The gestalt method: high level overview of the four steps

Dr Pamela Douglas23rd of Nov 202420th of Dec 2025

Step 1. Biomechanics

Intra-oral vacuum
Symmetrical face-breast bury
Intra-oral breast tissue volume
Landing pad (description)
Breast tissue drag

Step 2. The woman prepares

Deck-chair position
Landing pad (encroachments)
Acceptance and Commitment Therapy strategies
When out and about

Step 3. Switching on baby's mammalian reflexes

Chest and tummy
Hands
Lower half of face
Initial face bury above nipple-areolar complex

Step 4. Micro-movements

Three directions
- Horizontal
- Vertical
- Forearm roll
Breast and nipple sensation
- 0-10 scale
Baby's cues
Three views
- Lateral face-breast bury
- Front alignment of baby's spine
- From above face-breast bury
Three phone photos

Ultrasound and vacuum studies elucidate the biomechanics of the infant suck cycle in breastfeeding

Intra-oral depth

Ultrasound imaging demonstrates that when the infant’s tongue is up during breastfeeding, the mid-tongue rests against the hard palate, the junction of the hard and soft palate, and the soft palate, sealing the oral cavity from the pharynx. An oral cavity seal is also required at the breast-face interface to generate baseline vacuum.

When the tongue is up, the intra-oral depth (IOD) is measured between the junction of the hard and soft palate (HSPJ) and the highest part of the tongue. The IOD when the tongue is up is often but not always 0 mm in successfully breastfeeding pairs.
That is, the apposition of the tongue and palate which comprises the…

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