, stroke him and talk to him. A little expressed colostrum or breastmilk given on a spoon can help to calm him if he‘s desperately hungry.
Your baby needs full body contact
When your baby is held in full body contact against you, he will feel stable and be better able to coordinate his movements. Laid back positions ensure full body contact. If you’re sitting up, you’ll need to hug him in as tightly as if you were standing up holding him against you. Babies who don’t feel stable tend to wave their arms around, which can make latching more difficult. Pillows can get in the way and aren’t always necessary. So wait until after your baby’s latched on, and then tuck them in only if you need them for support.
Some babies need time
Some babies find it difficult to latch on, or simply nurse ineffectively at the breast. Often a difficult birth or interventions during labour or birth are the cause. Giving a baby time to recover, and using Biological Nurturing™ positions with skin-to-skin contact can maximise your baby’s natural instinct to breastfeed. If your baby isn’t latching or feeding well seek help from an LLL Leader and read our page My Baby Won’t Breastfeed. With time and patience, most babies will breastfeed. In the meantime express your milk for your baby to maintain milk production and give you both the time to work it out.
Many people assume you have to sit up to breastfeed. Not so. In fact evidence suggests humans evolved to breastfeed in laid back positions with our babies upright against our chests. You may have experienced this type of position when you had your first feed, soon after your baby’s birth. There is more and more evidence that Biological Nurturing™ or ‘laid-back’ breastfeeding positions help babies breastfeed more effectively and are more comfortable for mothers, especially in the early days and weeks. Biological Nurturing™ (BN) is really useful for those first few days and weeks when you want to rest and recover and your baby needs to be in close contact with you to get breastfeeding established. It can be done skin-to-skin or with you both lightly dressed. You don’t have to be in bed; the sofa or a reclining chair is a comfortable alternative. And you can use BN principles when sitting in an upright chair by shifting your weight back onto your tail bone and reclining your body back a little, to open up a space for your baby. This allows more of his weight to be supported by your body and less by your arms. It isn’t safe to sleep with your baby on a chair or sofa.
If your baby is sleepy, perhaps because of birth interventions, then using BN positions with skin-to-skin contact can encourage your baby’s interest in feeding. In BN positions babies often attach and feed when in light sleep so it helps to spend substantial periods of time with your sleepy baby against you. When you notice the little movements that indicate your baby is moving into a light period of sleep you can encourage him to latch.
How laid back breastfeeding works works
- You lay back in a comfortable, supported semi-reclining position (not flat) that opens up your body, creating space for your baby.
- Your baby lies against you, his whole front against your body, vertically or at any comfortable angle.
- Your baby feels stable and secure and his instinctive feeding reflexes are triggered, prompting him to bob his head and seek out the breast.
- Gravity helps him latch deeply and stay latched, rather than hindering the process.
- Your hands are free to support and caress your baby and help him attach.
- Your body releases the hormones that stimulate milk production and make you experience loving feelings towards your baby.
- There are no rules—you and your baby are free to work it out between yourselves.
- Your baby needs to tip his head back and reach forward with his lower jaw. As he tips his head back his jaw drops and his mouth opens wide, so he can anchor his chin and lower lip firmly against your breast. If he has to tuck his chin in to reach the nipple he won’t be able to open his mouth so wide. Tipping his head back also makes a deep latch possible, swallowing easier, and frees up his nose for comfortable breathing. In laid-back positions lay him with his head between your breasts. If you are sitting up, keep your supporting hand away from the back of his head. Babies tend to creep forward, so try shifting him so that his eyes and nose are opposite the nipple to encourage him to reach forward and anchor his chin first. In sitting or side lying positions a little push between the shoulder blades with your supporting hand or arm as he latches brings his chest in closer and helps his head tip back.
- His lower jaw needs a clear space to anchor. Think about how you might take a mouthful from a big sandwich by placing your lower jaw first then opening your mouth to accommodate the top of the sandwich—the principle is the same. Your baby’s lower jaw needs to be deeply placed on your breast well away from the nipple. Keep the fingers of your supporting hand away from the place where his chin and lower jaw need to be so his lower lip and chin can sink into your breast. Your baby’s chin needs to stay firmly in contact with your breast
- Your baby needs a big mouthful. When a baby chews on a nipple, this compresses the milk ducts, prevents milk flowing and hurts. When a baby has a good big mouthful of breast beyond the nipple, breastfeeding is comfortable and milk can flow. Some women like (or need) to hold their breast when nursing. They flatten their breast as they would a big sandwich they were offering to the baby, matching it to the oval of his mouth. This can help their baby grasp more breast tissue. It doesn’t matter if fingers are closer to the upper jaw but try to keep the “lower jaw fingers” out of your baby’s way. Biological Nurturing™ positions make use of gravity to help a baby get a bigger mouthful.
- The exaggerated latch. To get an even deeper latch you could try this optional extra. Place your thumb or finger near the base of the nipple where the middle of your baby’s upper lip will be, lined up with his nose. If you press, your nipple will tilt away from your baby, presenting him with your breast rather than your nipple. Avoid pressing your nipple into his mouth. As he opens wide, snuggle him in close and use your thumb or finger to tuck the breast into his mouth. Your nipple will be taken in last and unroll in his mouth. You can then slip your finger out.
Our own video below demonstrates flipple technique (aka exaggerated latch), it can be very helpful for getting an effective pain free latch:
- Let your breast rest at it natural level. It can be tempting to lift your breast and move it towards your baby’s mouth. If you do this, your baby probably won’t get a full mouthful, and after a while your hand will get tired and the breast will drop and slip out of his mouth. Breastfeeding pillows can get in the way too because they lift a baby up too high and prevent you tucking him in against your tummy. See where your breasts naturally rest and hold your baby accordingly. If you need them, tuck pillows in after he’s well attached.
- Bring baby to breast, not breast to baby. Since breasts are attached to you and you baby is moveable it makes much more sense to bring your baby to the breast, not the other way round! And it works better too. With his body tucked firmly against you (or laid on top of your body), your baby will feel more stable and have better head control, and you’ll feel a lot more comfortable too.
- It’s easier to latch onto a softer breast. It’s much easier to get a deep mouthful if the breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs his head and licks the nipple, he naturally makes it easier to latch on. If your breast is full and hard, you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Apply gentle steady pressure with your fingertips on the areola around your nipple for about a minute. You can also press with the sides of your thumbs or fingers. Denting the breast at the edge of the areola with a finger and placing your baby’s chin in the dent may also help. Gently hand express a little milk too if needed.
- Your baby needs to choose his own timing. Your baby will probably do best if he picks the moment to latch on. You can help by supporting him in a position that lets him do this when he’s ready. To encourage your baby to gape hold him close against you, close enough to the breast so he knows the nipple is there, but where he can’t quite reach it. Be prepared for your baby to lick and nuzzle for several minutes before he’s ready to open wide.
The natural or laid-back breastfeeding positions shown in the following video can be a great help in encouraging your baby to latch on well, as well as being comfortable for you. You can recline comfortably with your baby on top of you with his whole front against you and his body completely supported by yours.
Best Beginnings’ video demonstrates clearly how to make sure your baby is attaching well to the breast, you can view it here.
This video demonstrates how to enable your baby to latch deeply on to your breast so that breastfeeding is comfortable for you and means your baby get enough milk:
This video shows how to attach your baby well, and shows a variety of comfortable breastfeeding positions:
The cradle hold
Although the cradle hold is one of the most common nursing positions it can be a challenge for new mothers to learn. You need to hold your baby’s body firmly against you to give him stability because his weight is supported mainly by your arms. Shifting so you are sitting on your tailbone, rather than upright can help stability and reduce the strain on your arms (see picture right). It can be difficult to control a baby’s head and to keep him high enough and close enough to your breast. A small baby may tend to curl up in a ball in this position if not pulled in closely enough against his mother’s body. It may not be the best choice at first if you’re experiencing any problems with latch-on, milk transfer or if you have sore nipples. Once you’re more confident with breastfeeding, you may find you use a version of the cradle hold much of the time, especially when out and about.
- Your baby’s whole front is against your tummy, his hip resting on or near your thigh, tucked around you like a comma. His chest will be will be snuggled into the breast and your nipple near his nose.
- His head is resting on your forearm and/ or wrist (not the crook of the elbow).
- As he opens his mouth to take the breast, pull his body in firmly against you.
- Once your baby is attached, settle back a little for your own comfort and so that more of his weight is taken by your body.
Laid back breastfeeding
Remember that Biological Nurturing™ positions aren’t just for the first week or two. They can be really useful later on when you want to relax, and especially if you are breastfeeding more than one baby or if your baby is fussy or unwell.
Using different breastfeeding positions
The cross-cradle hold
The cross-cradle position can be useful in the early days because it gives you more control in guiding your baby to the breast. It can be uncomfortable to maintain without good support under your arms, especially with larger babies, so once your baby is attached, switch arms as shown in the picture below. After the first few weeks and as your baby grows longer and heavier, you may prefer to use other comfortable holds. Avoid touching the top or back of your baby’s head because it often causes a baby to pull back from the breast. Forcing a baby onto the breast by firmly holding the back of the head usually has the opposite effect and can put a baby off breastfeeding.
- Tuck his whole front against your tummy, his hip near or resting on your thigh.
- Your hand supports his neck (not the back of the head) with your palm between his shoulder blades.
- Your other hand is free to shape or stabilise your breast if needed.
- Make sure he’s not too far round the front—line him up so his eyes and nose are near the nipple.
- As your baby opens his mouth, give a little push with the palm of your hand to bring his chest in close against you.
- This will help his head tip back and let him plant his chin deeply against your breast.
The underarm (clutch or rugby) hold
The underarm hold is useful if you have had a caesarean birth. It helps keep the weight of your baby off your incision. It is also a good position for mothers with flat or inverted nipples and for babies with latch-on or sucking problems because it offers you a good view of baby and breast and control of your baby’s head. You can also feed two babies at once in this position. For larger, longer babies you may need extra cushions behind your back to bring you further forward and allow space for your baby’s length.
- Your baby’s front is close against your side, with your hand under his shoulders and neck.
- Your elbow keeps him tucked closely against your body.
- Your baby approaches your breast from below. This can work well if you have large breasts. If you have smaller breasts you may need to bring your baby into a semi-sitting position.
- Make sure your baby isn’t too far round the front. You may need a cushion between your back and the chair back to allow room for your baby’s length and prevent him pushing himself forward with his feet.
This side-lying position is helpful if you are recovering from a caesarean birth or an episiotomy and invaluable for nursing in bed during the night.
It can take a while to get the knack but it’s well worth persisting because it can make night feeds so much easier.
Some mothers decide to sleep with their baby alongside them. Others choose to move their baby back onto a separate sleep surface.
Safe Sleep and the Breastfed Baby will help you decide on the safest sleep arrangements for your family, based on your own individual circumstances.
At some feeds babies just do better if a mother stands up. You can sway or bounce gently to help calm your baby, and the lack of a lap can be helpful. As always keep your baby nice and stable and let him lead the way. Try angling his legs down instead of holding him horizontal, and see what happens. Or try starting with him against your shoulder, supporting him as he moves down to the breast. Even when using other positions, sometimes just standing up and sitting down again straight away helps everything settle into a comfortable position.
Whether you choose to breastfeed sitting up, reclining or lying on your side, you will need to adjust how you support your baby as he grows in length and weight. Use the principles shown here as you experiment with different positions. Sometimes there are physical or medical causes for pain or discomfort such as tongue tie or a thrush infection. If you are still finding it difficult to get comfortable, do persist with seeking further and continued support. There is almost always a breastfeeding solution to breastfeeding problems. You can contact an LLL Leader by calling our Helpline. You can also find support and encouragement from breastfeeding mothers in your local LLL group.
Written by Sue Upstone, Karen Butler and mothers of LLLGB
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Breastfeeding Your Baby – easy read
Caesarean Birth & Breastfeeding
Comfortable Breastfeeding – easy read
Engorged Breasts – Avoiding & Treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won’t Breastfeed
Safe Sleep & the Breastfed Baby
Sleepy Baby – Why & What To Do
Too Much Milk & Oversupply
Position to breastfeed
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.
Biological Nurturing: Laid-back breastfeeding for mothers (DVD). Colson, S. et al. 2012.
An Introduction to Biological Nurturing; New angles on breastfeeding, Colson S. Amarillo, TX: Hale Publishing, 2010.
Supporting Sucking Skills, Watson Genna, C. Burlington, MA: Jones & Bartlett, 2012.
Information, references and links on this page are taken from La Leche League resources, unless stated otherwise. Please note that LLLGB does not endorse information from outside sources, extra information is provided for you to consider. Information supplied is not intended as advice, and you are in the best position to make a decision as to how the information offered will affect you and your baby.
Copyright LLLGB 2016