Verity experiments with the gestalt method and Riku is breastfeeding well at our follow ups

Disclaimer: the case below is an amalgam of multiple cases that have presented to me, and is not derived from any specific or identifiable mother-baby pair who have seen me as patients. Needless to say, all names are fictional.

I help Verity and her newborn experiment with the gestalt method

Riku has had difficulty coming on to the breast from birth due to positional instability, and developed a conditioned dialling up at the breast, too. I talked to Verity about what we'd do once we brought Riku onto the breast. Now, we try it together.

I support Verity’s forearm as we work together with Riku

Riku has finally been starting to dial up despite Hiromi’s best efforts, and Verity is ready to try a breastfeed. She reclines in a deck-chair position, which helps open up the landing pad of her breasts. I experiment quickly with a rolled up cloth under the breast Verity has decided to offer, finding the right size and placement for good landing pad exposure.

I also fit a larger nipple shield which gives a greater space around the base of the nipple, so that when the nipple expands during breastfeeding it won’t rub and squeeze up against the plastic. I want Riku and Verity to have every chance of a positive experience and she says that the shield has seemed to Riku previously. It’s not that less prominent nipples themselves are abnormal or a barrier to breastfeeding, but there are many factors coming together which have interfered with Riku’s capacity to take his mother’s breast, and we want to build positive experiences quickly.

Then we move into a breastfeed. I lightly secure the nipple shield on her breast, and invite Verity to bring Riku on any old way, mouth over the nipple shield.

"Don’t wait for a gape," I remind Verity, and she aims his mouth over the plastic teat. His head is on her forearm now, but when I am not there to help she will probably hold him across his upper back, fingers under his armpit, just to get started with the shield.

"Just mouth over nipple, that’s it!" Riku is familiar with the plastic teat and soon has his mouth over and around it, suckling shallowly.

"Do you mind if I touch you by placing my hands on your forearm?" I ask quietly.

"Of course," Verity replies.

I place my hands on Verity’s forearm and we begin to work carefully together. I know we have a very short period of time in which Riku may be willing to stay on, even just a matter of seconds. Riku won't not tolerate any experience of breast tissue drag for long, given his conditioned dialling up.

"Can you let me take the weight?" I ask, noticing how tightly Verity holds her forearm and shoulder. "You could take a big breath in and then let the arm go heavy and floppy as you breathe out." I feel her consciously relax her arm into my hands. We watch for Riku’s signs of agitation. I hold the weight of Verity’s forearm and apply micromovements, millimetre by millimetre, in the three directions in response to even his most subtle communications.

"Let the weight of your forearm fall into my hands," I remind Verity, over and over, as I feel her tighten and draw the baby up higher than where her breast wants to fall, even with the rolled up cloth underneath. "Just let your arm go really heavy."

After we’ve worked together for a time, Verity says: "I’ve been holding him too high. But see, he doesn’t like to be pulled in deep, he fusses and objects."

I show Verity that when she pulls the baby in deep, the breast is also being lifted higher than its natural fall, so that the action of pulling the baby in for a deep face-breast bury is also creating breast tissue drag.

"Can you think down and in?" I ask again. "Think down and in, not in and up?"

We've got Riku tucked up under the other breast, with that breast rest on his hips and body.

"This ‘down and in’ movement, with the baby flat up against your body, and a very snug ribcage wrap, sets up the biomechanics best," I explain. I help her create a paddle-hand which she places between his shoulder-blades. I also ease Riku’s little lower arm around his mother’s side, to help him get nice and low under the breast.

"See how we now have his lower arm and bare hand wrapped around your side, which helps him fit low under the breast? Now his little face scoops in under the breast with your forearm movements for that lovely symmetrical face-breast bury," I explain softly, demonstrating millimeter by millimeter with my hands taking the weight of her forearm.

"It feels really weird and uncoordinated," Verity comments. "And I’ve got to say, how do you do this when you’re out?"

"It does feel weird at first," I concede. "But it’s like anything, it's like learning to ride a bike: it just takes practice and experimentation. You just do what you can. Women often find it takes a second consultation to really get the hang of it. And when you’re out, again, you just do what you can. It’s good for the baby’s sensory needs to be out as much as possible, tends to be easier overall. So when you’re out, it’s about workability, not perfection. And you can really be quite semi-reclined in the chair when you’re out and no-one would particularly notice."

I am working carefully with Verity’s forearm in my hands and as we experiment together. And Riku has his first ever long breastfeed, as we respond sensitively millimetre by millimetre to his slightest sign of agitation. We watch him start to settle down deeply, swallowing beautifully. In a while I move away. Verity continues on, making micro-movements over and over if he seems to frown or make little agitated sounds, experimenting to see where he is most stable.

In time, he drowses into sleep at the breast.

"I can’t believe it," Verity says in a while, looking up at Hiromi. "He’s just never fed like this, ever. I can’t believe it!" Hiromi is smiling.

"And you know," I say, "if you can, these are the moments that we want to grow. It doesn’t matter that he is sleeping – his nervous system is soaking up a wonderful, deeply rested experience at the breast, and because Riku has a conditioned dialling up at the breast, we want to grow these positive times so that the conditioned dialing up fades away. When things aren’t coming together, we don't persist on having a negative experience. In that situation, we offer Riku a new sensory adventure perhaps by stepping out of the house, and try the breast again a little later."

This is a photo of me working with a breastfeeding woman and her baby, with her consent supporting her forearm and experimenting together with micromovements

I take a photograph of the three views for Verity and Hiromi to take home

I ask if Verity would like me to take photos to have at home. With her consent, on her iphone, I snap a shot from the side, from above, and from the front.

I point out to Hiromi what we are looking for, so that if Verity asks, he might give her feedback: a symmetrical face-breast bury from the side, a lovely deep bury into the breast from above, and the straight spine from the frontal view.

I do always quietly emphasise ‘if Verity asks,’ because when someone is experimenting with something new, they may not want unsolicited input!

When Riku is seven weeks old

There were many other things we had to deal with, including the conditioned dialling up and transitioning from the bottle back to the breast, but we were underway. When they came back to see me ten days after the first consultation, Riku was feeding entirely from the breast, using the nipple shield, with one bottle of formula at night, up to about 80 mls.

Verity and Hiromi stopped that bottle of formula after that second visit.

When Riku is eleven weeks old

Four weeks after seeing me, Verity told me over the phone that Riku remained exclusively and happily breastfed, gaining over 200 gm a week on average, still using the shield but she knew now not to be worried about the shield use. Maybe one day down the track, when they were ready, she might start sometimes trying without, but for now, she was simply happy to be able to enjoy breastfeeding her baby.

Recommended resources

• You can find a video of me working with the gestalt method in a consultation with a mother and her baby here, and in demonstration with a mother and her baby here.

• You can find the story of the first four days of Riku's life and how difficult it was for Verity to bring him on to the breast here.

• You can find what has happened with breastfeeding for Verity and her newborn in the three weeks after they came home from hospital here.

• You can find out how I talked about steps 1 & 2 of the gestalt method with Verity and Hiromi here.

• You can find out how I talked about steps 3 & 4 of the gestalt method with Verity and Hiromi here.