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Position to Breastfeed Features
Updated April 23 2016
Nancy Mohrbacher, IBCLC, FILCA
Photo: Jax McCormick by Leilani Rogers
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How a natural position to breastfeed—mother leaning back, baby tummy down, and adjusting body, baby, and breasthelps make for an easier start.

During the first week after birth, 92% of the nursing mothers in one study reported major breastfeeding challenges (Wagner 2013).

In my 30-plus years of giving breastfeeding help, I’ve been puzzled by the huge numbers of mothers who struggle, especially at first. After all, mammals are born with responses that enable them to get to their food source and feed. In light of this fact, it’s not surprising that many first-time mothers begin breastfeeding thinking:

“How hard can it be? Isn’t it supposed to be natural?”

After pondering this mystery for decades, I’ve concluded that one major cause of this epidemic of breastfeeding problems is that we’ve been teaching mothers of newborns to use breastfeeding  holds that are better suited to more coordinated older babies.

Another way of looking at it is that in the places where bottle-feeding has been the norm, the early breastfeeding holds we have adopted (perhaps subconsciously) are variations of the bottle-feeding positions with which we are more familiar than any position to breastfeed.

When mothers sit up straight to breastfeed using the commonly taught cradle, cross-cradle, and football/rugby holds, it is impossible for newborns to use their inborn programming to get to mother’s breast. Even worse, in these common positions to breastfeed newborns’ inbuilt programming actually becomes a barrier to feeding, making the early weeks much more difficult than they need be. But more on that later.

What if instead of tackling each breastfeeding issue individually—latching struggles, milk supply concerns, sore nipples—there was a single way to address many challenges at once?

A new strategy

US obstetrician Theresa Nesbitt (“Dr. Theresa”) and I developed a new/old approach to early breastfeeding by drawing from the work of the Swedish breast-crawl researchers, UK scientist Dr. Suzanne Colson, international brain-science teams, the Prague School, and American experts Dr. Christina Smillie and Dr. Brian Palmer.

As we assembled these diverse but related puzzle pieces of mothers’ position to breastfeed, “Natural Breastfeeding” was born. Although its concepts are not new, we gave them a makeover so they would be more accessible. Part of that makeover meant creating a new, jargon-free vocabulary, and easy access to images through videos, some of which you can see here.

What makes this approach “natural?” In a nutshell, this Natural Breastfeeding approach takes advantage of newborns’ innate behaviors to make early breastfeeding easier.

One key part of Natural Breastfeeding is starting with feeding positions that use gravity to help. A position to breastfeed that uses gravity to help rather than hinder makes for an easier start. In gravity-assisted positions, mothers lean back and the baby rests tummy down on mother’s body.

During the first month or so, with gravity helping, there is less pain, strain, and struggle.

Think of these positions like the training wheels on a bicycle, a way to help you avoid the bumps and scrapes while you and your baby are learning.

 

How do natural positions to breastfeed help?

Why do many mothers find these Natural Breastfeeding “starter positions” easier at first?

Tummy down

According to the work of the Prague School, when babies rest on their tummies, they have more control over their movements (Kobesova 2014). Baby’s full frontal contact with mother also activates the baby’s internal GPS so she knows where she is and what to do (Widstrom 2011).

In these positions, even a brand new baby can do amazing things. In tummy-down positions, gravity helps your baby:

  • Stay in place without muscle strain
  • Latch on deeply
  • Be an active breastfeeding partner

If you Google “breast crawl,” you can see videos from all over the world of newborns in these gravity-assisted positions make their own way to the breast, latch on, and feed.

These starter positions will likely make breastfeeding easier for you, too.

With baby’s weight resting fully on your body, many mothers can:

  • Relax completely and rest while baby feeds
  • Avoid or minimize nipple pain
  • Breastfeed with one or both hands free

Lean back

I often suggest mothers notice how they position themselves when they watch their favorite television show. If you know you’ll be in sitting in one spot for 30 minutes or more, you’ll find a way to lean back and relax all of your muscles. Often ideal positions to breastfeed.

As an example, in this short video, notice Bryannah’s position while she breastfeeds her three-week-old son, Breon, and answers my question about where she learned about breastfeeding positions. Note especially what Bryannah does with her hands.

These are not just a set of instructions for another position to breastfeed, not just another breastfeeding “hold.” They constitute a completely different approach to positioning with many variations.

Imagine mother and baby as two pieces of a puzzle.

The strategies described in the next video clip are ways to help mother and baby find their own best fit.

Back to basics

One of the challenges with a new approach is conveying its concepts clearly, especially if it involves a new way of thinking. Many breastfeeding supporters have told me that they tried this approach to teach a position to breastfeed and it didn’t work. But from what I’ve seen, in most cases, they are unfamiliar with the idea of making basic adjustments.

This is where brain science comes in. In nearly all of the breastfeeding images with which we are all familiar, mothers are sitting up straight rather than leaning back. If that’s all we’ve ever seen, then those (more difficult) early positions may just seem more natural to us.

To help more people imagine themselves using a natural position to breastfeed, my channel now features around 20 short videos of diverse mothers with different body types making such positions work.

In this video clip, Dr. Theresa (with the red hair) and I explain to two pregnant mothers, Essie and Marivel, some basic adjustments:

Adjust your body, adjust your baby, adjust your breast.

Months after this recording, Essie, who was holding the doll, gave birth in a hospital where only the sitting-up-straight positions were taught. Her providers suggested she use the football/rugby hold, which she was able to master. But within a day or two she had such intense nipple pain that she made an appointment with a lactation consultant, who helped her tweak this position to make breastfeeding more comfortable. When we saw Essie again, her baby, Carlos, was two weeks old. Essie realized quickly that she had forgotten to try two of the basic adjustments, “adjust your body” and “adjust your baby.” With a little encouragement, she discovered that even a large-breasted mother can breastfeed in these positions hands free.

 

Another mother, Michelle, also suffered from nipple pain. Her pain was so intense that for the two days before the next video was recorded, instead of nursing two-week-old Vivian on her left breast, she opted to exclusively pump on that side. When Michelle switched from the cross-cradle hold to a natural position to breastfeed, she discovered that even on her really sore breast, gravity made it much easier for her baby to get a deeper, more comfortable latch. This video’s voice-over gives a step-by-step explanation of the adjustments she made to breastfeed pain-free.

Drawbacks of gravity-fighting positions

In the cradle, cross-cradle, and football/rugby holds, mothers must use their arms to get babies to breast level and keep their fronts touching, which can be tiring. If gaps form between mother and baby (which happens easily with gravity pulling baby down and away), this interrupts baby’s GPS signals, disorienting him, which can lead to feeding struggles. Even if baby starts with a deep latch, with the pull of gravity, many babies end their feedings with a shallower, more painful latch.

In the sitting-up-straight holds, the pull of gravity also makes it impossible for a newborn to get to their food source and feed. For baby, breastfeeding in gravity-fighting positions is a little like trying to climb Mount Everest. Instead of mothers and babies working together as breastfeeding partners, mothers must do all of the work. Instead of being able to relax while baby helps, many mothers sit hunched over, tense, and struggling.

To complicate things further, in sitting-up-straight positions to breastfeed, gravity can transform the same inborn feeding responses that should help babies into barriers to breastfeeding. Head bobbing becomes head butting. Arm and leg movements meant to move babies to the breast become pushing and kicking.

Sadly, most mothers who struggle with breastfeeding think the only solution is to try harder, but that’s frustrating and exhausting. It’s no wonder then that so many mothers give up on breastfeeding so soon!

In this clip, I describe to Michelle why gravity-fighting positions are at the root of many breastfeeding struggles.

 

Scientists once believed that most newborn reflexes were useless leftovers from our tree-dwelling ancestors. But now we know better. We know these reflexes are key to early breastfeeding (Colson 2008). Over time, as babies grow, they gain more head-and-neck control and can learn to breastfeed well in any position. But in the beginning, when breastfeeding is most vulnerable, this is not so easy.

Watch how

Dr. Theresa and I have made our basic resources free so that you can share them with mothers everywhere. Our basic videos are available in two places:

A 2015 study found that tablet-based prenatal breastfeeding education can increase breastfeeding initiation, duration, and exclusivity (Pitts 2015). Natural Breastfeeding: For an Easier Start includes more than 100 images and more than 60 short videos. Our hope is that this modern high-tech approach can help mothers reach their breastfeeding goals. We’d also like to create in the near future an “emergency” version of our program for struggling new mothers to watch.

SEE April 2016: Natural Breastfeeding for an Easier Start 

Breastfeeding was never meant to be difficult. With this new/old approach to early positioning, let’s make the most of what baby brings to the table so that more women everywhere can develop their own  comfortable position to breastfeed and nurture their newborns.


References

Colson, S. D., et al. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev 2008; 84(7): 441-9.

Kobesova, A., & Kolar, P. Developmental kinesiology: Three levels of motor control in the assessment and treatment of the motor system. J Bodyw Mov Ther 2014; 18(1):23-33.

Pitts, A., Faucher, M.A., & Spencer, R. Incorporating breastfeeding education into prenatal care. Breastfeed Med 2015; 10(2):118-23.

Wagner, E., et al. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics 2013; 132(4):e865-75.

Widstrom, A-M., et al. Newborn behaviour to locate the breast when skin-to-skin: A possible method for enabling early self-regulation. Acta Pediatr 2011; 100: 79-85.


Nancy Mohrbacher, a native of the Chicago area, fell in love with breastfeeding when she breastfed her three sons, Carl, Peter, and Ben, who are now grown. Nancy began helping families as a La Leche League Leader in 1982 and became an International Board Certified Lactation Consultant in 1991. For ten years she founded and ran a large private lactation practice. She has also worked for a major breast-pump company and a national corporate lactation program. Nancy is author of breastfeeding books for professionals. She co-authored (with Kathleen Kendall-Tackett) the book for parents, Breastfeeding Made Simple. Her tiny troubleshooting guide, Breastfeeding Solutions, is also available as the Breastfeeding Solutions app for Android and iPhone. Her latest book, Working and Breastfeeding Made Simple, debuted in 2014. Nancy speaks at events around the world. You can find her at NancyMohrbacher.com, facebook.com/NancyMohrbacherIBCLC, pinterest.com/nancymohrbacher/ and YouTube.com/NancyMohrbacher.

Resources

Natural Breastfeeding for an Easier Start 

Positioning and Attachment

Positioning: A New Perspective

Sore Nipples When Breastfeeding


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