Bury the lower half of your baby's face into your upper breast then bring baby on mouth over nipple

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.

Bring baby in for a deep and symmetrical face-breast bury

It works best to support baby's head on your forearm as he comes onto your breast.

As you get started, bring your baby's face into contact with your breast above your nipple and areola, on the upper half of your breast. I call this 'smooshing' baby's face into your breast! Once you have the baby against your body and the little face buried in (- don't worry, he will pull back if he's unable breathe, and anyway, you're there -) you'll notice that baby bobs his head around, getting oriented.

Smooshing baby's face into your upper breast turns on his bobbing and oral seeking reflexes, so that he starts looking for the nipple.

You'll be surprised at just how much the baby is able to bob his head around if you are in the deck-chair position and providing some support between the shoulder blades with your hand. That will be your right hand between his shoulder blades, if you are bringing baby onto your left breast, or vice versa.

It's as if you are now providing the core stability the baby needs to activate her reflexes and find the breast. Look for how the baby's mouth opens up when her little face buries into your breast.

We want to take advantage of this opening-up-the-mouth reflex as we bring the baby on. If the baby seems to be hovering over the breast in frustration, but not coming on, this is because baby's face and chin don't have the contact with your breast that is required for her to get oriented and to open up her mouth.

Once baby opens her mouth, a little help with the forearm to lower her down and over the nipple usually works well, although you could also let baby do it herself. But if you have nipple pain, actively lowering your baby to bring her on mouth over nipple works best.

You don't need to worry about waiting for a wide gape or taking baby off if he comes on shallowly

Don't worry about nipple to nose, or waiting for a wide gape, or trying to achieve an asymmetric latch. Just bring baby on mouth over nipple.

Waiting for a perfect 'gape' can frustrate your baby, dialling him up at the breast. Usually a wide 'gape' doesn't happen anyway. We just wait for the oral seeking reflexes to activate and the little mouth to open up enough so that you can bring baby's mouth directly onto the nipple.

We also don't need to take the baby off if he seems to come on quite superficially. Most babies come on shallowly, and easy effective breastfeeding doesn't depend on the nipple being deep in baby's mouth at the beginning. We do what is workable to get our baby on.

More and more nipple and breast tissue will be quickly drawn up as your baby's jaw and tongue drop reflexly now that the baby is underway. The vacuum generated in your baby's mouth does its work.

It's what comes next with the micromovements that matters, to make sure there is no breast tissue drag stopping your baby's mouth from filling up with nipple and breast tissue.

You can't see baby's face-breast bury from the side but you could ask someone to look or take a photo for you

You mightn't be able to see how your baby's lower face is burying into the breast from your vantage point above, looking down. This is normal, and you'll just keep experimenting by feel, and by watching your baby's responses.

No breastfeeding woman can see what's happening from the side view when she is in a semi-reclined position - although some women like to use mirrors, or they ask their support person to take a photo. Mostly though, you are working by feel and by noticing your baby's responses.

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.

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

Thompson RE, Kruske S, Barclay L, Linden K, Gao Y, Kildea SV. Potential predictors of nipple trauma from an in-home breastfeeding programme: a cross-sectional study. Women and Birth. 2016;29:336-344.