5.0 Breastfeeding the Baby
There is no knowledge or skill more important for you to possess and pass on to mothers than how to position their babies for comfortable latching and efficient milk transfer. If positioning and latching isn't correct then breastfeeding isn't working at all. When a mother is confident her baby is breastfeeding well there's very little else she needs to know to be successful.
Mothers who have the confidence to breastfeed their babies find it an empowering experience. Teaching by 'hands-off' methods will enhance the mother's confidence when her baby achieves good latch.
When should baby be fed?
The best time to commence feeding an infant is when he first exhibits cues that he is ready to feed. When early cues are ignored the infant's behaviour will progressively become more agitated until he is crying, making latching more difficult. If the feed is further delayed the infant may tire quickly and feed poorly once feeding is finally offered.
Early feeding cues
- mouthing and non-nutritive sucking - the infant moves his mouth in a searching or sucking manner
- subtle body movements, wriggling
- rooting when face touched
- hand-to-mouth movements, with or without sucking on hand

Newborn displaying early feeding cue.
© D.Fisher, IBCLC
Answering baby's cues

Workbook Activity 5.1
Complete Activity 5.1 in your workbook.
It's a team effort!
The team consists of the mother and the baby. Supporters of the team include the baby's father, the mother's other relatives and friends, and her health care providers.
- The mother's role is to position the baby to facilitate the breastfeeding reflexes.
- The baby's role is to be free to respond to the stimulation of those reflexes. If not interfered with the baby's reflexes will cause him to latch perfectly to the mother's breast and suckle effectively.
- Your role is to guide the mother to position the baby so that the baby's reflexes are stimulated - not to either do it for the mother and baby, nor to tell the mother how she should latch the baby.
Preparing to guide the mother
Expensive teaching aids aren't necessary to demonstrate good positioning and latch. Common positioning and latching problems can be avoided by using these simple strategies.
- Demonstrate positioning using a doll. This is an effective visual aid.
- Ask the mother to try to swallow when her head is turned to one side, or when her head is tilted forward. This demonstrates how difficult it would be for baby to swallow if he had to turn his head or flex his neck to latch.
- Ask the mother suck on her own thumb. Firstly have her put her thumb midway into her mouth and suck, then move the thumb back to the junction of the soft and hard palate and suck. Ask her to compare the effort required to keep the thumb in her mouth in both positions and the different tongue action necessary in each position. This may help the mother to understand the importance of facilitating a deep latch where her nipple will move to the back of the baby's mouth to prevent undue pressure on the nipple.
- Show the mother a photograph of a baby who is well positioned and latched to the breast. Be very discerning though - there are many posters available that show poorly latched infants.

What's your practice like?
How do you assist a mother to position and latch her baby? How often do you achieve this being totally 'hands off'? Note the number of times the mother latches her baby well herself after your 'hands off' instructions, and the number of times you give hands-on assistance. Think about why you are needing to do it for her, or giving her significant assistance. Reflect on ways to reduce the number of times hands-on assistance is necessary.
How would you feel about benchmarking your results against those of several of your colleagues? Get a small group together that you feel 'safe' with and keep your individual statistics for a month, then compare them. Explanations for unsuccessful cases can be discussed together.
What should I remember?

- Ways to teach and pass on knowledge without touching
- Variations of early feeding cues
- A baby who is crying in hunger is detrimental to breastfeeding