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    Positioning Baby at the Breast

    breastfeeding positions

    Modern Age has different names for breastfeeding positions and breast holds. This can make each position seem like a unique and necessary technique to master with rules and tricks that must be memorized before the baby even arrives. Humans were breastfeeding long before labels like “football hold” and “C hold” were part of the lexicon. First, let’s look at how babies and parents function as a set when feeding, then we’ll see how common positions and holds stack up.

    Reflexes + Comfort = Optimal Position

    Babies are born to feed at the breast. Full term, healthy infants will begin displaying feeding cues within moments of birth. In the womb, babies are practicing sucking and swallowing. Once born, babies are ready to latch to the breast when placed skin to skin on their parents’ body. Sometimes this is referred to as “the breast crawl” or “the golden hour.” Baby spends these moments after birth tummy to tummy, forearms pressed against the chest, hands out with fingers moving, head bobbing and lifting, mouth opening and closing, tongue protruding and seeking a nipple. This fresh from the womb behavior is controlled by the feeding reflexes the baby is born with. These reflexes will continue to drive baby’s feeding behaviors for weeks to months, until learning can fully take over.

    Parents are best able to position a baby in a tummy to tummy, skin to skin position if they are comfortable too. If your back is bent at a weird angle or shoulders are overstretched, it’s impossible to get settled in for a feeding session. The parent’s body is the foundation. First, we make it stable and sturdy, comfortable and calm. Then we add the baby to the parent’s body in a way that makes sense to the infant’s reflexes. The reflexes expect tummy to tummy, skin to skin, forearms to chest, hands out, head free to bob and lift, mouth free to open wide. If the position meets these reflexive expectations, baby is easily able to latch and feed.

    Common Positions and Infant Expectations

    The Cradle Hold

    This position has baby cradled in the parent’s arms. If baby is cradled with the right arm, then baby will feed from the right breast. Baby’s head and body are supported by one arm. The opposite arm may be supporting the breast.

    + / - Tummy to tummy: It is possible to get baby tummy to tummy in this position. Also, because one arm is supporting baby’s weight, the arm may get tired. Baby may roll away from the parent’s body such that the tummy is facing the ceiling. This means baby’s neck is turned, making swallowing more difficult.

    + / - Skin to skin: this position can be done skin to skin or with clothing on

    + / - Forearms to parent’s chest: the parent can achieve this by stretching baby’s arms around the chest. Often, babies bring their hands to their chest when they are placed to feed tummy up. Keeping baby rolled in can help maintain the arms touching the parent’s chest.

    + / - Hands out: once the forearms have stretched out, baby can stretch their hands. Mittens would prevent this.

    - Head free to bob: with the parent’s arm tucking the head toward the parent’s body, having free bobbing movement is unlikely in this position

    - Mouth free to open wide: since the head is often tucked in this position, the chin stays close to the chest. Babies need more space between the chin and chest to open wide to feed

    Cradle Hold overall score: 4 out of 6 reflexes can be supported in this position, 6 out of 6 reflexes can be suppressed in this position

    Cross Cradle

    The twin position of the cradle hold has one major change: baby feeds on the breast opposite of the parent’s supporting arm. If baby is feeding on the right breast, the parent will support the baby with the left hand. The breast may be supported with the right hand in this case. Generally, parents will hold baby with the hand near the neck. Sometimes parents place a hand between the shoulder blades for support.

    + / - Tummy to tummy: It is possible to get baby tummy to tummy in this position. Also, just like the cradle, because one arm is supporting baby’s weight, the arm may get tired. Baby may roll away from the parent’s body such that the tummy is facing the ceiling. This means baby’s neck is turned, making swallowing more difficult.

    + / - Skin to skin: this position can be done skin to skin or with clothing on

    + / - Forearms to parent’s chest: the parent can achieve this by stretching baby’s arms around the chest. Just like the cradle hold, keeping baby rolled in can help maintain the arms touching the parent’s chest.

    + / - Hands out: once the forearms have stretched out, baby can stretch their hands. Mittens would prevent this.

    + / - Head free to bob: with the parent’s hand on the neck, the head is always tucked toward the chest. Shoulder support allows the head to move freely.  

    + / - Mouth free to open wide: again, if the parent’s hand is on the neck, the chin will tuck preventing a wide-open mouth. Shoulder support will extend the neck, relax the chin, and help baby open very wide.

    Cross Cradle hold over all score: 6 out of 6 reflexes can be supported in this position, 6 out of 6 reflexes can be suppressed in this position

    The Football Hold

    This position is prized in the hospital after cesarean births. Baby is held to the side of the parent’s body, reducing strain on the abdomen and keeping baby away from the incision site. Baby is placed under the breast and held tucked under like a football, hence the name.

     - Tummy to tummy: It is not possible to get baby tummy to tummy in this position.

    + / - Skin to skin: this position can be done skin to skin or with clothing on

    - Forearms to parent’s chest: baby is on the side of the parent’s body and unable to reach the chest. Arms are usually placed down along the sides of the baby’s body in this position.

    + / - Hands out: baby can stretch their hands by the sides of their own body. Hands will not feel for breast or nipple in this position. Mittens would prevent hand extension.

     - Head free to bob: the parent’s hand will support the head, neck, and back. The head is always tucked toward the chest.

    - Mouth free to open wide: again, if the parent’s hand is on the neck, the chin will tuck preventing a wide open mouth.

    The Football hold over all score: 2 out of 6 reflexes can be supported in this position, 6 out of 6 reflexes can be suppressed in this position

    The Koala Hold

    This is also referred to as the Saddle hold because the baby may look like they are sitting on the parent’s lap the same way parents sit a baby to pretend “ride the horsey.” Parent begins sitting semi upright or semi reclined. Baby is placed tummy to tummy with the parent, nose below the nipple level. The parent uses one hand or arm to support the baby’s back. Gravity presses baby to the parent’s body. Baby lifts head back to latch and comes to breast chin first.

    + Tummy to tummy: Tummy to tummy is a key feature of this position.

    + / - Skin to skin: this position can be done skin to skin or with clothing on

    + Forearms to parent’s chest: the parent can achieve this by stretching baby’s arms around the chest. Baby will always have forearms touching the chest in this position so the tummy can touch the tummy.

    + / - Hands out: once the forearms have stretched out, baby can stretch their hands. Mittens would prevent this.

    + Head free to bob: with the parent’s hand on the shoulders, the head can move freely. Hands on the head or neck would not be koala hold position.  

    + Mouth free to open wide: again, if the parent’s hand is on the neck, the chin will tuck preventing a wide-open mouth. Shoulder support will extend the neck, relax the chin, and help baby open very wide.

    The Koala hold over all score: 6 out of 6 reflexes can be supported in this position, 2 out of 6 reflexes can be suppressed in this position


    Danielle Downs Spradlin, MFA, IBCLC, CLC, BRMT, NOMAS

    Danielle is the lactation consultant behind Oasis Lactation Services. She focuses on whole family wellness solutions for meeting your personal breastfeeding goals. She provides telehealth lactation support globally. Reach her at OasisLactationServices.com


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