By Kittie Frantz
Issue 138, September-October 2006
First I was a mother of 19 years, nursing my first baby without any help. As was the practice in the early 1960s, the nurses just handed my baby to me in the hospital and she nursed herself. Then, for 20 years, I was a La Leche League leader. We just said to mothers, over the phone, "Keep nursing, the rhythm will come." Then, 15 years into being an LLL leader, when I went back to work as a nurse practitioner, I saw women nursing in greater numbers. In those days, we were told that all nursing babies made your nipples sore, but I noticed a pattern: Women who had sore nipples held their babies differently from women who didn't. When I applied what I'd learned to the mothers experiencing soreness, they got relief.
In 1980, I decided to present this simple concept at a breastfeeding conference in Israel. I illustrated my talk with a series of pictures, taken by a photographer friend, of a well nursing infant as she went to the breast and attached. The presentation of this simple concept went well, and I was asked to publish it.1 I hired an artist to make drawings based on the photos, as the publication would accept only drawings. These drawings became very popular; for teaching purposes, I made them available as slides, postercards, tear-offs, etc. They were used for years by those who teach new mothers how to breastfeed. In the 1990s, new, more complicated concepts in attachment became popular, and everyone was concerned about doing "the latch" correctly. At about that time, medical journals began revealing more about how an infant uses the tongue in suckling, and where the infant's optimal placement is on the breast. What seemed best was an asymmetrical latch, the baby's mouth covering the lower part of the areola more than the upper. Wondering if my drawings were outdated, I looked at them again and saw that the baby we'd photographed had done it perfectly. That baby wasn't outdated at all.
Holding the Baby
Babies prefer to be somewhat upright, lying in the mother's arms at about a 45 degree angle, not laid flat on a pillow or lap. When babies are laid flat, the milk can escape from the stomach, come back up the throat, and disrupt swallowing. Babies also prefer to face the mother. When baby is laid on her back, she must turn her head to the breast, which also disrupts how she swallows. When baby is facing you, you should be able to see her eyes—all babies love that—for perfect placement.
Holding the Breast
However you hold your breast, keep your fingers off the areola—that is where the baby's mouth will fit. And watch those fingers under the breast: using all four fingers under the breast and your thumb on the top will best support a heavy breast. This helps a newborn's tongue get the nipple deeper into his mouth, and more quickly, as he learns how to suckle in those first days.
Getting the Mouth to Open
A baby will open her mouth automatically, as a reflex action, when her chin and/or lower lip touches the breast. (The third baby in Dr. Lennart Righard's video Delivery Self Attachment shows this beautifully.2) Touch the baby's lower lip and chin with your nipple. She will open her mouth wide and tilt back her head ever so slightly. Babies do this best when only the lower lip is touched; they don't open as wide when the upper lip is touched. Try this with your finger before you start to breastfeed and see for yourself which lip the baby responds to more.
When she opens wide, move the baby straight in toward you with the arm holding her, and she will attach to your lower areola. If you use an opposite-hand or cross-cradle hold, just move her shoulder toward you and her head will follow, in perfect position. She has tilted her head back slightly to attach to the lower areola. How clever!
Keep it simple, keep it easy, keep it fun, and let baby do her thing.
Kittie's Rule of Unders
- The arm holding the baby is under the baby—you're holding him, not the pillow.
- Fingers under the breast and off of the underside of the areola.
- Touch the baby's under lip and chin with the nipple to get her mouth to open wide.
- Bring her straight in so she attaches to the underpart of the areola.
In the DVD version of his Delivery Self Attachment, Dr. Righard says it is not mom who breastfeeds, but the baby. Dr. Nils Bergman, in his DVD Kangaroo Mother Care,3, 4 says that babies instinctively know how to breastfeed. Inspired by Righard and Bergman, Dr. Christina Smillie began letting babies attach to the breast by themselves in her practice, using Righard and Bergman's principle of skin-to-skin contact between baby and mother to provide the stimulus that inspires the baby to seek the breast. When I learned what Dr. Smillie was doing in her office setting, I went back to my own office and placed six six-day-old babies, clad only in diapers, upright on their mothers' bare chests. Each baby worked his or her way down and over to one breast, wiggling until he or she was at a 45° angle and under the breast. Then each baby magically tilted back its head, anchored its chin on the breast, opened wide, and attached. After more than 33 years in clinical practice, I was in awe.
I watched as these babies fed, then came off the breast all by themselves. What a novel concept—they knew when they were finished. I instructed the mothers to put the babies back upright on their bare chests. This not only provided a great opportunity to burp the babies, but gave them more choices. All six babies made their way to the opposite breast and did the same attachment thing. I was hooked. How could we have missed this simple concept of a baby instinctively attaching on his or her own?
I now watch more and more babies attach themselves, and filmed two babies doing it.5 Some babies do it quickly; some take their time getting in position and attaching. All this has led me to ponder why we spend so much time and energy micromanaging "the latch." Mothers can be empowered to see that they don't have to learn any "method" of doing this—the baby already knows. If everything you've tried has ended in frustration, let the baby do it. From handing a baby to a mother in 1960 with no instruction, to placing the baby on her chest in 2006—also with no instruction—and watching as the baby finds the breast herself, we have come full circle. It's taken us only 46 years to get it right. Now you try it.
1. Kittie Frantz, "Techniques for Successfully Managing Nipple Problems and the Reluctant Nurser in the Early Postpartum Period," in S. Freier and A. Eidelman, eds., Human Milk: Its Biological and Social Value (Amsterdam: Excerpta Medica, 1980): 314-317.
2. Lennart Righard and M. Alade, "Effect of Delivery Room Routines on Success of First Breast-feed," The Lancet 336, no. 8723 (3 November 1990): 1105–1107. Six-minute DVD of study results: Delivery Self Attachment, www.geddesproduction.com/self.html.
3. G. Kirsten, N. Bergman, F. Hann, "Kangaroo Mother Care in the Nursery," in R. Schanler, ed., The Pediatric Clinics of North America: Breastfeeding 2001, Part II: The Management of Breastfeeding (Philadelphia: Saunders, 2001): www.kangaroomothercare.com.
4. N. Bergman and J. Bergman, Kangaroo Mother Care: Rediscover the Natural Way to Care for Your Newborn Baby (76-minute DVD of study results: 2006): www.geddesproduction.com/kangaroo.html.
5. Kittie Frantz, Self Attachment, in First Attachment (48-minute DVD, 2005): www.geddesproduction.com/1.html
Kittie Frantz, RN, CPNP-PC, is the Coordinator of Lactation Education at Los Angeles County University of Southern California Medical Center, and Instructor in Pediatrics for the Keck School of Medicine, University of Southern California-Los Angeles. She has been a pediatric nurse practitioner for 33 years. She has three children and six (soon to be seven) grandchildren—all breastfed.