Kirsty is mother of a six week old Alva. Alva has had poor weight gain and fussy behaviour, and feeds both from the breast and the bottle with formula. Kirsty consults with Dr Pamela Douglas for a review at Nova Health Co, Wagga Wagga, Australia, October 2023. This is PART 2 of that consultation.

For PART 1, see here. Thanks to Kirsty for her great generosity to other breastfeeding women in agreeing to participate in this educational video.

The video below demonstrates:

• Use of clinicians arm supporting forearm to give the mother the experience of micromovements, which helps her lay down the neural pathways for experimenting with tiny micromovements.

• Symmetrical face-breast bury from lateral view

• Angle control with micromovements

• In the first part of the video below, and also towards the end, Alva's nose is burying in and obstructing her breathing so that she tends to pull back every now and then to breathe. I didn't pick up the sound of her breath obstructing (although it's important to always be listening to the baby's breathing), and I also didn't have access to the lateral view which the midwife Amy was taking on video. Usually I'd check to make sure that obstruction of the nostrils was not the reason for some pulling back.

After working together on the gestalt method, little Alva settles into an enjoyable feed. The video below shows a stable fit and hold from the three views

• Mother's view looking down or clinician's view from above
• Lateral view (accessible to clinician only)
• Front on view (accessible to clinician only).

The video below shows a view from above (the mother's view looking down). You'll notice

• Baby is dialled down

• Nostrils no longer obstructing but touching breast lightly

• Lips not visible

• Some swallowing but Alva is now very relaxed and drowsing. (What matters is that both mother and baby are having an enjoyable, stable, painfree breastfeeding experience, as they experiment with a new approach to fit and hold.)