How do you use the gestalt method when you're lying down to breastfeed?

How do you apply the gestalt method when you're side-lying to breastfeed?

Here are the steps you'd take as you apply the gestalt method in the side-lying position.

• Lie on your side, with the breast you want to feed your baby from against the mattress.

• Place a long very firm pillow behind your back and bottom for support in side-lying breastfeeding, since your hips and knees need to be in a straight line with the front of your torso, not bent up at all, to accommodate the length of baby's body. Bending up your hips or knees often results in breast tissue drag or baby fussing at the breast.

• Adjust the tilt of your body so that your breast and nipple fall with enough height from the mattress to be level with your baby's mouth (that is, to create the landing pad!).

• Bring baby up under breast, applying the same principles of the gestalt method - bringing your baby in for a symmetrical face-breast bury.

• When baby takes the breast, hold her firmly to your body, flat against you, with your hand with fingers spread out over the lower back and bottom. (Although side-lying breastfeeding seems to be working beautifully well for the mother and baby in the photo on this page, it will be important for many babies that you are holding them in firmly against your body with the spread out hand and fingers over their bottom and lower back.) Your other arm rests up out of the way near your head. The baby's face will be buried into the breast with nose just peeking up.

• The micromovements are either slight tilting forward and back of your shoulders and body to alter the landing pad exposure and fill the baby's face with breast tissue once he or she is on, or slight movements up and down against your body (most typically down, since the baby's feet often push him up too high).

What things can stop side-lying breastfeeding from working for you and your baby?

The most common reasons why women find that lying down breastfeeding doesn't seem to work are

• Knees and hips are bent up so that the length of the baby can't be flat against the mother's body

• Baby is too high up relative to where a woman's breast and nipple want to fall

• Baby's head is resting on her arm instead of on the mattress.

Occasionally a woman's breast may fall in a way that requires a folded up towel between the baby's chest and tummy the mother's body, because baby's head and body has to tilt so far back to reach and bury into the breast that the extreme backward bend and head tilt is not stable for the baby. Occasionally, no matter how far a woman tilts her body back away from the mattress, a generous breast may not show enough of a landing pad, and a folded face-cloth under the breast better exposes it for the baby's face bury. Mostly, cloths aren't needed for side-lying breastfeeding.

You can watch two videos of babies and their mothers breastfeeding in the side-lying position, using the gestalt method, 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.