Different feeding positions

Cradle Hold :

T h e m o t h e r i s usually sitting or semi-reclining. To feed from the left breast, the baby’s head in the rook of the mother’s left arm, and his body rests in the mother’s lap, supported by her left forearm and and usually up to buttocks of baby. Some women find this a “natural” position. Their other hand is usually Completely free to support the breast if needed.

Cross-Cradle Hold :

Similar to the cradle hold, except opposite hand supports the baby: for the baby to feed on the left breast, the mother’s right hand crosses her own body to support the baby’s head and neck and her left hand is free. It can provide better control of the baby’s head, especially important for low birthweight or preterm infants, or those with low muscle tone. (Image at lower right corner of the page)

Side-Lying Hold :

When the mother lies down on her side, her baby can also lieon his side, facing her, and feed. The baby’s head can rest flat on the bed, or on the mother’s downward arm — whichever she finds positions the baby better. Many mothers find this to be the most restful position for feeding; they can doze or sleep.

Football Hold:

To feed on the left breast, the mother tucks the baby under her left arm and supports the back of the head and neck to bring the baby to the breast. The baby lies on his back beside the mother, with his legs out of sight under and behind her arm. The baby’s body may rest on a pillow. It allows goodhead control, especially for s m a l l o r preterm babies & can be useful for a mother with C section, as baby is away from incision.

Less Common Positions:

There are as many different ways to position a baby for breastfeeding for specific indications.

Over the shoulder:

The mother can lie on her back and the baby approaches her breast on his tummy, from over her shoulder supported by a pillow. This position can be helpful if she has a plugged duct at the top of her breast, or if her nipples are very sore and damaged toward the bottom or sides.

Upright:

Here, the baby is in a sitting position, either straddling the mother’s thigh, or in an upright football hold position. He approaches the breast directly from the front, and the mother supports his neck and back with her hand. This is useful when the baby has reflux or spits up a lot.

Lay back Position:

Spearheaded by Suzanne Colson, a new approach called biological nurturing emphasises that breastfeeding may be more of an instinctual process for both mother and baby. Breastfeeding may work best when the mother chooses “natural” “instinctive” positions often, reclining. Breastfeeding then becomes an activity that is nurturing, enjoyable, and relaxed (Colson, 2005).

Amazed?

So was I, when I first time read about it. We as doctors are hammered since our infancy about the risks of breastfeeding in lying down position mostly by our seniors. In fact, the (mis)belief that breastfeeding while lying down can cause aspiration or ASOM is widespread amongst the community [mostly disseminated by medical fraternities].

If a baby is fed in supine position, gravity will not help for passage of milk from throat to tummy, the poor & fragile baby will swallow it inefficiently, milk will accumulate in pharynx & will go to the lungs with one unfortunate breath. Same pooled milk may seep in to the eustachian tube to cause ASOM. Although at first sight, it seems so logical. But wait!

Look at the above 2 photographs: whether in SITTING / SUPINE POSITIONS of the mother, baby is lying down only!

Gravity should not be playing more than a negligible role in swallowing of milk by a healthy infant. After all, mammals feed in heterogenous positions.

This is an active process whereby milk secretions matches with baby’s desire & ability to swallow. Initially, the hungry baby suckles fast & as later he becomes full, suckles intermittently. The milk from breast flows accordingly.

Baby determines the milk flow from breast by stimulating nipple according to its own hunger & vigour. Hence, there will be minimal pooling of milk if any inside the baby’s mouth.

Then what about the aspirations we had heard about but never seen? The perception is analogous to what may happen while bottle-feeding. The milk drips at constant speed from the bottle whether or not baby wants to suck. It will accumulate in a sleepy one’s mouth to be aspirated anytime. If a baby is in a vertical or semi-reclining position, milk may drip into stomach.

Even than, what’s the harm in giving feeds in sitting positions only? For true perception of the impact of feeding in “SITTING POSITION” only, one has to be a lactating woman. Just recovering from the “LABOUR”, easily EXHAUSTIBLE, wanting to feed the baby on demand & baby with its small stomach capacity asking for frequent feeds. The mother will rapidly drain out & feeding + sitting will become “yet again” trouble rather than a satisfying experience.

The mother must be positively reinforced for feeding in lying down positions especially if she is primi & everybody around her is insisting for “Sit up straight back & feed”.
If the mother is feeding in a comfortable & relaxed position, her milk flows more. In older days, a lactating mother would sleep with bear breasts with baby on her sides, whenever baby would awaken with hunger, half awake mother will attach the baby to breast, let it suckle while herself in a semi-sleeping mode. Evidence says, prolactin levels are higher while feeding in a sleepy state. And the sleep cycles of the baby & mother coincide so well that chances of baby being suffocated by turning over of mother’s breast over baby’s face are hypothetical unless mother is intoxicated with drugs or alcohol. So now onwards, whenever you counsel a mother about breastfeeding, do her one more favour. Encourage her actively about feeding in lying down position.