Things that tell you the position is STABLE	Things that tell you the position is UNSTABLE
Baby signs	Baby signs
Cheeks symmetrically buried into the breast from side-on view	One cheek is pressed more into the breast than the other from side-on view
Lower half of face deeply buried into breast from top-down view with lips and chin not visible	Lips and chin are visible and the lower half of the face is not deeply buried into breast
Nose rests lightly against the breast with air moving in and out freely	Nose is not touching breast
	Nose is buried too far into breast so air is not moving freely, causing baby to pull back
Good spinal alignment. Straight line from top of head through to sacrum. Pelvis tucked somewhat forward (flexion of lumbar spine)	Poor spinal alignment. Side-bends (lateral flexion). Banana-back (hyperextension of lumbar spine). Neck turned (cervical rotation)
Rib-cage wrap (horizontal tucked up under other breast if newborn; or diagonal across mother's body (if an older, longer baby)	Chest and tummy turned out from your body, not pressed up snug against your body. Body close to vertical or even diagonal if young baby
Bare hands embracing breast with lower hand and arm tucked around your side	Hands caught between your baby's body and yours
Baby relaxed at breast	Baby dials up at breast
Gap between baby's forehead and mother's upper arm, which limits the way the forearm can be used as a lever to control micromovements	Forehead and head touching mother's upper arm
Mother signs	Mother signs
Deck-chair position so that breastfeeding reflexes are turned on in baby and mother has control over baby's fit into her body without having to carry baby's weight	Sitting straight upright or leaning forward
Good spinal alignment and support (helped by footstool when at home in the early days of breastfeeding)	Side-bending or twisting of her trunk or body
Gentle pressure with paddle hand secures baby between his shoulder blades against her body without her needing to hold baby's weight	Carrying baby's weight with hands, wrists or arms, shoulders tensed
Relaxed wrist of same forearm that is supporting baby's head, so that wrist is in neutral position and usually not touching baby's body	Flexion of wrist so that hand is on baby's back, which can result in wrist pain or repetitive strain injury of wrist
Use of hard cushions or pile of towels (or improvised support when out) under elbow of forearm supporting baby's head	No elbow support
Physical comfort	Musculoskeletal pain - shoulder pain, neck pain, wrist pain, back pain
Deep tugging sensation on nipple and breast but no discomfort or pain	Nipple pain or damage

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.