Do other approaches to fit and hold work?

The gestalt method of fit and hold is only one part of the Neuroprotective Developmental Care (NDC) or Possums breastfeeding programs (under development as Breastfeeding stripped bare), but an important place to start. This version of the gestalt method of fit and hold for breastfeeding women has been available since 2016. I'm hoping that Breastfeeding stripped bare, the comprehensive NDC approach to breastfeeding and lactation, will be publicly available by the end of 2024. Key elements of the NDC breastfeeding work are also found in The discontented little baby book, and in my research publications, starting here.

What about the koala or 'baby-led' or 'biological nurturing' position?

This woman and her baby are happy feeding in a koala position in a breastfeeding chair. In a koala position, the baby straddles one of your thighs. Due to the length of babies, this often works best across the thigh that is opposite to the breast the baby feeds from. It still usually helps to be in the deck-chair position - this will give your lap more length and help the baby remain stable.

However, a lot of women run into problems when they try this position, such as

• Not enough room in the mother's lap for the length of the baby, so baby is coming on to the breast too high relative to where the breast naturally falls, resulting in nipple pain, which causes nipple pain or baby fussing with feeds and pulling off

• The baby's head twists or falls off to the side, which results in breast tissue drag

• Baby's spine is hyperextended into a banana shape, which results in baby fussing and pulling off

• Limited capacity to experiment with micromovemnts since baby's head is in crook of mother's arm and his head pressed against her upper arm.

In the following photos of breastfeeding in a koala or 'baby-led' position, you'll see there is poor spinal alignment - that is, the babies spine, pelvis and head are on a twist. However, the babies were feeding well. But these mothers have a more delicate breast and longer torso. You can see that the little face is deeply buried into the breast, and the baby came on with a symmetrical face-breast bury, just where the breast wants to fall. Even if it seems to be wroking, a baby with his head turned off to the side like this might pull off or fuss, and need to change positions.

Breastfeeding on the move

Over time you'll work out how to adapt the principles of a stable breastfeed to a more upright seating arrangement, though many women find a moderate backwards lean always works best, particularly if the baby is fussing. You can usually adopt a deck-chair position without people really noticing, when you're feeding on the go.

The most important things are to remember the feel of the baby deeply drawing up the breast tissue and to make sure you get that sensation without any discomfort at all, even if you are more upright, and to adjust what you are doing if the baby signals that he or she isn't stable at the breast.

This woman is demonstrating gestalt breastfeeding on the move. You will notice that she is sitting quite upright, there is often not much of a landing pad exposed, the baby's spine might have a twist, and the baby's feet may not have much support.

However, they've been laying down the neurological pathways of the gestalt method for quite some time. Now, when they are out, this mother continues to ensure that her baby's face is deeply buried into her breast and that he is feeding from the sweet spot, which feels just right. She watches to see if he is stable and makes adjustments when he signals that he isn't. Overall, it's working for them - this woman and her baby are having a great time out of the home enjoying a social life, which is what matters. She's painfree and the baby isn't fussing.

Selected references

Douglas PS, Keogh R. Gestalt breastfeeding: helping mothers and infants optimise positional stability and intra-oral breast tissue volume for effective, pain-free milk transfer. Journal of Human Lactation. 2017;33(3):509–518.

Douglas PS, Geddes DB. Practice-based interpretation of ultrasound studies leads the way to less pharmaceutical and surgical intervention for breastfeeding babies and more effective clinical support. Midwifery. 2018;58:145–155.

Douglas PS, Perrella SL, Geddes DT. A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series. BMC Pregnancy and Childbirth. 2022;22(1):94. DOI: 10.1186/s12884-12021-04363-12887.