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Baby-led attachment to the breast

The following is the Australian Breastfeeding Association’s description of baby-led attachment: how your baby can attach him or herself. This can be an answer to many attachment problems.

Baby-led attachment is the term given to the process where your baby follows a pattern of instinctive behaviours to get to the breast. This can be for the first breastfeed or at any time when the attachment is not correct and your nipples are damaged. The process is most often described as follows:

1. Sit comfortably, whether in bed with pillows behind you and one under your knees, or on a chair with your feet on a low stool or cushion. It is helpful to be well-supported and comfortable, as you may be sitting in that position for a while. Speak to your medical adviser if pain is making it difficult for you to relax.

2. Start with a calm baby and a calm mother. Humans learn best when they are in a calm, receptive state. Your baby’s instincts in response to hunger will lead her to the breast and to suckle, however it is the flow of milk she then receives that teaches her this is where milk comes from. If your baby is stressed, crying or upset, she will not be in a receptive state to be able to follow her instincts. Calm your baby by gentle rocking and cuddling, talking to your baby, making eye contact and being skin-to-skin.

3. Skin-to-skin contact is a very important part of this instinctive process, so while you are both learning, you may find it useful to remove your shirt and bra, and to remove your baby’s clothes, leaving her in just a nappy. Make sure the room is warm enough to be comfortable for you both.

4. Hold your baby in a way you both find comfortable. Many mothers find that holding their baby upright on their chest, between their breasts, works best for them.

5. Your baby will start to move her head. As your baby starts to follow her instincts, she may start to ‘bob’ her head around on your chest. As you support her in a way that feels right to you, she will start to slide, crawl, fall or even throw herself towards one of your breasts.

6. Support your baby. As she moves towards one breast, you may find it helpful to move your baby’s bottom across your body towards the other breast. You may also need to move your hand and wrist to support your baby’s back and shoulders. This support to your baby’s upper body gives her the stability to be able to control her head movements as she attaches.

7. Attaching to your breast. Now that your baby’s head is near your nipple, she may nuzzle your breast for a little while. That is fine. As long as she is still calm, she will eventually dig her chin into your breast, reach up with an open mouth, and attach to the breast. You may find it helpful to pull baby’s bottom closer to your body, or to give even more firm support to her back and shoulders at this time. This will help her to dig her chin in, keep her nose free of the breast, and get a good mouthful of breast. If she loses contact with your breast, this may interrupt the instinctive process. She may continue once in contact again, or if she does not, you may need to move her back to a more upright position between your breasts and start again.

8. When your baby is well attached to the breast, her mouth will be right over the nipple and well onto the surrounding darker area (areola), with her tongue underneath the nipple. She should have more of the ‘chin-side’ of areola in her mouth than the side adjacent to her nose. Her top and bottom lips will open out over the breast, with her chin pressed against the breast and her nose clear. A correctly attached baby will be able to breathe while feeding – most mothers find they do not need to hold the breast away from the baby’s nose. Doing so may pull the nipple from her mouth or even block the milk ducts below. If her nose is pushing into the breast, try moving her body and legs closer to you. This will bring her chin further in towards the breast and free her nose naturally.

‘Chest to chest, chin to breast’ is a quick way to describe good positioning.
Your baby’s body will be positioned such that her head, neck and spine are in a straight line, with her head tipped back over your hand or arm. Her body should be facing yours. She may end up being held almost horizontally under your breasts, or she may be lying more diagonally across your body, or even into your lap. As long as her back is straight, her body close to yours, and you are both comfortable, that is all that matters. Take the time to try different positions to find what best suits you both.

If you feel pain beyond the initial stretching of your nipple, your baby may not have taken a big enough mouthful of breast. You can break the suction by inserting a clean finger in the corner of her mouth, between her gums, and try again. Baby may be happy to re-attach without changing position, or you may need to bring her more upright and start the process again. Similarly if your baby becomes upset or distressed during the ‘baby-led attachment’ process, calm her first, and start again. This is a learning process for both of you, it is okay to take your time.

As you and your baby start to feel comfortable with breastfeeding, you will quickly learn to put your baby straight into the feeding position you have both come to enjoy.