Try not to shape the breast with your hand

A friend tells me over dinner that she remembers a well-meaning if insanely overworked midwife coming into the ward just as she was attempting to bring her newborn on to the breast. The midwife, hands busy with other tasks, began calling out repeatedly that my friend should ‘make a burger, make a burger!’ Now, my friend is able to laugh about this.

‘I had absolutely no idea what she meant!’ my friend says. ‘I was in pain from the caesarian section, hadn’t slept a wink, could hardly think, and there she is yelling at me to ‘make a burger’. What one earth did she mean?’

I knew what the midwife intended. She was trying to help.

But an excellent Australian study by another midwife Dr Robyn Thompson demonstrates that this particular style, still widely used, of shaping the breast (for instance, into a burger or sandwich shape, sometimes called a ‘c-’ or ‘v-’ or ‘u-hold’ or scissors hold) and bringing the baby on with a hand on the back of the baby’s head and neck (sometimes called the ‘cradle hold’), actually increases a woman’s risk of nipple pain fourfold. This may be because hands and fingers on the back of the baby’s head and neck switch off the baby’s breastfeeding reflexes - the baby might start back arching and fussing because of this, and dragging on the nipple.

But before all else, it’s because as soon as a woman let’s go after shaping the breast, the breast falls back to where it was, and baby experiences breast tissue drag. Bringing the baby to the breast, just where the breast falls naturally without manipulating the breast in any way, means that there is not likely to be much breast tissue drag once baby is on.

Popular advice to line the baby up nipple to nose, or have the chin and lower lip pressed into the breast first, or to watch for the tongue to go down, or to wait for a big gape, or to get an asymmetrical latch, is all unhelpful, and comes from old understandings of how babies suckle. These recommendations are to avoided in the gestalt approach.

Bring your baby onto your breast any old way!

Instead, we invite you to turn on the baby’s breastfeeding reflexes by burying the little face into your breast above the nipple and areolar, with your forearm under his head. Then, as the baby bobs and roots, you help him on. ‘Bring baby on mouth over nipple any old way’, I hear myself saying, repeatedly. ‘What matters is what comes next: the micromovements.’

If you find shaping your breast works best, just know how to quickly get rid of any breast tissue drag

Some women do find that shaping their breast tissue into a mouth-size ‘sandwich’ as the baby comes on (without using any force or coercion) and then using micromovements to compensate for any resultant breast tissue drag works best for them. If you are experimenting and find this works for you, just be mindful not to push the breast away from where it naturally wants to fall, so that the baby isn’t immediately faced with serious breast tissue drag when you let go.

Recommended resources

COMMON BREASTFEEDING PROBLEM #1: nipple and breast tissue drag

The three key elements of stable fit and hold for enjoyable breastfeeding

The mechanical effects of nipple + breast tissue drag on breastfeeding

Selected references

Thompson RE, Kruske S, Barclay L, Linden K, Gao Y, Kildea SV. Potential predictors of nipple trauma from an in-home breastfeeding programme: a cross-sectional study. Women and Birth. 2016;29:336-344.