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PBL Intermediate


  • Comparing a stable vs an unstable position in breastfeeding
  • Notice where your nipple falls when baby comes off the breast
  • When baby's nose buries into the breast and airflow is obstructed
  • Is baby's suck too weak or too strong?
  • Let's work out what might be going wrong in these videos
  • Let's work out what might be going wrong in these photos
  • Why skin-to-skin contact in the bath is unlikely to help breastfeeding problems and might make things worse

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  • PBL Intermediate
  • S4: Getting fit and hold right for you and your baby
  • CH 3: Using the gestalt method to trouble shoot problems
  • PT 3.1: Things to notice about fit and hold during breastfeeds

Notice where your nipple falls when baby comes off the breast

Dr Pamela Douglas1st of Sep 20238th of Jan 2025

The gestalt method of fit and hold is only one part of the Neuroprotective Developmental Care (NDC) or Possums breastfeeding programs (under development as Breastfeeding stripped bare), but an important place to start. This version of the gestalt method of fit and hold for breastfeeding women has been available since 2016. I'm hoping that Breastfeeding stripped bare, the comprehensive NDC approach to breastfeeding and lactation, will be publicly available by the end of 2024. Key elements of the NDC breastfeeding work are also found in The discontented little baby book, and in my research publications, starting 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.

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Next up in Things to notice about fit and hold during breastfeeds

When baby's nose buries into the breast and airflow is obstructed

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Blocked off nostrils is a common cause of babies fussing a lot at the breast

Babies can breathe freely with their little noses lightly touching the breast, and this position is best for fit and hold.

But blocked off nostrils are a common reason why babies fuss, back arch, and pull off the breast, even though this problem is often not picked up. Your baby might start relaxing her little body after the first avid sucking, but if she’s not stable, this relaxing means that she sinks in closer to the breast and her nostrils block off and she can’t breathe!

Using a finger to press your breast back from baby's nose isn't a workable solution

Pressing…

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Possums acknowledges the traditional owners of the lands upon which The Possums Programs have been created, the Yuggera and Turrbal Peoples. We acknowledge that First Nations have breastfed, slept with, and lovingly raised their children on Australian lands for at least 65,000 years, to become the oldest continuous living culture on Earth. Possums stands with the Uluru Statement from the Heart.