Ina May's Guide to Breastfeeding

Getting Started: The Basics

How will you feel immediately after giving birth? You’ll know for sure only when that moment arrives. But however your baby’s birth happens, there is a very good chance that, besides feeling relieved and elated, you’ll be physically exhausted and all of the muscles of your body will want to relax. If so, this is exactly what you should do. Ideally, those who are assisting you will help you find a position in which you don’t have to hold any muscle in your body tense.

There is no single perfect position for you to be in to hold your baby for the first time. If you feel strong, it’s fine to hold him while seated, but if you feel shaky and exhausted, he can make very nice contact with you if placed facedown on your belly or chest. In fact, if he’s breathing well, the best place for him to be is on your belly (or chest), covered with a warm blanket or towel.

Remember: The more uninterrupted skin-to-skin contact you and your baby have during the first two hours after birth, the greater the chance that he will be able to find your breast and latch on to it in the way nature intended. If the hospital where you give birth wants you to wear an open-back hospital gown, I suggest that you turn it around in the latter hour or two of labor so that it opens in the front instead. That way, when your baby is born, he can immediately be placed on your warm, soft skin instead of on the crinkly, uncomfortable sterile paper that is used to cover the examination surfaces in most hospitals. Even if you’ve had a cesarean, your baby can be placed on your chest for a while if you’re feeling well enough. You’ve done your hard work. Now you’re supposed to get comfortable so that you can fully enjoy the precious beginning moments of his life.

Even though your hospital may allow several of your family members in your room soon after you give birth, I recommend that you educate your family that it’s better for them to express their love by tidying your house, doing laundry, and preparing meals. The presence of too many loving people around a newborn can overwhelm his senses and cause him to shut down, interfering with his ability to find the breast and learn to suck effectively. Getting a good start to breastfeeding should take priority over getting early photographs. Your baby will appreciate this consideration at the time and probably later in life as well.

When you first hold your baby, he will be wet with amniotic fluid and perhaps some blood if you had a laceration or an episiotomy. He may also have some white cream called vernix on his skin, either in the creases of his arms and legs or, in some cases, all over. If your midwife or nurse wants to wipe away some blood while you are holding your baby, that’s okay—although you may prefer to do it yourself. The other fluids are more important, because they are part of nature’s signaling system for the next phase of your relationship with your baby to begin. Amniotic fluid and vernix both help to facilitate the process of bonding and attachment. It’s as important to let the amniotic fluid and vernix dry on your baby’s skin as it is for you to keep soaps and lotions away from your own nipples. Vernix will also protect the skin of your newborn; it will soak in over the next few hours, helping him make the transition between the watery environment he had inside your body and the dry one he’ll live in for the rest of his life. If there is a lot of vernix on your baby’s back, you’ll find what an excellent hand cream it is. Your unwashed baby will exude a wonderful odor, which new mothers often describe in those moments just after birth as “heavenly” or “intoxicating.”

Barbara’s story shows how much a newborn infant’s natural smell can mean to his mother.

 Barbara: Our son was welcomed into our arms after a perfect home birth. The midwife left three hours later, and my husband and I proceeded to call family members with the happy news. My older sister, who lived just an hour away, asked if she could come over to help. She did some laundry, cooked, and then offered to bathe the baby. We didn’t think much of it at the time, so I told her to go ahead. I was really surprised after the bath when she handed my baby back to me and I didn’t recognize him. I knew it was my baby, but the smell was wrong. This was very upsetting to me. I could never tell my sister this, but this has been one of my most vivid memories of that birth.

  Will you feel an impulse to nuzzle, kiss, or lick your newborn baby? I hope so, and if you do, I invite you to surrender to it. Touch of this kind is calming to a newborn. Your baby will be comforted by your smell, your warmth, and the softness of your breast, even though he may not yet show signs of readiness to suck.

Usually, babies do some licking and nuzzling before getting down to the business of opening their mouths wide enough to really suckle, and they’re not even ready for the licking and nuzzling until they’re breathing freely and easily and feeling somewhat calm. It’s always best not to try to force things but rather to let your baby’s natural responses unfold in their own time. Pay attention to his movements and signals, as well as to your own sensations and impulses, without hurrying him or becoming upset with your lack of progress. Being in a rush will only make latching more difficult.

Babies love being nuzzled.

Babies love being kissed.

Don’t think there is any one posture that you should take in order to be doing it “right.” Together, you and your baby will find out which positions and practices work best so he gets off to a good start.

Some newborns figure out how to get a good latch at the breast almost immediately, while others require much more time and patience to learn how to feed effectively. Getting a good latch means that your baby is able to draw colostrum or milk from your breast efficiently without injuring your nipples in the process. It may be easier to accomplish this after your placenta has delivered and any stitches you need have been made. Anything that makes you uneasy will have a ripple effect on your baby and will make nursing more difficult. You were your baby’s environment for nine months, and that situation does not change once he is born.

Intrinsic Newborn Reflexes and Responses

Research findings now support common sense.

—Suzanne Colson, PhD

Did you know that your baby’s nervous system and your own are programmed to mesh together after birth in a way that creates interactions between the two of you—interactions that can greatly facilitate breastfeeding? Some of the most interesting research on breastfeeding in recent years is the work on “biological nurturing” by Suzanne Colson, PhD, a midwife-researcher based in England and France. Her message is that breastfeeding generally gets off to the best start when mother and baby are able to interact with each other in the ways that mothers themselves find most comfortable in the days following birth. In basic terms, “biological nurturing” is “doing what comes naturally.” Although this approach sounds simple and reasonable, it may not be followed in hospitals, where it is common for a new mother to be strongly directed in how to position herself when first introducing her newborn baby to the breast.

Dr. Colson’s biological-nurturing approach assumes that both mothers and babies—if they are able to spend uninterrupted time in body contact with each other—exhibit certain behaviors that are intrinsic and instinctual. These very reflexes facilitate effective breastfeeding. Keeping the baby belly-to-belly with the mother often begins the breastfeeding process. Dr. Colson’s research suggests that your urges to handle your newborn baby’s feet or to give him other kinds of caresses are all part of a familiar pattern of behaviors that trigger your baby’s intrinsic responses in preparation for breastfeeding. It’s good for you to be able to recognize his cues for what they are, instead of thinking, as overwhelmed new mothers sometimes do, that some of them mean the baby is refusing to take the breast. If your baby turns his head from side to side, this doesn’t mean that he is refusing your breast. On the contrary, it means that he is looking for it. More than fifty of these cues have been identified in new-borns, including: nuzzling, licking the lips, tongue-darting, snuffling and snorting, opening the mouth, hand to mouth, and bobbing the head.

Your baby is most likely to exhibit these behaviors while next to your body, especially when he is cuddled up close to you or when you are hugging him. They are clues that he is searching for your breast.

This baby is ready to latch.

By carefully analyzing videos of feeding sessions of forty healthy mother-baby pairs from England and France during the first month of breastfeeding, Dr. Colson’s team found that most of the mothers whose babies exhibited the highest number of inborn reflexes were in a semi-reclined position, with their babies facing toward them in full body contact.1 This is interesting since, in much breastfeeding literature, this position either isn’t mentioned at all or is labeled “incorrect.” The current teaching on the subject holds that babies are meant to lie on their backs or sides while feeding and that pressure along the baby’s back is necessary for effective feeding. (Maybe people have trouble understanding that the gravity factor makes no difference in milk transfer from mother to baby. No one can drink “uphill” from a cup, but drinking from a breast is another matter.) In the U.K., it is common for a new mother to be instructed that she must sit in an upright position with at least one foot on the floor or lying on her side for there to be a good latch.

Dr. Colson’s studies appear to contradict these beliefs, suggesting instead that the positions many mothers take without direction—even nontraditional positions—may be the ones that best trigger the inborn reflexes that help newborns initiate enjoyable, pain-free breastfeeding and satisfactory milk transfer. According to Dr. Colson, “When mothers encountering problems changed to full [biological-nurturing] postures, gulping and gagging diminished, and the baby often became the active agent controlling the feed, aided by the different types of [primitive neonatal reflexes].”

It’s worth knowing that one hundred percent of the mothers in the group Dr. Colson’s team studied were still breastfeeding at six weeks postpartum (regardless of what position they used for nursing). Compare this with the sixty-three percent in the general U.K. population who were still breastfeeding at this stage after having followed conventional advice from the beginning of their breastfeeding experiences.

When my partners and I began helping mothers initiate breastfeeding during my early days as a midwife, we took the approach that Dr. Colson suggests (although I didn’t know her then and she hadn’t yet begun her research). We followed the lead of the mother and baby as they moved together. If a mother needed help or encouragement, we gave it. Otherwise, we let nature take its course: We placed the baby on the mother’s body (making her as comfortable as we could while waiting for the placenta) and let the two of them figure it out for themselves. Very often—but not always—breastfeeding began with the baby still in that position. For each of my own three home births, I chose to lean back with my babies held on top of me. Any other posture would have been less comfortable, from my perspective, just after giving birth. Each of my babies latched perfectly and within half an hour of being born.

Biological-nurturing position

In short, Dr. Colson’s research buttresses the approach that my partners and I have taken for four decades. Our degree of success in initiating and sustaining breastfeeding is as compelling as it gets (ninety-nine percent initiation of breastfeeding and ninety-seven percent still breastfeeding at six months). We managed this high degree of breastfeeding success without professional advice or manuals, not because we would have rejected either—we just didn’t know in our pioneering days that these existed.

Naturally, a semi-reclined position will not be comfortable for a woman who has just had a cesarean, and not every baby will latch best in the semi-reclined or fully reclined position. The important consideration is that Dr. Colson observed mothers as they behave of their own accord, without outside interference.

An unexpected observation of one of Dr. Colson’s earlier studies was that biological nurturing also increased the length of exclusive breastfeeding for a group of babies who had been considered “at risk” and therefore less likely to enjoy breastfeeding success.2–3 Some of the mothers involved in these studies chose to sit upright, while others leaned back while sitting, and still others nursed while lying on their backs or sides. Some had complete skin-to-skin contact with their babies; others were lightly clothed (while still allowing easy access to the breast). The mothers who adopted these postures remarked that they were comfortable, with no neck strain and with their shoulders held low and relaxed. Each had good support to all areas of her body and was able to stay in that posture for quite a long period of time without shifting.

Those mothers who were in semi-reclined positions or who were lying flat on their backs with a pillow under their head and perhaps another under the knees rarely needed more pillows to support their babies. Instead, the mother’s own body provided full support. Many of the mothers didn’t use their hands for support but instead for caressing and stroking the baby while breastfeeding. In case you’ve read elsewhere that babies can’t get hold of the nipple from this position, this may be true of some tiny premature babies, but most others are fully able to find their mother’s nipple and latch on from this position, just as puppies, kittens, and most other mammals do. Newborn babies can scoot forward if placed on their bellies. If they’re on their backs, they need to be cuddled so they are lying on one side as they come to the breast.

Babies who are routinely placed on their mothers’ abdomen just after birth usually find the breast and latch (with a little help) within an hour. It’s best to allow the baby who latches well to stay at the breast until he lets go or falls asleep rather than to interrupt this precious connection because of some external schedule. When your baby is well latched, he has a sense of connection to you and will be able to relax fully. His innate responses function best when he is in this state of mind.

In Dr. Colson’s study, some mothers wanted to hold their breasts during a feeding, while others didn’t. She concluded that mothers themselves were the best at deciding whether or not to hold the breast and that routine directions (however well meant) about holding the breast can often inhibit mothers’ instinctual behaviors. Some women even varied in breast-holding during a feeding from time to time.

Feeding Postures

As you can see, there is no one correct way to hold a feeding baby. Different ways will work better for different women and babies, depending upon the mother’s arm length; the size, shape, and height of her breasts; and the baby’s mouth habits. It’s a good idea to try more than one way if you experience any problems at all in getting started, as you may not yet have discovered what works best for you and your newborn. In these first moments, much will depend upon how your bottom feels right after giving birth and on how tired you are when you first hold your baby.

The Lying Position

If you feel like leaning back with your legs outstretched or with your legs slightly bent at the knees and supported by a pillow, with your feet resting on the bed, go ahead. If your baby is placed immediately on top of you after birth, you are in biological-nurturing position. Not only that—you are also multitasking. Your baby begins to exhibit his inborn reflexes by crawling toward your breasts or massaging them, and your uterus will respond by contracting and expelling your placenta in good time. Bravo! If your bottom is quite sore in the day or so following birth, this semireclining position is likely to work better and be less tiring for you than trying to sit completely upright. It may even allow you to have one or both of your hands free to caress your baby.

The Sitting Position

If you decide that you would be comfortable sitting more upright, you’ll probably want a pillow behind your back. You should have two more pillows ready: one for your lap and one for the elbow of the arm holding your baby. A relatively small percentage of women will find that they do not need any pillows, but you should be sure to use one if you must lean forward in order to make contact with his mouth (a forward-leaning posture will cause muscle strain, tension, and backache). Some high-breasted women may find it necessary to prop their baby with more than one pillow. However many pillows you decide to use, be sure to adjust yourself so that there is no strain in your neck and shoulders as you sit, and take a few long, deep breaths as you get settled.

Side-Lying Position

You can also lie on your side with a pillow under your head, holding your baby facing you and in contact with your body. You’ll probably want a pillow behind your back as well, because it is important for you to refrain from leaning toward your baby; you should instead be pulling your baby close to you. You may want yet another pillow under your upper leg to achieve a good level of relaxation.

Take note of your baby’s position in relation to you before you bring him to your breast. He should be facing you, lying on his side, with his head aligned with the rest of his body. His head should not be tipped way forward or way backward, as this will make swallowing difficult for him. It is no simpler for babies to swallow this way than it is for adults! Your baby’s best nursing position is with his head tilted slightly back with his chin gently buried in the underside of your breast.

The side-lying position

Always correct your baby’s position when you notice that his chin is resting on his chest while nursing. This will not only make it hard for him to swallow, it will soon make your nipples sore. Without detaching your baby, you can simply slide his body about an inch in the direction of his feet. Don’t be surprised in the beginning if you have to adjust and readjust your baby in relation to your body until you find what works best for you.

Will your baby’s head rest on the bed or on your upper arm as you lie on your side? This depends upon the shape and size of your breasts. As always, choose the posture that is most comfortable for you, adjusting your baby’s position accordingly. Once the positioning seems right, you can watch for his “I’m ready” cues (lip-smacking, tongue movements, hands brought to the mouth, or, best, a widely gaped mouth) and, before a moment is lost, pull him toward your breast, aiming so that his chin, not his nose, first contacts your breast. The perfect wide gape, combined with a close cuddle, should result in your baby holding your nipple and areola slightly off center, with a little more of the underside of your breast held firmly in his mouth and his lips flanged outward (someone else might need to look at his lower lip). His body should be tucked in close to yours.

The side-lying position is particularly good for mothers who have had cesareans, as it puts no pressure on the incision, while allowing them to rest comfortably.

Different Ways to Hold Your Baby If Those
Already Mentioned Don’t Make the Grade

Cradle Hold

As always, step one is to get comfortable. Put a pillow behind your back and shoulders, another under the elbow of the arm that is holding your baby, and—if necessary—another one (sometimes two) in your lap under the baby. It’s important that your arms, upper back, and neck do not have to work to support the weight of your baby.

Make sure that he is held snugly to your chest, with his head resting on your forearm, not in the crook of your elbow, and the rest of his body positioned along your arm. He should be lying on his side, with his tummy facing yours and his entire body pulled in close. His lower arm should be tucked under your breast, with his upper arm and hand being held away from his mouth as you bring him toward your breast. His head should be facing straight forward and tilted back just a little, allowing his chin to approach your breast first. If his nose reaches the breast first, a poor latch will be the likely result. If this happens, slide his entire body a little in the direction needed to correct his head position. This move will protect your nipple from an uncomfortable latch at the same time that it will make swallowing much easier for your baby.

The cradle hold

Underarm Hold

This feeding position also requires that you get comfortably seated first, with pillows behind your back and shoulders. Arrange one or two at your side to bring your baby up to the level of your breast and then place him on top of these pillows.

Supporting your baby’s upper body with your forearm and his neck with your hand, hold him facing you, with the lower half of his body tucked under your arm. You’ll want to make sure that his body is positioned so your breast is directly in front of his mouth; he shouldn’t have to bend his neck forward in order to latch. Neither you nor your baby should be leaning forward.

When using the underarm hold, it’s important that you hold your baby by the back of the neck rather than by the head. In this way, his head is supported, but he is still able to turn it from side to side. Babies don’t like having their heads shoved into their food any more than we grown-ups do, and they will resist this if you try it.

Once your baby latches from this position, you can settle back as much as you need to get comfortable. If your arm tires from holding him, you’ll need to add another pillow or folded blanket to provide support. (It’s possible to develop carpal tunnel syndrome if you make a habit of nursing in this position for weeks without proper support. If you already have carpal tunnel syndrome, you may not like this position.)

The underarm hold may be easier than other positions for women with very large breasts, because it allows a clearer view of the baby while giving the mother better control of the baby’s head. It also works well for many women who have had cesareans, because it puts no pressure on the incision. Premature babies with a weak suck may also nurse better in this position.

The underarm hold

Cross-Cradle Hold

This seated position is sometimes used for babies who are having a hard time latching (or staying latched) when they are held in a different way. It has sometimes been heavily promoted as the best nursing position, but, in my opinion, it is not a very natural hold—only rarely would a mother discover it on her own. In Australia, I met a few women who continued to use it even though they were having trouble with sore nipples and poor milk transfer. They were simply obeying advice they received just after birth that this position was superior to others, whether or not it was natural-feeling for the mother. Continuing to use this hold once a baby is well latched and breastfeeding may increase your risk of backache and carpal tunnel pain.

Though the cross-cradle hold may involve some difficulties if it becomes the “position of choice,” you may find it useful for getting your baby to take your breast for the first few times. Some lactation consultants particularly recommend it for small premature babies, who may still hold themselves in the fetal position while in the cradle hold, thus interfering with a good strong latch.

To use this hold, sit in a comfortable position with enough support behind you so that you are neither leaning back nor forward. Then hold your baby with the arm opposite to the breast you will be offering—in other words, support your baby with your right arm if you want him at your left breast. You will probably need a pillow in your lap to bring your baby up high enough to reach your breast and to support some of his weight. Your baby-holding hand should be supporting your baby’s head with your thumb behind his upper ear and your other fingers holding his cheek near his lower ear. Do not push on the back of his head with your hand, as this usually causes babies to arch their backs and to resist. Your other hand (the one on your breast-using side) should cup and support your breast from below. It should be held in a U-shape, with your fingers forming one side of the U, your thumb the other side, and your palm facing upward. Your hand should be below your areola, so that you are sure it is not covering the part of your breast that needs to be inside your baby’s mouth.

As with the other feeding positions, you should pull your baby to your breast with his body positioned so that his chin touches your breast first, enabling him to make the ideal off-center latch that protects your nipple from injury and makes it possible for your nipple to be drawn well back into his mouth.

Once your baby is latched well, you can switch from the cross-cradle hold to the cradle hold, which you will probably find more relaxing.

The cross-cradle hold

Other Positions

There are a few more acrobatic positions that may prove temporarily useful if you are having problems with injured nipples or an obstructed milk duct. If the obstructed duct is above your areola, for instance, you might find it useful to nurse your baby with his feet held toward your head. Or you might lay your baby on his back as you crouch over him on your elbows and knees in order to find the alignment between his body and yours that puts his chin on the place closest to your blocked duct.

To Hold or Not to Hold Your Breast

The advantage of holding your breast when you and your baby are learning effective feeding is that proper holding can make your breast firmer, which will make latching on easier for your baby. Your holding hand becomes a one-cup living bra. However, it’s important to hold your breast correctly if you don’t want to introduce secondary problems. Whether you use the C-hold or the U-hold, your hand needs to be positioned well back from the areola. Check this carefully, and make sure that you are presenting your baby with a nipple that is being squeezed into a shape that can fit into his mouth (an oval that’s lying down).

If your breasts are rather small, holding your breast with one hand may not be necessary at all.

Sometimes women with really large breasts find it easier to put a pillow under the breast to support its bulk, using one hand to support the part near (close to, but never over) the areola.

Once your baby has become an adept eater, you’ll probably find that he has no trouble maintaining a good latch without your hand supporting the weight of your breast. However, as long as he sometimes loses hold of a good latch when he’d rather be suckling, it’s a good idea to continue holding your breast while nursing. It won’t be long until he’s strong enough to keep his grasp with less help.

It will be easier for your crying baby to latch well if you calm him before bringing him to your breast.

Knowing If the Latch Is Right

To qualify as a correct latch to the breast (rather than a signal that you need to protect your nipple and try again), the latch should have your baby’s lips curled outward and firmly applied to your breast. If your breasts are large, you will find it hard to see for yourself, but this is what should be happening if your baby has a good latch: If you pull slightly on your baby’s lower lip while he is suckling, you should see that his tongue is curled up on each side and cupped around your breast, forming a trough to the back of his mouth. A large area of his tongue should be in direct contact with the underside of your breast, massaging it in a wavelike motion that brings the milk into his mouth with every suck.

A good latch

Other Signs of a Good Latch:

·   You hear your baby swallowing—gulp, gulp, gulp.

·   You can see movement at the place between your baby’s temple and ear.

·   You hear no clicking or smacking sound as your baby sucks (indicating that he is breaking and reestablishing suction again and again).

·   Your breast is greatly softened after the baby feeds there.

·   Your nipple doesn’t hurt after the first few sucks.

·   Your baby seems relaxed when he’s feeding.

Signs of a Bad Latch

When your baby is nursing, there should be absolutely no friction taking place between the baby’s mouth and your breast, and your breast should not be pulled in and out as he sucks. If you or someone else sees this happening, it’s time to end this incorrect latch and start again, even if you have to repeat the process thirty-seven times. Remember, you are not a failure as a mother if your baby decides that it is too much trouble to nurse and goes to sleep before achieving a good latch. Soon enough, he will wake up again, wanting to suck. If you are patient and persistent, newborn babies can learn new habits fairly quickly, because, unlike adults, they live completely in the present moment and do not cling to the past or worry about the future. One thing to remember, though, is that it will be easier for you to teach your baby to correct his latch if your immediate surroundings are not full of distractions.

Another sure sign that your baby’s latch needs correction is when your nipple has been sucked into an asymmetrical shape just after nursing. For example, you may notice that it has been drawn into the shape of a new lipstick.

Fixing Your Baby’s Latch

If your baby has trouble latching, it may be that you are leaning forward and trying to aim your breast dead center into your baby’s mouth. This strategy is likely to make your baby grasp your nipple only in the front part of his mouth, which will be bad news for your nipple. I like the sandwich analogy, as described by Diane Wiessinger, a U.S. lactation consultant and La Leche League leader. She points out that when you are going to take a bite out of a large sandwich, your lower jaw is the movable part and, in taking that first bite, you will position it well back into the underside of the sandwich. Your upper jaw will be the last part to complete the bite. Think of this approach as you bring your baby’s mouth to your breast. Instead of making a bull’s-eye approach—trying to get your nipple centered in your baby’s mouth—try instead to have his head tilted slightly back so his chin reaches your breast before his mouth. Pull him toward you so that your breast is rolled onto his lower jaw first; this way, he can take a large mouthful of the underside of your areola. Your areola should go into his mouth a split second before your nipple gets there. Just as your nipple begins to disappear into his mouth and his jaws start to close, pull his shoulders in even closer to your body. Doing this gives him a better chance of getting your nipple (and much of your areola) well back into his mouth.

Wait to bring your baby toward your breast until his mouth is about as wide as a yawn. Think of how baby birds ask for food from their parents. If your baby doesn’t open wide, there are a few strategies for encouraging better gaping. One is to gently tickle and tease his lips with your nipple. Another is to hold your own mouth open wide. (Researchers have demonstrated what countless mothers already knew: Newborn babies come equipped with the ability to imitate facial expressions.) Another is to press your baby’s palm. If all these methods fail to produce the response you want, you can gently and firmly pull down on his chin with the index finger of the hand that is supporting your breast. Do this only as your baby is opening his mouth—the act of opening puts his mind into a relaxed state, so you shouldn’t encounter resistance at that moment. It may help you to obtain assistance if you have trouble coordinating all the movements necessary to accomplish this. Timing is everything, and practice makes perfect.

Getting Baby to Let Go

Knowing how to get your baby to let go of your breast once he has latched on incorrectly is an indispensable skill. I have noticed that many women will put up with nipple pain rather than end a bad latch in order to try again—as if they are afraid to disturb the baby once he is sucking, even if he isn’t well latched and it hurts. The trouble with this is that nipple tissue can easily be injured, and when this happens, that injury can quickly worsen, inhibiting your baby’s ability to get your milk. Remember: When the latch is bad, he isn’t getting much milk, so please don’t be afraid to stop an unsatisfactory latch until he gets it right. There are several methods that you might use:

·   Push down on your breast near the corner of your baby’s mouth and quickly pull your nipple out.

·   Put your finger into the corner of his mouth to break suction.

·   Pull down on his chin.

Don’t be surprised if you have to make your baby let go many times as you learn together how to get the latch right. Neither you nor he will be graded on your performance. He is depending upon you to teach him how to get eating right. Once this skill is learned, he will remember how to do it, because the reward will be great.

The most important thing is that your baby must attach to you in a way that doesn’t hurt you. If it is a real stretch for you to say that the first latch feels comfortable and good, you should break the suction between his lower lip and your breast by pushing down on your breast at the corner of his mouth, then deftly and quickly snatch your nipple out of reach of his gums. Most babies will be surprised but not upset or angry if you do this.

Remember that you need to be attentive to your nipples’ sensitivity right from the beginning. You are not supposed to tolerate your little one gumming your nipples, so don’t tell yourself that you can probably stand it or that you are undergoing something that is normal. Your nipples are not supposed to “toughen up” or become blistered, red, raw, or shaped asymmetrically after your baby has been suckling. Your baby can and must learn how to latch on correctly. However, this learning takes place only when you go through the routine of disconnecting and then reintroducing the breast, trying for a better latch. Mother animals in the wild instinctively make sure that their little ones get sucking right rather than putting up with unnecessary pain. With them, suckling is about feeling good as much as it is about making sure their young ones thrive.

There is no reason to put a time limit on how long your baby feeds from each breast. It’s actually a good idea to let him decide when to let go of one side before you offer the other, because this allows him to get both the thirst-quenching foremilk and the higher-calorie hindmilk.