Bury the lower half of your baby's face into your upper breast

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

Support baby's head with your forearm as he comes onto the breast.

Aim to bury the baby's face into your breast above the nipple-areolar complex, on the upper half of your breast. Once you have the baby against your body and the little face buried in ( - don't worry, he or she will pull back if unable breathe!- ) you'll notice that the baby bobs his or her head around, getting oriented.

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.

It's as if you are now providing the core stability the baby needs to activate his or her reflexes and find the breast. Look for how the baby's mouth opens up when his or 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 the baby's face and chin don't have the contact with the breast that is required for him or her to get oriented and to open up the mouth.

Once the baby opens the mouth, a little help with the forearm to lower him or her down and over the nipple usually works well, although you might let the baby do it him or herself.

If you have nipple pain, actively helping to bring the baby on over the nipple once the mouth-opening reflex is triggered works best.

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 the baby, dialling the baby up at the breast. Usually a wide 'gape' doesn't happen anyway. We just wait for the mouth to open up enough and then bring the baby on with nipple directly into the mouth.

We also don't need to take the baby off if he or she seems to come on quite shallowly. Most babies come on shallowly and easy effective breastfeeding doesn't depend on a deep latch at the beginning.

Babies usually come on to the breast superficially. But more and more nipple and breast tissue will be quickly drawn up as the jaw and tongue drop and the vacuum does its work.

We do what is workable to get our baby on.

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

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.