About micromovements in 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.

What are micromovements?

As soon as the baby is on, and even if the baby has come on quite imperfectly towards the end of the breast or nipple, I suggest you begin to apply micromovements.

These are tiny steady movements of the baby in various directions, perhaps just a millimetre or two at a time, to find what

• Feels best for your breast and nipple

• Gives the baby the best face-bury

• Is most relaxing for the baby.

There are three kinds of micromovements to experiment with, millimetre by millimetre.

• Your forearm gives you control over vertical movements, higher or lower relative to your breast

• You 'snuggle and slide' your baby's body against your own, in tiny horizontal movements either towards baby's toes or toward baby's nose

• Your forearm moves as a lever, changing the baby's angle of contact with your breast with slight rolling movements.

The sweet spot

As you do these little exploratory micromovements, you are paying attention to the sensations of your breast and nipple. You are looking for a deep drawing sensation of your breast, which has no discomfort.

This is the 'sweet spot', where the nipple, areola and breast tissue are being pulled directly and deeply into the baby's mouth, without any drag. Once the baby has this big mouthful of breast tissue, the nipple is safely up near the junction of the hard and soft palate, and can't be damaged.

You are also looking for where the baby seems to be most relaxed and stable, not pulling or fretting.

Babies are often restless at the breast because of nipple and breast tissue drag. This is a common cause of breastfeeding problems in older babies, who have grown much longer but who are still being positioned as if they were younger. We can tell the baby has this kind of positional instability if the nipple falls towards the baby's chin or ear when he or she pulls off the breast.

Your forearm as lever

In gestalt method of fit and hold, we use the forearm that is supporting the baby's head (on the same side as the breast he or she is feeding from) as a lever to control how the baby's face falls into the breast.

The first way you can eliminate breast tissue drag is by experimenting with tiny vertical adjustments of the baby's head, higher or lower. If you drop the forearm down a millimetre or two, the baby tends to fall towards the end of the nipple and the lips become visible. If you lift the forearm a little, you will notice how the lower half of the baby's face buries into the breast, making it possible to draw draw up the breast tissue deeply.

The second way that the forearm acts as a lever is by a slight rolling action, to get that lovely symmetrical face-breast bury, which those supporting you can see from the side (but you can't see!). If the forearm is hugging the baby up too close to his or her neck, the little face will tend to fall back over your forearm and the lips become visible. Experiment with having your forearm further towards the back of your baby's head, so that you can do micro-movements adjusting the plane of contact between baby's face and the breast, again so that there is no breast tissue drag.

Once you have worked out where your forearm needs to be to help the baby bury the lower half of his or her face deeply into the breast, without drag on the nipple, we suggest you support your elbow in that position using firm cushions. This is so that you can deeply relax your shoulder muscles and let the shoulders drop down, even as your forearm provides active support for the baby's head,and ongoing experimentation with micromovements.

Vertical micromovements of baby's body

A micromovement worth checking out regularly throughout the feed is the 'down and in' (just by millimetres!). This is because we often forget, and hold our baby too high relative to where the breast wants to fall, placing an upward drag on the nipple.

It's common to be holding our baby against our breast up higher than where the breast naturally wants to fall, creating breast tissue drag. That's why experimenting with dropping baby lower, millimetre by millimetre, can be helpful.

But there are other women (often with more delicate breasts) who find that baby is dragging the breast tissue down too low, and they are much more comfortable when baby is held higher.

Horizontal micromovements of baby's body

With horizontal micromovements, the baby remains deeply pressed in against your body. The aim is to move the baby relative to your breast, rather than having your breast move with the baby. These micromovements are directed either from your hand placed like a paddle, with fingers together, pressed between his or her shoulder blades, or from your arm which is wrapped over his or her bottom in the rib-cage wrap.

We often need to pull baby back from an overshoot when coming on to the breast, just by a tiny amount. We may bring the baby on a little too far towards the upper arm on that side. We need start pulling back slightly towards the baby's feet - always only by millimetres, experimentally, to see what it feels like, and what the baby does.

You will notice that if your baby seems to have drowsed off, a micromovement or two often remindsyour baby that she is at the breast, and she begins to suck again.

Pay deep attention to even slightly different sensations in your nipple and breast tissue as you use micromovements. Experiment! Keep trying to find the place that feels just right, without discomfort or pain, right throughout the feed.

Baby's head is tilted back

Your baby is most comfortable drinking with his or head tilted back slightly. It is difficult for us as adults to drink from a glass with the chin tucked down. For the same reason, the baby needs the head tilted backwards to feel stable at the breast during feeding. But you don't have to think about this. You just need to be experimenting with micromovements.

You'll notice that wrapping the baby's bottom and legs tightly up under the opposite breast, with slight micromovements towards her feed, and lovely firm pressure using your 'paddle-hand' between her shoulder-blades, will release her nostrils just that little bit as they rest against your breast, so that baby is breathing comfortably. That's all you need to be experimenting with!

Remember it's not so much how you get the baby on, but what you do next once the baby is on, with your micromovements, that matters.

Angle control with your forearm

Although you will never be able to see from side on, and are doing this by feel, getting that deep, symmetrical face-breast bury with the little cheeks symmetrically buried in against your breast will also require what I call 'angle control', experimentation with the angle at which baby buries the lower half of his little face into your breast.

Acknowledgements

I first introduced the term micromovement into clinical breastfeeding support as a foundational part of the gestalt method in 2015. I borrowed this term from NIA dance. My NIA teachers used the term micromovement when describing women's relationships with their bodies and particular movements. In 2015, I had not heard the term micromovement used in any other context.

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.