Most of the clients I’ve been seeing recently report that the position they were shown to use in the hospital was the cross-cradle hold. And they also report that they were told they had to hold baby’s head when breastfeeding or that they had a HCP push their baby’s head into their breast when attempting to get baby latched. But pushing a baby’s head into his mother’s breast in an attempt to get him to latch is, in general, not helpful. It might get baby latched for that feed, but in the longer term it’s is not going to help with breastfeeding. And here’s why:
1. Babies don’t like it. They know how to breastfeed. They are born with instincts and reflexes to help them find their mother’s breast and latch. But we need to give them an opportunity to do this by putting them in the right place, in the right position, and being patient with them. Pushing them to the breast with a hand to the back of the head may mean asking them to do something they are not ready to do, and not inclined to do in that moment. And it may not be a positive experience for them. Imagine that someone has prepared a delicious sandwich for you. They place it on a plate, bring it to you, but before you’ve even had a chance to open your mouth or get your gastric juices flowing, they bring the sandwich to your mouth and shove your face into it. How would that feel? What would you do? You’d probably be pissed off. And you might just instinctively react by pushing back and tensing the muscles around your neck and jaw. It’s the same for babies. The push to the back of the hand can cause tension, which in turn can inhibit baby getting an optimal latch, and ultimately it could lead to breast aversion.
2. Pushing a baby’s head into his mother’s breast can inhibit neck extension, which can contribute to nipple pain. Neck extension is one of the things we want for a baby to be able to open wide, extend their tongue and get a good latch. It’s much better for a mother to use gravity (with laidback breastfeeding positions) and gentle pressure along the baby’s back or back of the shoulders to bring baby close. Positioning really matters, because breastfeeding is about the whole body – the mother’s whole body and the baby’s whole body – not just the mouth and the nipple. If neck extension is inhibited, it can lead to a sub-optimal latch and nipple pain. An Australia study on found that cross-cradle hold ‘appeared to limit the baby’s instinctive ability to activate neuro-sensory mammalian behaviours to freely locate and effectively draw the nipple and breast tissue without causing trauma’ (Thompson, Kruske, Barclay et al., 2016).
3. If a baby has been born with the assistance of forceps or vontuse suction his head might be sore or tender (Ohlsson and Shah, 2015). I regularly see babies with cranial molding, bruising and abrasion on their heads. And the last thing they need is a hand pushing their head to the breast, because this could cause them more pain! And naturally, if they experience pain every time there is an attempt to being them to the breast, they could very easily develop an aversion to breastfeeding.
4. Pushing a baby’s head into his mothers breast can inhibit breastfeeding self-efficacy. It might result in a baby latching for that feed, but what happens the next time the baby wants to feed and there is no one to help the mother. She may lack the confidence to make it happen again without help. What she feels is that the midwife was able to get baby to latch, but that she can’t. Or that the baby can’t. We need to as far as possible, be hands-off and offer verbal instruction to mothers who need help with getting their baby to latch. This does take more skill, more practice and often a little bit more time. But the rewards are huge. ie a mother who can get her baby latched without someone else handling her breast or touching the baby’s head. She feels confident and empowered, and positive about her ability to replicate what has just happened. In any case, what the research tells us is that women dislike receiving physical help to latch their babies. One qualitative study on women’s experiences of breastfeeding found that ‘the women found a health professional touching their breasts daunting, intrusive and distressing’ (Spencer and Fraser, 2018).
5. Unwanted hands-on support can be experienced as abuse. According to a 2012 study of women experiencing breastfeeding difficulties, “an intrusive hands-on approach can obviously be experienced as an abuse and as a necessity to be endured. An intrusive hands-on breast approach increases the mother’s sense of being a machine that can be turned off and on by others.” (Palmer et al., 2012). Another study found that health professionals ‘handling’ of women’s breasts in an attempt to help with breastfeeding was often negatively internalised by women (Thomson et al, 2015).
I remember quite clearly the moment a well-meaning midwife gently pushed my baby’s head into my breast while I was sitting in the baby unit trying to get her to latch (she was in the unit for a couple of days due to tachypnea and infection after a very fast BBA birth in the hospital carpark). I knew she was trying to help me. I knew her instincts were good. But I was stressed and emotional and doing what I felt was best to help my baby latch. She was my third baby. I understood breastfeeding and I was prepared to give it time. The moment the midwife touched her head, I remember feeling a very intense anger. The words in my head were something like “GET YOUR F**KING HANDS OFF MY BABY!” but I contained it and responded with “Please don’t touch her head.” I think the anger I felt was primal; .a mother’s protective instinct that came from a very deep place within me. So perhaps the stories from clients of unnecessary hands-on ‘help’ or of touching without permission are triggering for me. But I do feel strongly that hands-off help should be the first course of action when assisting with breastfeeding. Of course there are times when hands-on help is appropriate and necessary. But for the most part breastfeeding support should be hands-off, and babies heads should definitely not be pushed into their mothers’ breasts!
- Ohlsson, A. and Shah, P. S. (2015) ‘Paracetamol (acetaminophen) for prevention or treatment of pain in newborns’, Cochrane Database Syst Rev, (6), pp. Cd011219.
- Palmér, L. et al. (2012) ‘Severe breastfeeding difficulties: Existential lostness as a mother—Women’s lived experiences of initiating breastfeeding under severe difficulties’, International journal of qualitative studies on health and well-being.
- Spencer, R. L. and Fraser, D. M. (2018) ‘‘You’re kinda passing a test’: A phenomenological study of women’s experiences of breastfeeding’, British Journal of Midwifery, 26(11), pp. 724-730.
- Thomson, G., Ebisch-Burton, K. and Flacking, R. (2015) ‘Shame if you do – shame if you don’t: women’s experiences of infant feeding’, Maternal and child nutrition, 11(1).
- Thompson, R. et al. (2016) ‘Potential predictors of nipple trauma from an in-home breastfeeding programme: A cross-sectional study’, Women and birth : journal of the Australian College of Midwives, 29(4), pp. 336-344.