Have baby's chest and tummy flat against your chest during breastfeeding
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.
Bringing baby's chest and tummy flat against your body turns on his breastfeeding reflexes
Bringing the baby to your body, so that his or her chest and tummy are flat against your chest and tummy, switches on the breastfeeding reflexes.
Being in the deck-chair position helps this, making it easier to hold the baby against you without fighting against gravity, that is, without the baby wanting to fall off you or fall away from the breast.
If you press your baby's face into your upper breast above your nipple and areola, her oral seeking reflexes will switch on.
Some women like to start with the baby placed vertically between their breasts. You'll need to help as baby bobs her way down towards the breast, following with your hands, snuggling her in between the shoulder blades, guiding her bottom so that she ends up in a horizontal position which doesn't create breast tissue drag.
Baby is horizontal across your body in a rib-cage wrap
If you and your baby are having any difficulties, including if the baby is fussing even a little at the breast, we strongly recommend starting with the baby horizontal across your body.
If the baby is still little, in the first weeks of life (depending on length), being tucked up under your other breast is best for biomechanics. The rib-cage wrap is definitely the best for young babies - held very snug, with the baby's tummy, hips and legs tucked around the side of you opposite from where he or she is feeding.
Women often lift the other breast and wrap baby underneath, then allow that breast to rest on baby's body. This allows his head to tilt back - and also protects caesarean section wounds.
A somewhat diagonal position works as baby grows, still with his chest and tummy pressed up against you, but his legs out to the side draped onto the couch. Often our older babies have their bottom and legs much further off to one side than you would imagine, if you are to avoid dragging the breast tissue towards the other side.
Babies will pull off if their nose buries in so that they can't breathe. However, sliding a baby a millimetre or two across towards the baby's feet, or securing that horizontal ribcage wrap if he is still little, will tilt the head and lift the nose a little.
Your hand supports the baby's upper back
You may find it easiest as you bring the baby onto the breast, depending on the age and size of the baby, to support him or her against your body with a palm across the shoulder blades and fingers in the baby's armpit. You might also support the baby's head with your forearm as he or she comes onto the breast.
Support between the shoulder blades with a firm (but never forceful) hand pressure helps stabilise your baby at the breast once he is on. It helps to hold your hand as if it is a paddle, flat, with fingers together. This also tilst baby's head back and lifts the nose a little for comfortable breathing, even as her nostrils rest lightly on the breast.
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.
Moore ER, Berman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2016(Issue 11. Art. No.: CD003519):DOI: 10.1002/14651858.CD14003519.pub14651854.
Schafer R, Watson Genna C. Physiologic breastfeeding: a contemporary approach to breastfeeding initiation. Journal of Midwifery and Women's Health. 2015;60:546-553.
Smillie CM. How infants learn to feed: a neurobehavioral model. In: Watson CG, editor. Supporting sucking skills in breastfeeding infants. New York: Jones and Bartlett Learning; 2016. p. 89-111.
