Notice where your breast and nipples naturally fall before bringing baby on

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.

In the semi-reclined position, take a moment to notice where your breasts and nipples fall when you have no bra or clothing on. You may notice a difference between the right and left breast and nipples. This is usual, but worth being aware of, because it means that the best fit and hold on one side might be different on the other. You can find out more about the different directions our nipples might look, and what to do about this if you have breastfeeding problems, here.

If we can, we want to work out how best to bring the baby to your breasts exactly where they fall, without needing to hold or shape your breasts in anyway. Babies often become unstable during feeds because there is a drag on the breast tissue in their mouth as gravity pulls the breast back down or off to the side. The breast always wants to fall back to its natural position.

You can see how this will make it difficult for the baby to draw the breast tissue up deeply into his or her mouth, due to the weight or drag of the breast.

• Breast tissue drag is a common cause of the baby having trouble coming onto the breast, or not being able to stay on the breast for long. You can find out about this here.

• Nipple and breast tissue drag is also a common cause of nipple pain and damage. You can find out about nipple pain and damage starting here.

If we push the breast tissue towards or into the baby's mouth with our own hand, it might seem at first the baby has a big mouthful of breast tissue. But as the feed progresses, due to the way the breast weight falls, breast tissue drag begins to cause stretching pressures on the skin of your nipple or the baby to become unstable and start to fuss.

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.