Why does positional instability cause babies to fuss with breastfeeds?

Your baby has 'positional instability' when she fits into your body in a way that isn't comfortable or relaxed or effective, for either youself or for your baby during breastfeeding. The photo above shows a little one whose fit and hold at the breast is unstable. There are many ways in which babies might experience and show an unstable position during breastfeeds.

Positional instability is a very common cause of babies fussing at the breast, and is often not picked up by health professionals, through no fault of their own. Many of the mothers and babies I've seen over the years have been told by their breastfeeding support professionals that their fit and hold, or 'latch and positioning', is fine, but in fact they have fit and hold problems which cause serious positional instability and breast tissue drag. It all settles down when we work together using the gestalt method, which was developed over decades as I experimented with fit and hold responses to breastfeeding women and their babies in the clinic.

There are a number of ways positional instability can cause babies to fuss at the breast. This might sound confusing at first, and different to what you've heard.

Positional instability can cause

• Breast tissue drag (here)

• Landing pad encroachment (here)

• Spinal misalignment (here)

• Little nostrils to bury into your breast, obstructing her airflow.

A baby who is positionally unstable or experiencing breast tissue drag can't deeply relax while suckling at the breast, even if he copes for a little while through muscle exertion before pulling off.

A baby whose airflow through the nose is blocked off by the breast will pull off a lot and dial up during breastfeeds

This happens so much, and is so often overlooked, that it's worth a special mention. A baby whose nose is obstructed by the breast may suckle well enough when he is alert and able to pull his head and neck back a little. But as his sympathetic nervous system dials down and he relaxes his little body into the breastfeed, and relaxes his neck muscles, his nostrils bury into the breast, air flow stops, and he will soon need to pull back suddenly to breathe.

This is a surprisingly common problem in the women who come to see me for help with a baby who is fussing at the breast! We want his little nostrils resting on the breast, but not blocked off by the breast. Women can hear when their baby is having more trouble with airflow because the nostrils are partly blocked off, and use a micromovement to adjust.

Placing a finger on the breast to keep baby's nostrils clear is not a good solution

Placing a finger on the breast to keep the nostrils clear is not the best way to manage this problem because

• It's uncomfortable holding your hand up throughout the feed, and can cause you neck and shoulder pain

• Your finger's pressure will compress the milk ducts, which are very easily blocked off, putting you at risk of breast inflammation.

• You are also likely to accidentally cause breast tissue drag inside the baby's mouth, which might result in nipple pain or worsen fussiness with the feed.

You can find out how to help your baby fit into your body in a stable way with nostrils resting against your breast but breathing freely, step by step, starting here. Alternatively, you can search for an NDC Accredited Practitioner online or located near you 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.