How babies suck in breastfeeding

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.

When your baby is at the breast, baby's jaw drops down and a vacuum is created in the baby's mouth.

When a mother and her baby have good fit and hold, this vacuum draws more and more breast tissue in, little by little, deeper and deeper, with each drop of the jaw. The more breast tissue that is drawn up by the vacuum as baby's jaw drops, the more her mouth is opened up wide by that breast tissue between sucks. When her mouth is as full of breast tissue as it can be, the nipple will be drawn safely up onto the back of the tongue near where the hard and soft palate meet. Here the nipple is protected from damage, and can heal.

You might have heard that the baby's lips need to flange for successful breastfeeding, but this isn't the case. In fact, if you can see the baby's lips, the baby won't be transferring milk optimally. The lips need to be buried into the breast, with the lips and face together creating a seal so that a vacuum develops inside the mouth when the jaw drops.

You can see that there is no reason to pull the breast back to look at what the baby's lips are doing - unfortunately, this will pull breast tissue out of the mouth, and the baby has to start again drawing the breast tissue in incrementally deeper with the jaw movements.

We know from ultrasound studies that the tongue moulds under and around the breast tissue during sucking, but breastfeeding does not require compression by, or a peristaltic movement of, the tongue. Healthy sucking also doesn't need the tongue to lift to half-way up the mouth or to move from side to side. Once the bolus of milk touches the back of the tongue and throat, the soft palate lifts and the bolus slides down between the soft palate and the back of the tongue into the oesophagus, with the swallow.

The most important mechanism of milk transfer on the baby's part is the vacuum created by the jaw dropping down, bringing the tongue down with it. The tongue only needs to be able to reach the lower gum to be effective in breastfeeding, once fit and hold problems are taken care of.

So much of what you might hear, and the various exercises you might be told to have your baby do, haven't been shown to be helpful when researched, and don't improve breastfeeding for women and their babies.

• You can see a video and animation about how babies breastfeed here.

• You can find out about how the baby's tongue works in breastfeeding here.

• You can find out about the role of bodywork in breastfed babies here.

• If you need help and would like to find a local NDC Accredited Practitioner, you can look here.

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.