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How women and their babies fit together for pain-free, enjoyable breastfeeding

Dr Pamela Douglas1st of Sep 202325th of Dec 2024

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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.

Gestalt: a whole that is more than the sum of its parts

The gestalt approach to helping with fit and hold in breastfeeding is a genuinely holistic form of bodywork, which I refer to as evolutionary bodywork. The gestalt method is built on the belief that you are the expert on your own baby, your body, and your breastfeeding experience - but that there are some things you have the right to know, which give you the best chance of success.

The gestalt method is an evidence-based innovation in clinical breastfeeding support, developed from two decades of my clinical experience as a breastfeeding medicine physican and lactation consultant, and drawing on ultrasound and MRI studies which elucidate the biomechanics of infant suck.

You've probably heard the terms 'latch and positioning' or 'attachment and positioning' used elsewhere. I find 'fit and hold' an easier, friendlier phrase for the same thing.

Normal mother and baby anatomies are highly diverse. The gestalt method of fit and hold in breastfeeding considers the many different factors which interact together to result in either enjoyable, pain-free breastfeeding - or breastfeeding problems.

The gestalt method of fit and hold empowers you to:

  • Switch on your baby's inbuilt breastfeeding reflexes

  • Experiment with the fit between your own and your baby's unique anatomies, to find what works

  • Create ease and comfort for your own body

  • Manage the incredibly powerful effect of breastfeeding problems on both the baby's and your own psychological states.

In the video below, Renee Keogh RN IBCLC NDC Educator gives you an overview of the gestalt method.

What are the four steps of the gestalt method?

The steps to achieving easy effective pain-free breastfeeding are

  1. Understanding the biomechanics of effective milk transfer

  2. Preparing your body and mind for relaxed and comfortable breastfeeding

  3. Switching on your baby's breastfeeding reflexes

  4. Applying the power of micromovements.

  • You can find out about evolutionary bodywork here.

  • You can find the video showing how babies suck with breastfeeding here.

WARNING: If your baby has health problems or weight gain problems, or if you have health problems that are affecting lactation, it is important that you seek the help of an appropriately qualified health professional. This program does not replace the care of your health professional.

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.

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Next up in the gestalt method: holistic bodywork for breastfeeding babies

How do you know if your breastfed baby has fit and hold problems?

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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.

Unworkable fit and hold is a very common problem for breastfeeding mother baby pairs. Unworkable fit and hold causes nipple and breast tissue drag and positional instability for both the baby and yourself.

Your baby may have fit and hold problems if he or she consistently shows one or more of the following...

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