Proper Latch & Positioning

Reference:

Toronto Public Health. Breastfeeding Protocols for Health Care Providers: Protocol #2 Positioning and Latching, (revised 2019), Retrieved from: Toronto Breastfeeding Protocols (2013)

Principles of Positioning

Mother is relaxed and in a comfortable position, that does not cause pain
Mother holds infant unswaddled, tucked in close “tummy-to-mommy” with shoulders and hips aligned (Infant is well aligned if you can draw an imaginary line from infant’s ear, to shoulder, to hip)
Encourage the use of supports to help the mother find a comfortable position. This can include a pillow, rolled blanket, rolled towel and/or a footrest
Encourage the mother to relax her shoulders

Principles of an Effective Latch

Infant is well supported with mother’s hand behind the shoulders, supporting the neck, not the head. The infant’s hands can remain free to explore the mother’s breasts and assist with latching
Infant approaches the nipple using “nose-to-nipple” as a landmark and begins to lick the nipple
Infant’s head is slightly extended with the lower lip or chin touching the breast. This triggers them to open their mouth wide and will allow for a deep latch

What to Look for in an Effective Latch

L – Lips flanged out (wide mouth)

A – Asymmetric latch (more areola visible above top lip)

T – Tummy to mommy (ears, shoulders and hips aligned)

C – Chin touching breast (nose in sniffing position)

H – Have a listen and watch (active suckling and swallowing)

Biological Nurturing (laid-back position)

This is a mother-centred approach that promotes the mother’s postures and helps infant-led latching.

The mother is leaned back in semi-reclined position
Place infant tummy down and in full contact with mother’s body
Cuddle and nest the infant in mother’s arms with skin-to-skin if preferred
Let gravity support infant, there is no need to apply pressure on infant’s back or neck
Latch infant anywhere along the 3600 circle of the breast

Infant-Led Latching

Baby-led latching is a natural way for the infant to find the breast

Other Breastfeeding Positions:

Cross-Cradle

To breastfeed on left breast, use right side of body to support infant:

Mother’s right arm holds infant along spine and forearm supports infant’s bottom
Mother’s right hand supports infant’s shoulders and neck
Mother holds the left breast with her left hand

Cradle

To breastfeed on left breast, use left side of body to support infant:

Football

The breastfeeding side will be the same side of the body used to support infant:

Mother places infant on her forearm, tucking the infant at her side
Mother’s hand will support infant’s shoulder and neck
Infant is looking up and facing towards mother’s side
Mother holds the infant back far enough so that their head extends into a sniffing position
Mother’s other hand can support the breast

Side-Lying

Mother lies on her side with pillow(s) supporting her head and lower back
Infant is side-lying with the entire body facing mother
Support this position by placing hand on infant’s back or with a rolled towel to support infant’s shoulders
The infant’s body is at a distance away from the breast that allows the head to slightly extend to latch, to reach up to the nipple
Mother brings infant closer once infant’s mouth opens wide for latching

How to Unlatch an Infant

Often times, Infants will come off the breast on their own
The mother can break the suction by doing either of the following:
- Gently insert clean finger into corner of infant’s mouth, between the gums
- Gently pull down on the infant’s chin to unlatch
Pulling the nipple out of the infant’s mouth while latched is best to avoid because it can cause nipple damage

Breastfeeding Multiples

Tips for breastfeeding multiples:

Mothers can adopt a breast rotation pattern that fits everyone’s needs, this can include:
Switch between breasts for each feeding
Rotate infants and breasts every 24 hours
Assign breasts to each infant
Mothers of odd number sets (e.g. triplets) may alternate infants and breasts more frequently than every 24 hours

Further Your Learning:

Toronto Public Health. Breastfeeding Protocols for Health Care Providers: Protocol #2 Positioning and Latching, (revised 2019)

Shareable Resources for Clients:

Referral Sources: