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  • what is the gestalt method of fit and hold?

About experimentation and workability in 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.

I invite you to experiment with the four steps of the gestalt method of fit and hold, and to discover what works for you and your baby.

Fitting your baby to your breast is like the rest of parenting: approximate, and imperfect. Things usually don't come together ideally all at once. We find ourselves settling for what's workable at any moment in time, which is how we develop resilience.

So as you experiment with fit and hold, remember to aim for workability, not perfection.

Our bodies are all quite unique, and it can take time to sort out how to fit your own and your baby's unique anatomies together. Over time, with experimentation and practice, most women and their babies can work it out together for easy, pain-free and efficient breastfeeding. (Though the truth is that for complex reasons breastfeeding may never completely come together for some women and their babies.)

The sooner we get in with effective help once challenges arise, the better.

You can find out about experimentation and resilience when you're caring for a baby 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.

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The three views of a stable fit and hold (in photos)

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Photo 1: side view

In the photo above, the baby has a lovely symmetrical and deep face-breast bury, from the side view.

You'll also see that I have my hands on the mother's forearm, with her consent, as we work together using the gestalt method with micromovements to eliminate the nipple and breast tissue drag which was causing her pain. She relaxed the weight of her forearm into my hands, and gave me feedback whenever her baby suckled about the effects of the micromovements that we were experimenting with, so that together we were able to find where her pain was zero out of ten on the painscale.

Photo 2: front view

The baby below had a pattern of fussiness with breastfeeding, and was more stable when we brought him into the gestalt position. He still has a slight twist to his little...

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