Finding the best position for a relaxed and comfortable breastfeed

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.

We need to prepare for breastfeeding by placing your own body in a relaxed and comfortable position, which can be sustained without causing muscle tension or pain.

The semi-reclined or deck-chair position is by far the best position for switching on your baby's breastfeeding reflexes and teaching him or her to lay down new neurological pathways during feeds.

Sitting upright to feed is a common cause of breast tissue drag, even though you might think that sitting upright would help the breast fall forward and down in a way that makes it easier for the baby to come on. Actually, for many mothers and babies, especially at the beginning, sitting upright makes breastfeeding more likely to fail. Remember too that it is not gravity which pulls milk out of the ducts, but the baby's suck (negative pressure) combined with your milk gland contraction (positive pressure). If breastfeeding seems to go better when you are semi-reclined, it is not because your milk flow is altered - it's because everything works better for baby's suck, mechanically.

When you are semi-reclined you are using the downward pull of gravity to help

• Support the baby's body without effort on your part

• The front of the baby's body fall flat against your chest and tummy

• The lower half of baby's face fall into or bury into the breast.

When you are breastfeeding at home, get comfortable with

• Footstool under your feet

• Soft pillow in the small of your back

• Lots of room on either side of you, so that the baby's feet don't kick or press against a chair arm (a two-seater lounge chair is best - dedicated nursing chairs often have arms that can get in the way)

• Very firm pillow or pile of folded towels ready to put under your elbow when feeding.

The deck-chair position is a very effective way to help breastfeeding get on track in the early days, or to help repair breastfeeding problems that have arisen later on.

This position can seem weird or extreme at first, and you might be thinking: “this isn't workable - how will I ever get out of the house?”

Being out of your house or apartment a lot meets your baby's need for rich and diverse sensory nourishment, as well as your own needs for social contact and exercise (e.g. walking!), so it's important that you feel you can breastfeed in public whenever you think it might help keep the baby downregulated.

When you are out and about, just do what is workable with breastfeeding. But you can still lean back into a semi-recline and no-one will know.

Lying back doesn't slow down the flow of milk being released during a let-down, just as leaning forward doesn't increase the flow. Milk flows in response to contraction of the mother's milk glands (letdown) and the vacuum created in the baby's mouth as the jaw drops - these aren't altered by gravity.

But good positional stability helped by the deck-chair position allows babies to better manage a vigorous let-down.

Selected references

Colson SD, Meek JH, Hawdon JM. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev. 2008;84:441-449.

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.

Moore ER, Berman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2016(Issue 11. Art. No.: CD003519):DOI: 10.1002/14651858.CD14003519.pub14651854.

Schafer R, Watson Genna C. Physiologic breastfeeding: a contemporary approach to breastfeeding initiation. Journal of Midwifery and Women's Health. 2015;60:546-553.

Smillie CM. How infants learn to feed: a neurobehavioral model. In: Watson CG, editor. Supporting sucking skills in breastfeeding infants. New York: Jones and Bartlett Learning; 2016. p. 89-111.

Svensson KE, Velandia M, Matthiesen A-ST, Welles-Nystrom BL, Widstrom A-ME. Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial. International Breastfeeding Journal. 2013;8:1.

Widstrom A-M, Lilja G, Aaltomaa-Michalias P, Dahllof A, Lintula M, Nissen E. Newborn behavior to locate the breast when skin-to-skin: a possible method for enabling early self-regulation. Acta Paediatr. 2011;100:79-85.