The Mother-Baby Dance:
Positioning and Latch-On
Andrea Eastman, MA, CCE, IBCLC
From: LEAVEN, Vol. 36 No. 4, August-September 2000, pp. 63-68
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
There are many pieces to this dance of positioning and latch-on that occurs between mothers and babies
Leaders around the world understand how important it is for mother and baby to be positioned well to avoid sore nipples and breastfeeding problems. This topic is covered in many books and videos, some in more depth than others. In some books, the text says one thing but the photos say another and do not illustrate optimal positions or latch-on. Finding consistent, accurate information about positioning and latch-on techniques can sometimes be a challenge. Each person and each institution may teach these techniques in different ways. Problems often arise when an institution or individual gives more emphasis on teaching one particular position to every mother and baby.
In 1989 in the Journal of Human Lactation, Mary Renfrew wrote, "To insist that the baby is positioned precisely in the way that the caregiver has been taught will be counterproductive unless there is careful consideration of the effectiveness of that positioning, and the individuality of both mother and baby. This individual patterning can be seen as a dance between mother and baby."
Renfrew continues, "This dance simply needs reinforcing and encouraging rather than controlling and limiting. The concept of 'managing' breastfeeding as often referred to in textbooks implies control and is unhelpful. The mother and baby manage their own feeding experience with sensitive input and assistance when required. In gaining a greater awareness of positioning techniques, we must avoid overemphasizing the technicalities at the expense of the individuality of each mother and baby."
We all prefer telling mothers about the breastfeeding positions that worked well for us because of our familiarity with them. We tend to avoid mentioning the positions that we ourselves did not favor. Some mothers and babies breastfeed well in every position and other mothers and babies may rely on one or two positions as they are learning to breastfeed. What works for one mother may not work for another. What works best at one breastfeeding session may not work well at the next.
Mothers need to have the opportunity to learn all possible breastfeeding positions, all possible ways to hold their breasts, and all latch-on techniques. This allows them to choose what works best for themselves and their babies. Let the mother know it should not hurt to breastfeed and trust her to find a position that does not cause pain. Trust the baby to know when he is correctly positioned. When baby is in the position that works best for him, he will be rewarded by his mother's milk flowing into his mouth. Trust the mother to know her baby. Give mother and baby time to learn from each other. Empower the mother with knowledge and trust her to choose wisely. This is after all the heart of LLLI philosophy—that each mother knows her baby best.
It is important to watch how mother and baby interact with each other and how baby behaves at the breast. Observe the cues that mother and baby give each other so that they can be reinforced if they are working well. Baby needs to be deeply attached with a mouthful of breast so that he can transfer milk effectively. Mother needs to be pain-free and her nipple should not look compressed or misshapen when it comes out of baby's mouth. Mother needs to be attentive to baby's signals so that she is able to offer her breast on cue. If all of these things are happening then it doesn't matter whether mother's technique is picture perfect. Mother and baby have found a position that works for them and we should not interfere. In other words, "If it isn't broken, don't try to fix it!"
Basic Positions for Breastfeeding
The Cradle Position
The BREASTFEEDING ANSWER BOOK describes the cradle position: "To get comfortable, suggest the mother use pillows behind her back and shoulders, under the elbow of the arm she will be using to hold the baby, and in her lap to support baby's weight. The mother holds the baby securely, with his head resting on her forearm or in the crook of her arm, whichever is more comfortable. His back is supported by her forearm, and her hand cups the baby's buttocks or thigh. The baby should be positioned on his side with his knees pulled in close to his mother. He should not have to turn his head to take the breast. If he were naked, his umbilicus would not be visible. His ear, shoulder, and hip should be in a straight line. The baby's bottom arm can be either under the mother's breast or tucked around her waist, depending on which is easier and more comfortable." See Figure 1. Kay Hoover, LLL Leader and IBCLC from Morton, Pennsylvania, USA, suggests that another possible position for baby's arm is to place it across his chest.
Many experts encourage mothers to place baby's head on her forearm rather than in the crook of her elbow. For a large-breasted woman, the crook of her elbow may be too close to her body for the baby to reach the breast. For some women, putting the baby's head in the crook of the elbow places baby's head too far to the outside of the breast. This could mean that in order to latch on baby must drop his chin to his chest. Putting his chin to his chest means that baby's lower jaw and tongue, which do most of the work of breastfeeding, are too far away from mother's breast. Baby cannot get a good mouthful of breast and may end up shallowly attached or hanging onto the nipple. It can be hard to swallow with the chin on the chest.
The cradle position is one of the most common nursing positions. It is the one that is featured most frequently in photographs in books and is the position that many experienced nursing mothers favor. Unfortunately, the cradle position can be a challenge for new, inexperienced mothers to learn. It can be difficult to control baby's head when using this position, and to keep baby high enough and close enough to mother's breast. When held in this position, a small baby may tend to curl up in a ball. The cradle position may not be the best choice if mother and baby are experiencing any problems with latch-on, milk transfer, or if the mother has sore nipples.
Diane Wiessinger, LLL Leader and IBCLC from Ithaca, New York, USA, believes that using the usual C-hold on the breast when a baby is in the cradle hold can cause problems. She uses a sandwich analogy to help explain why shaping the breast in a "sandwich hold " may help baby latch on better. "Imagine eating a very large, very thick sandwich. First the hands squeeze it a bit to create more of an oval, the long axis of the oval running corner to corner across the mouth. Fingers and thumbs form a C on each side of the sandwich, with the thumbs well out of the way to allow for a big bite. The bottom side of the sandwich is brought toward the mouth as the mandible (the lower jaw)—the working jaw—drops. The mandible is planted on the bottom of the sandwich, well back where the filling is. Only then is the sandwich swung up to let the prominent but passive maxilla (upper jaw) land on top. The asymmetry of this motion compensates for the different placements and actions of the upper and lower jaws, and results in a larger bite than would be possible with a symmetrical, fully frontal bite. A big bite requires that the sandwich be put on the tongue, which is why one cannot take a bite out of a sandwich as round and as firm as a soccer ball. Having food pushed against the tongue does not allow for it to be manipulated by the mandible; the food must land on the tongue."
She continues, "Now imagine a very big, squeezable, stationary, but suspended sandwich. If it is approached from above, the nose burrows in, and only a small bite of bread, not filling, is available because the all-important mandible (lower jaw) swings toward the chest and away from the sandwich as the chin tucks. If the sandwich is approached straight on, for a symmetrical bite, the bite is still not very large. The lips may press in rather than curling out, further limiting the size of the mouthful. To take an efficient bite from this immovable sandwich, it must first be shaped into an oval. Then it must be approached from below, starting with the nose near the sandwich stuffing. The head tips back slightly and the mandible (lower jaw) comes up and forward to fix itself well back onto the sandwich. The maxilla (upper jaw) is the last part to land on the sandwich, and it is then possible to take a large and satisfying bite."
The Football or Clutch Position
The BREASTFFEDING ANSWER BOOK describes the football or clutch hold: "To get comfortable, suggest the mother put a pillow behind her shoulders and firm pillows at her side to raise the baby up to the level of her breast. The baby faces the mother while his body is tucked under her arm along her side. The baby's bottom rests on the pillow near the mother's elbow with his hips against the back of the chair, sofa, or against the wall, if she is sitting up in bed. The baby's upper back rests along his mother's forearm while she supports his neck with her hand." See Figure 2.
The football or clutch position is a very useful position for mothers who have had a cesarean birth. It helps keep the weight of baby off mother's incision. It is also a good position for mothers with flat or inverted nipples and for babies with latch-on or sucking problems because it offers mother a better view of baby and breast and offers her better control of baby's head. The football or clutch position is a good choice for smaller babies. This position is most effective when combined with the C-hold. Unfortunately some caregivers are not familiar enough with this position to be able to teach it well. Some mothers find it is just not a comfortable position.
Alison Hazelbaker, LLL Leader and IBCLC from Columbus, Ohio, USA, finds that many people use the football hold incorrectly by combining it with the bulls-eye latch-on technique and by placing baby's mouth too far away from mother's nipple. The bulls-eye latch and asymmetric latch techniques are discussed in depth later in this article. A bulls-eye latch is one in which the nipple is centered in baby's mouth. When using an, asymmetric latch, mother aims for an off-center placement of nipple in baby's mouth so that more of the areola is covered by baby's lower jaw.
The Cross-Cradle Position
Linda Barrett, LLL Leader and IBCLC from Centerville, Ohio, USA, tells mothers that "when cross cradling, the baby is tummy to tummy with mother, supported by a pillow across mother's lap to help raise baby up to nipple level. When mother is ready to latch on baby, it is important that baby's mouth is very close to the nipple from the start. If she is planning to breastfeed on the left breast, she supports the baby with the fingers of her right hand placed loosely behind the baby's ears and neck. The baby rests in the web between the thumb, index finger, and palm of mother's hand, forming a "second neck" for baby. This helps stabilize baby's head and neck. She has the palm of her hand placed between the baby's shoulder blades. When baby opens his mouth wide, the mother pushes with the palm of her hand from between the shoulder blades not with the fingers behind the neck. This helps to bring the chin into the breast slightly before the nose, which points the nipple toward the roof of baby's mouth. As the nipple grazes the juncture of baby's hard and soft palates, it elicits baby's suck. This method also helps the baby to latch deeper onto the breast so that he can compress the milk sinuses (also called milk reservoirs) which allows for efficient milk transfer. It is important not to touch the top or back of the newborn's head because it is very sensitive after birth. When the head is touched the baby may have a tendency to pull back from mother's breast rather than move in toward the nipple. This may be the reason why some mothers have trouble getting the baby to latch on. They try to force the baby onto the breast by firmly holding the back of baby's head which causes baby to arch away from mother's breast." See Figure 3.
Many experts recommend that mother be sure that baby is tucked around her like a comma. If it seems as though baby might have trouble breathing, all the mother has to do is pull the baby closer to her body with the elbow of the arm that is supporting baby. This changes the angle so that baby's nose remains clear. In the cross-cradle position, the U-hold is more effective for supporting the breast. (The U-hold is described later in this article.)
Jan Barger, RN, IBCLC from Wheaton, Illinois, USA, recommends that mothers use what she and Judith Lauwers, BA, IBCLC from Chalfont, Pennsylvania, USA, call the dominant hand position. They find that mothers have better control of baby and are better able to position baby well when they use their dominant hand to support baby at the breast in the early days. "In the dominant hand position, the right-handed mother supports the baby's neck with her right hand and supports his body with her forearm. She then moves her arm that is holding the baby across her body to the opposite breast. This makes it possible to begin the feed at one breast in the football or clutch position and end it with the cross-cradle hold on the opposite breast without repositioning her hold on the baby." Or mother could start with the cross-cradle position and finish with the football or clutch position.
The cross-cradle position is often recommended in the early days for babies who need extra help getting latched on well. It can be easier for the mother to latch baby on in this position because it gives her more control in guiding baby to the breast. Mother's hand creates a "second neck" for baby, thus giving baby more stabilization. This makes the cross-cradle position good for premature babies and smaller babies, and for babies with low muscle tone. Dr. Jack Newman finds this position most useful when teaching mothers the asymmetric latch.
Mary Kay Smith, LLL Leader, IBCLC, and Professional Liaison (PL) Leader from Romeoville, Illinois, USA, says she suggests a new mother use the cross-cradle hold to get baby latched on well, then slide her other arm under the baby so she finishes the feeding in the more comfortable cradle position. The mother needs to be sure she keeps the baby positioned well while she does this so she doesn't disturb his sucking.
The cross-cradle position may not work well with the bulls-eye latch. In fact, trying to use this position with the bulls-eye latch may cause problems for mothers. If a mother is taught to place her hand at the back of baby's head rather than at the neck, then she may experience problems with baby arching away from her breast. She may perceive baby's action as breast refusal when it is actually a reflex. The cross-cradle position can be uncomfortable for mother to maintain without adequate support of the arm holding baby and the arm holding the breast, especially with large babies. Encourage mother to use enough pillows for optimal support. It is very important that mother is told that the cross-cradle hold is a temporary breastfeeding position. Once she and her baby are more experienced, they can use other, more comfortable nursing positions.
Diane Wiessinger says, "The first defense I heard of the cross-cradle position was by Laura Best in 1990. She said that when a mother tenses, her supporting arm tends to move out to her side. So if she's supporting the baby in her left arm at her left breast in the cradle position, she will tend to pull him toward the left—the wrong direction for a good latch. But if she is supporting him with her right arm for her left breast, she will tend, if anything, to draw him into an even better position."
Alison Hazelbaker explains that "the cross-cradle hold supports the baby's thoracic area (upper spinal column) and thus stabilizes baby's jaw. it works well with some babies who have certain types of sensory sucking problems."
Catherine Watson Genna, LLL Leader and IBCLC from Woodhaven, New York, USA, prefers the cross-cradle hold with the asymmetric latch "for babies with recessed chins and/or babies who are tongue-tied because it allows them to get more tongue in contact with the breast. This stabilizes the tongue and decreases excessive compression of mother's breast and nipple which allows baby to get bigger mouthfuls of his mother's milk."
Claudia Morse-Karzen, an LLL Leader from Illinois, USA, has a different opinion about the cross-cradle hold. She writes: "My co-Leaders and I have had dozens of calls over the past three years that stem from problems with the cross-cradle hold. We continue to see mothers coming to our meetings using the cross-cradle hold when their babies are several weeks old and not knowing why they are having problems. One mother said, 'My arms aren't strong enough to nurse.' When we showed her how to use the cradle hold she felt instant relief from her nipple soreness. Leaders should be aware of this when a mother calls with sore nipples or baby pulling off the breast and ask if the mother is using the cross-cradle hold. Even if mothers are told in the hospital that the cross-cradle hold is only a transitional hold, they often don't realize it is not necessary to use it long-term."
The Side-lying Position
The BREASTFEEDING ANSWER BOOK explains: "In the side-lying position, the mother lies on her side. To get comfortable, she can put pillows under her head, behind her back, and under the knee of her upper leg. Her body is at an angle to the bed as she leans slightly backward into the pillow behind her back. The baby is on his side facing his mother with his back resting against his mother's forearm and his knees pulled in close to his mother. To keep the baby on his side facing his mother, a folded towel, a rolled receiving blanket, or a small pillow may need to be propped behind his back." See Figure 4.
The side-lying position is helpful for mothers who are recovering from a cesarean birth or an episiotomy. This position is a good way to soothe baby to sleep and for nursing in bed. Some experts find that this is another position that works well for mothers and babies who are having trouble getting started with breastfeeding. Others feel that this position can be too challenging for new mothers. Unfortunately, this position is not always taught to new mothers in hospitals. It is rarely used in the early weeks in spite of the fact that researchers report significantly less fatigue following nursing in the side-lying position versus the sitting position. They suggest that increased emphasis on the restfulness of the side-lying position for breastfeeding may decrease postpartum fatigue and enhance breastfeeding success.
Basic Positions for the Support of the Breast
The BREASTFEEDING ANSWER BOOK explains. "The purpose of supporting the breast is to make it firmer for easier latch-on and to keep its weight off the baby's chin during feedings so that he stays latched-on well." Kay Hoover has noticed that sometimes a baby will not latch on due to the weight of mother's breast lying on his chest. When mother lifts her breast off baby's chest, he latches on.
The C-hold is described as supporting mother's breast with her thumb on top and her four fingers underneath. See Figures 1. and 5. When done properly, this hold allows mother to support her breast with her fingers far enough away from her areola to avoid interfering with baby latching on. Some photographs of the C-hold show mother's lower fingers too close to the lower part of her areola.
Remind mother to keep her fingers well back toward her chest wall. This hold allows mother to support her breast comfortably. It is a good breast hold to use with the football or clutch position or the side-lying position because it allows the alignment of the oval of breast tissue to match the position of baby's mouth. The long axis of the oval goes corner to corner in baby's mouth. This allows baby to get a larger mouthful of breast. When the C-hold is used with the cradle or cross-cradle positions, the improper alignment of this oval to baby's mouth can make it harder for baby to latch on well. This is like holding a sandwich vertically while you try to take a bite out of it holding your mouth horizontally.
Diane Wiessinger describes the U hold in this way: "To shape and stabilize her left breast, the mother can start with her left hand flat on her ribs, under her breast, with her index finger in the crease under her breast. If she now rotates her hand, her thumb will be on the outer aspect of her breast with her fingers on the inner aspect. Her breast will rest in the U formed by her thumb and index finger."
The U-hold helps keep mother's fingers behind her areola so that they do not interfere with baby's latch. it allows mother to support her breast comfortably. It is extremely useful when holding baby in the cradle or cross-cradle position because it allows the alignment of the oval of breast tissue to match the position of baby's mouth. The long axis of the oval goes corner to corner in baby's mouth. This helps ensure baby gets a larger mouthful of breast. When the U-hold is used with the football (clutch) position or the side-lying position, the improper alignment of this oval to baby's mouth can make it harder for baby to latch on well.
Norma Ritter, LLL Leader, PL Leader, and IBCLC from Big Flats, New York, USA, explains that "when using the U-hold the mother does not have a thumb on top of the breast. This eliminates the possibility that mother will be tempted to press down on the breast 'to let baby breathe,' which inadvertently moves the nipple within baby's mouth so that the latch is no longer optimal and he is 'cliff-hanging' off the end of mother's nipple."
The Scissors Hold
In the scissors hold, mother supports her breast by holding it between her index finger and middle finger. Many books discourage this way of supporting the breast because it can be very tricky for a mother to keep her fingers far enough away from the areola to avoid interfering with baby's latch. Mothers with long fingers may be able to use this hold successfully.
Basic Latch-On Techniques
When baby is latching on to mother's breast, it is very important that baby is held close to the breast. Diane Wiessinger explains that "a newborn nursing vigorously at a newly lactating breast will probably show nothing but an upper lip and fat cheek. His cheek will press against the breast so that his wide mouth is hidden. One of the questions that I ask when working with new mothers is 'Are baby's lips flanged out?' if she answers right away, I tell her to try pulling baby closer. To be able to see that easily and answer me so quickly tells me that baby is not close enough to her breast."
Babies often give feeding cues before they start crying. A mother may find it easier to try to nurse baby when he is wriggling, moving his arms around his head, bringing his hands to his mouth, or making sucking movements with his mouth. If mother waits until baby is actually crying, she will have a much harder time getting baby to nurse, especially in the early days.
Dr. Jack Newman encourages mothers, once their milk becomes abundant, to watch for the "open mouth wide - pause - close mouth" type of sucking motion as one way to tell if baby is latched on well and swallowing large mouthfuls of milk. Carol Brussel, IBCLC and former LLL Leader from Denver, Colorado, USA, explains, "the baby gets on and does a series of quick sucks and then stimulates mother's let-down. With the let-down, baby's mouth seems to widen even more on each suck. When baby's chin is at the lowest point there is a slight pause as I hear baby swallow, and then baby's mouth closes."
Although some breastfeeding books recommend mothers use firm pressure on a baby's chin to help him open his mouth wider, this may actually cause a baby to clench and may cause injury. Pressing down firmly on baby's chin is a therapeutic technique used with babies who have certain types of neurodevelopmental problems and is not recommended for normal, healthy full-term babies.
The Bulls-Eye Latch-On Technique
With the bulls-eye latch-on technique, a mother is encouraged to tickle the baby's lips to stimulate the rooting reflex. She then waits for the baby to open his mouth wide, centers her nipple in baby's mouth, and brings baby quickly and gently to her breast using rapid arm movement (RAM) as first described by Chele Marmet and Ellen Shell, both LLL Leaders and IBCLCs from Los Angeles, California, USA. See Figure 5.
The bulls-eye latch-on technique is taught in most breastfeeding books, classes, and support group meetings. Many Leaders and other breastfeeding helpers are very familiar with this technique and have been recommending it successfully for years.
Unfortunately, the bulls-eye latch-on technique can make it difficult for some babies to get a large enough mouthful of breast so that they can compress the milk sinuses (also called lactiferous sinuses or milk reservoirs) and effectively remove milk from mother’s breast. Barbara Wilson-Clay, IBCLC and former LLL Leader from Manchaca, Texas, USA, explains that "the moveable parts of the infant's skull are the lower jaw and the tongue. These must grip and compress the lactiferous sinuses that lie under the areola. If the nipple is centered in the baby's mouth the jaw closes too close to the nipple, pinching and distorting the shape of the nipple when baby comes off."
With the bulls-eye latch-on technique, babies commonly tuck in their lips which causes mother pain. This technique may not be effective at all when it is used with the football (clutch) position or in the cross-cradle position.
The Asymmetric Latch Technique
Maureen Minchin, MA, IBCLC from Victoria, Australia, feels that "there are particular problems likely with any nursing position if the person helping the mother is focused on the position itself and not on the outcome and the quality of the mouthful of breast achieved by baby in that position." Dr. Jack Newman firmly believes that "even more mothers and babies will have an easier time of it if the baby comes to the breast and latches on asymmetrically, covering more of the areola with his lower lip than his upper lip."
In their book The Breastfeeding Atlas, Kay Hoover and Barbara Wilson-Clay write, "The trick of helping the baby latch onto the breast rather than the nipple is to remember that it is the orientation of the lower jaw that is the key. The upper jaw is immobile, providing only counter pressure. The hinge-like opening and closing of the lower jaw and the massaging action of the tongue against the breast alternate to create the positive and negative pressure needed to remove milk. Therefore, it is essential that the lower jaw be correctly placed. Mothers should aim for an off-center placement of the baby's mouth on the areola with much more of the 'target' being covered on the chin side. This positions the jaw closure over the milk sinuses and prevents nipple pinching."
They continue to discuss how to enable the baby to open his mouth wide. "It requires drawing the baby's body in close, so that the chest, stomach, and knees are touching the mother's body in a 'wrap-around' fashion. The baby's body is placed with the baby's nose opposite the mother's nipple, so that the baby begins the latch-on sequence needing to reach for the nipple. This forces the baby to open wide. The head should be allowed to tip back slightly. Minor extension of the head results in the lower jaw approaching and being placed on the breast first. If instead, the mother pushes on the baby's head, it will flex forward, and the nose and upper jaw will make first contact with the breast. This is like trying to bite an apple with your chin tucked into your chest." See Figure 6.
The asymmetric position allows baby to get a large mouthful of breast. It helps keep baby's lips flanged out. As mother brings baby to the breast leading with the chin, when the breast comes into contact with baby's tongue, she can use it to help encourage him to open a little wider. Baby's upper lip is the last part of baby that touches the breast. Alison Hazelbaker explains that "the asymmetric latch helps facilitate proper placement of baby's tongue on mother's breast. When baby's chin is placed well and baby has proper tongue placement, baby's lips flange automatically."
Many mothers find that when they use the asymmetric latch technique, any nipple pain that they had been experiencing disappears. In several cases, I have helped mothers who had sore nipples. When their nipples came out of their babies' mouths, they were misshapen with obvious compression stripes. When I showed these mothers the cross-cradle position using the U-hold for breast support and the asymmetric latch technique, they were able to get their babies latched on much better. When their nipples came out of babies' mouths, they were shaped normally. The babies nursed more effectively and got more milk and the mothers' nipple pain disappeared.
In the preface of her book Breastfeeding: A Guide for the Medical Profession, 5th Edition, Ruth Lawrence cautions, "The field [of human lactation] has moved from a dogma of rules about breastfeeding that demanded rigid schedules, and specific managements through a brief period in which thoughtful contemplation and recognition of the variability of the human condition were recognized. Well-timed, skilled clinicians recognized the value of flexibility and individualizing care. Once again, however, ritual and protocol are being enforced. The Baby Friendly approach, whose very being was spawned to set us free from rigid dictums, is requiring protocols and policies. Mothers tell us they cannot breastfeed because there are too many rules. Medicine, itself in the era of managed care, has come forth with care guidelines for one disease or circumstance after another. Will breastfeeding be next?"
Rules and regulations have no place in the mother-baby relationship. Each mother and baby dyad is different and what works well for one mother and baby may not work well for another mother and baby. The important thing to do is to look at the mother and baby as individuals.
Laure Marchand-Lucas, MD, LLL Leader, Administrator of PL Resources for LLLI's International Division, and IBCLC from Paris, France, reminds us that "a baby who hasn't been too disturbed will by himself or herself find its way to the best position which my vary according to its own mouth conformation and the mother's breast, nipple, and areola conformation. All the trouble begins when the baby has 'lost' the 'instructions for use' because of the interventions at birth or for some other reason." These sentiments are reinforced by the research done by Dr. Lennart Righard on the effect of delivery room routines on the success of the first breastfeed and illustrated in his video Delivery Self-Attachment.
As you can see, there are many pieces to this dance of positioning and latch-on that occurs between mothers and babies. It is important for Leaders to share information with mothers about all the various nursing positions, breast holds, and latch-on techniques. With support and knowledge, Leaders can empower mothers to choose what works best for them and their babies. Trust mothers to choose wisely. Help mothers recognize babies' cues. Reminding each mother that she knows her baby best supports the bond between mother and baby. Respecting the mother and trusting her to choose what works best for her and her baby while supporting and encouraging the mother-baby relationship is at the heart of La Leche League philosophy.
La Leche League Sources
Gotsch, G. BREASTFEEDING PURE AND SIMPLE. Schaumburg, Illinois: La Leche League International, 2000.
La Leche League International. Positioning your baby at the breast. Schaumburg Illinois: La Leche League International, June 1996. Publication No. 304-17
La Leche League International. THE WOMANLY ART OF BREASTFEEDING. Schaumburg, Illinois: La Leche League International, 1997.
Meintz-Maher, S. An Overview of Solutions to Breastfeeding and Sucking Problems. Schaumburg, Illinois: La Leche League International, 1988.
Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK, Revised Edition. Schaumburg, Illinois: La Leche League International, 1997.
Black, R., Jarman, L., and Simpson, >.B. Lactation Specialist Self-Study Series Module 2: The Process of Breastfeeding. Sudbury, MA: Jones and Bartlett Publishers, 1998.
Hazelbaker, A.K. Skills and Techniques for Lactation Consultant Practice. Independent Study Module 3. Columbus, OH: Self-published, 1999.
Hoover, K. Latch-on difficulties: a clinical observation. J Hum Lact 2000; 16(1):6.
Huggins, K. The Nursing Mother's Cornpanion, 3rd revised edition. Boston, MA: Harvard Commons Press, 1995.
Lauwers, J. Counseling the Nursing Mother, third edition. Boston, MA: Jones and Bartlett Publishers, 2000.
Lawrence, R. Breastfeeding: A Guide for the Medical Profession, 5th edition. St. Louis: Mosby, 1999.
Marmet, C., and Shell, E. Lactation Forms: A Guide for Lactation Consulting Charting. Encino, CA: Lactation Institute, 1986.
Milligan, R.A., Flenniken, P.M., and Pugh, L.C. Positioning intervention to minimize fatigue in breastfeeding women. Appl Nurs Res 1996; 9:67-70.
Minchin, M. Breastfeeding Matters, 4th Revised Edition. Australia: Alma Publications, 1998.
Newman, J. and Pitman, T. Dr. Jack Newman's Guide to Breastfeeding. Canada: HarperCollins Ltd., 2000.
Renfrew, M., Fisher, C., and Arms, S. Bestfeeding: Getting Breastfeeding Right for You. Berkeley, CA: Celestial Arts Press, 1990.
Renfrew, M.J., Lang, S., Martin, L., and Woolridge, M. Interventions for improving breastfeeding technique. Cochrane Database Syst Rev 2000; 2:CD000041.
Renfrew, M. Positioning baby at the breast: more than a visual skill. J Hum Lact 1989; 5(1)13-15.
Righard, L. and Alade, M. Effect of delivery room routines on success of first breast-feed. Lancet 1990; 336:1105-1107.
Righard, M. Video: Delivery Self Attachment, copyright 1992, Geddes Productions.
Riordan, J and Auerbach, K. Breastfeeding and Human Lactation, 2nd edition. Boston: Jones and Bartlett Publishers, 1999.
Riordan, J. A Practical Guide to Breastfeeding. Boston, MA: Jones and Bartlett Publishers, 1991.
Sears, M. and Sears, W. The Breastfeeding Book, Boston, MA: Little, Brown and Company, 2000.
Tamaro, J. So That's What They're For! Breastfeeding Basics. Holbrook, MA: Adams Media Corporation, 1996.
Wiessinger, D. A breastfeeding teaching tool using a sandwich analogy for latch-on. J Hum Lact 1998; 14(1):51-56.
WiIson-Clay, B. and Hoover, K. The Breastfeeding Atlas. Austin, TX: LactNews Press, 1999.
Newman, J., and Barnes, A. "When Latching." http://www.bflrc.com/newman/articles.htm
Wiessinger D. "New Thoughts on Positioning." http://www.geocities.com/HotSprings/8978/sandwich.html
- Jan Barger, RN, MA, IBCLC
- Linda Barrett, IBCLC, APL Ohio
- Carol Brussel, BA, IBCLC
- K. Jean Cotterman, RNC, IBCLC
- Catherine Watson Genna, BS, IBCLC
- Alison K. Hazelbaker, MA, IBCLC
- Kay Hoover, MEd, IBCLC
- Laure Marchand-Lucas, MD, IBCLC
- Maureen Minchin, MA, IBCLC
- Claudia Morse-Karzen, LLL Leader
- Jack Newman, MD
- Norma Ritter, IBCLC, APL New York State West
- Linda J. Smith, BSE, FACCE, IBCLC
- Melissa Vickers, MEd, IBCLC, Online PL Resource Leader
- Diane Wiessinger, MS, IBCLC, AAPL New York State West
- Barbara Wilson-Clay, BS, IBCLC