The Breastfeeding Couple: Positioning of Infants

There are four positions that are commonly used for breastfeeding an infant. Mothers and babies may find others that they like. A mother should choose a position where she and the baby are comfortable. Before nursing a baby, women are encouraged to wash their hands and to position themselves comfortably in bed or a chair. They may need to put a pillow on their lap to help support the baby; holding the baby with one arm can be very tiring. The common positions used are illustrated below.

In the side lying position both the mother and the baby are lying down in bed.

In the football position the mother holds the infant's head while his legs are tucked under her arm in the manner in which a football (US style) is carried.

The infant is held across the front of the mother's chest in the cradle position. The mother's arm is under the baby's head and her hand is holding the baby's buttocks.

In the cross cradle position or reverse cradle position, (not shown), the babies feet are tucked under the mother's arm and she holds the baby's head with her hand.

In all of these positions the mother uses one hand to hold her breast. This is usually described as the C technique. In some positions the hand is rotated to form a U.

Babies nurse "tummy to tummy" with their mother. This means the baby's stomach should be up against their mother's stomach. Babies get a lot of warmth from being next to their mother and consequently if they get too warm and comfortable while nursing they may fall asleep. Mothers should hold their breast using the C or U technique while getting the baby latched on to the breast.

The baby needs to open his or her mouth wide (as big as possible) ( Biancuzzo, 1994 , Neifert, 1998 ). This will encourage the baby to take not only the nipple but at least half of the areola into his or her mouth. Taking this much of the areola into the baby's mouth is necessary for milk ejection or milk let down. Babies who only take the nipple into their mouth may suck on the nipple, not stimulate good milk let down, and not get enough milk. They then suck more vigorously which can contribute to sore, cracked nipples. When a mother is holding her breast she needs to make sure that her fingers are behind the areola and not close to the nipple. The baby's tongue should be down under the nipple and the baby's lips should be flipped out ("fish lips") to ensure effective latch-on. A good indication of effective latch-on is a long rhythmic suck with frequent swallows. Poor breastfeeding techniques (including sucking on the nipple) at 4 to 6 days of age, if not corrected, is associated with more breastfeeding problems and earlier weaning ( Righard, 1992 ).

Colson and coworkers in England videotaped episodes of infants breastfeeding to evaluate the infant's use of their reflexes to support breastfeeding. When breastfeeding mothers are lying semi-reclining and the infant is lying prone on the mother's abdomen or chest, the infant is able to use their infant reflexes of stepping, placing, and hand massage of the mother's breast. Mothers using their arms to provide side boundaries for the infant, often stroked their infant's feet. This triggered the Babinski reflex of the feet, and head nodding which "in turn trigger mouth gape, tongue dart and rooting" which lead to breast attachment. These authors hypothesize that infants are really abdominal feeders and they use their anti-gravity reflexes to help them latch onto the breast ( Colson, 2008 ).