**Quick little disclaimer here before I rapid-fire-bullet-point all my favourite breastfeeding attachment tips - every baby & mum combo is so different.

That means there is no ‘one size fits all’ piece of breastfeeding advice that anyone can (or should) give! Think of this list as a toolbox of suggestions and you will find what works exclusively for you and your baby. So in terms of breastfeeding positions, holds or attachment techniques - there are so many options, and this is by no means a comprehensive guide.

With that being said - here are some starting tips:

• Set yourself up comfortably with everything you need first. A comfortable place with good back and arm support, water and maybe some snacks nearly! A place for you to put your feet up is great too!

• Make sure both you and your baby are calm if possible (the earlier you can recognise your baby might be hungry and respond, the easier this part is to achieve!)

• For early feeds with your new baby, undress them down to their nappy so they have direct skin-to-skin contact with you. This encourages their temperature regulation, alert and productive feeding as well as oxytocin release (our love hormone, responsible for helping our milk ‘let-down’).

• Your baby’s body should be in a straight line and facing your body, they should not need to turn their head to face the breast. This is because, even for us, it is harder to swallow with our head turned to the side instead of facing forward.

• Your hand should be supporting the top of their shoulders and base of their neck instead of holding their head. This allows them to tilt their head back freely and keeps their nose free when feeding.

• Bring your baby up to you, not leaning forward to bring your breast down to your baby. This is so important because leaning forward changes the shape of our breast and can mean its difficult for you to move/readjust to be comfortable later!

• Once they are attached there shouldnt be any pain or a ‘pinchy’ feeling on the nipple. If there is, gently detach them by inserting a clean finger into the corner of their mouth and push or ‘invert’ your nipple towards you. Then try again to attach them again.

Initial positioning tips:

• Your baby’s nose should be in-line with your nipple.

• Their bottom lip should sit below the nipple, chin tucked into the breast, head slightly back, top lip free.

• Use your nipple to brush across your baby’s nose and mouth to encourage them to open their mouth wide. They may open only slightly at first so do not try to ‘shove’ your nipple in.

• Instead wait and keep stimulating them to open until their mouth opens wide. When they do, it should be as wide as if they are yawning. Their tongue should be down and forward in their mouth.

• When this happens, keep their chin and lower lip fixed or ‘anchored’ well below the nipple and quickly draw their shoulders in close. This should simultaneously bring their top lip up just over the top of the nipple.

• They need to get a large mouthful of breast tissue too, not just the nipple.

What to look out for:

• Your baby’s lips should be flanged/turned out resembling the letter ‘k’ against your breast, if you can see their lips at all. If their lips are curled inwards (you cant see the colour of their lips) it is possible they have not latched correctly. Their cheeks are ideally so close to the breast when they attach you may not see their lips at all though and that’s good!

• You should see your baby’s deep jaw movements, rhythmical cycles of short and long sucks with short breaks inbetween.

• Once your milk has started to come in (72+hrs after birth) you should be able to start hearing them swallow intermittently at the breast too

• Your baby’s arms are relaxed and they are calm at the breast once they begin feeding.

What you shouldn’t see:

• Your nipple. The entirety of the nipple should be very securely in the back of your baby’s mouth, between the junction of the hard and soft palate. This keeps your nipple safe from being pinched or squashed between their tongue and hard palate at the front of their mouth (and why so many mothers experience nipple pain and damage!).

• Minimal areola should be visible (this varies however due to the many varied areola shapes and sizes between mothers!).

• Your baby’s cheeks dimpled or appearing ‘sucked in’ when they feed

• Repeatitive clicking sounds or milk spilling out of the corners of their mouth during active sucking

• A pinched, ridged, pointy or misshappen nipple when your baby detaches. It should still resemble its usual shape (can be elongated, but should be round!).

Important to note:

• In the first few days of breastfeeding, you may not hear your baby doing big gulps or swallows. This is because they are receiving small amounts of colostrum and they have to rhythmically suck for longer periods to receive this.

• If your baby is attached well, productively sucking without lots of prompting required and there is no pain - you can let them feed for as long as they want! Their productivity is more important than the ‘minutes’ they take on either breast. I say this sentence so often but “Watch your baby, not the clock”.

• The letdown reflex has been described as a tingling sensation, pins and needles or fullness.

• You may experience “Latch pain” in the initial days of Breastfeeding. This may be due to damage or sensitivity from baby attaching shallow and/or, often. This pain should subside within 60 seconds of baby sucking at the breast. If it does not, the latch may be incorrect and it will usually be beneficial to re-attach your baby

Problems requiring further support:

• Nipple pain*

• Bleeding, cracked, blistered or grazed nipples

• Breast pain including hot/red/engorged breasts +/- palpable lumps

• Your baby is slow to gain weight/continues to lose weight after first 4 days of age.

• Your baby has minimal or no wet nappies in 24 hours

*If you are experiencing nipple pain and struggling to attach your baby to the breast - the earlier you can seek support, the better! Midwives and lactation consultants are an amazing resource in those early few weeks of feeding to help you learn what works for you and your baby best!

References

Charette, C. and Théroux, L., 2019. Musculoskeletal Impairment: Causes of Pain with Breastfeeding Insight into 11 Cases. Breastfeeding Medicine, 14(8), pp.603-608.

Thukral, A., Sankar, M., Agarwal, R., Gupta, N., Deorari, A. and Paul, V., 2012. Early Skin-to-Skin Contact and Breast-Feeding Behavior in Term Neonates: A Randomized Controlled Trial. Neonatology, 102(2), pp.114-119.

Wang, Z., Liu, Q., Min, L. and Mao, X., 2021. The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis. BMC Pregnancy and Childbirth, 21(1).

Widström, A., Lilja, G., Aaltomaa-Michalias, P., Dahllöf, A., Lintula, M. and Nissen, E., 2010. Newborn behaviour to locate the breast when skin-to-skin: a possible method for enabling early self-regulation. Acta Paediatrica, 100(1), pp.79-85.