“So, how does the latch look?”

I get this question a lot. Many new moms tell me that the hospital nurse or lactation consultant talked with them about what to look for when baby is latching: baby’s wide-open mouth and smooth cheeks (no dimpling), upper and lower lips flanged out, a generous amount of the areola in baby’s mouth, no clicking noises or loss of suction, a round and elongated nipple after breastfeeding, and no pain. Often, moms are tripped up by the last item on the list. If the latch looks good, why is it still painful?

Because in breastfeeding, looks aren't everything.

Pain is a signal that something needs adjustment, whether it’s the baby’s position or the breastfeeding pair’s emotional state or the way the baby is sucking. Sometimes the adjustment is as simple as manually flipping a baby’s bottom lip out, which can be hard to see when that little chin is deeply buried in the breast. Flipping out the upper lip may help, too, but there is evidence that this is not as critical for a deep, comfortable latch as was once believed.

If a baby’s mouth is not wide open when latched, I find that pushing down on a baby’s chin typically doesn’t help. Instead, I recommend moving the whole baby! Often I see babies being brought to breast with their chins tucked into their chests, so pushing on the chin is futile if baby is curled up in this way. The snuggle and slide move is very useful in these cases.

When breastfeeding has been stressful, I find that moms and babies are often holding tension in their bodies as they attempt positioning and latching. Relaxed babies tend to open wider, and relaxed mothers tend to feel less pain. I like to look for ways to help the pair relax together, particularly the mom since her baby will take cues from her. Often a few deep breaths and some measures to soothe the baby, such as skin-to-skin holding, make for a much better experience initiating breastfeeding.

I also encourage moms to take a few moments to let baby relax into a latch. If baby came to the breast very hungry or fussy, her mouth is likely to be tighter, and she may need a minute or two to settle in. Rather than unlatching baby immediately to get a “correct” latch, I ask mom to see what happens if she waits a short time. Does baby open wider? How does the latch feel now? Often, the improvement comes quickly, and without the frustration of baby going on and off the breast several times until she gets it “right” (which can lead to more soreness for some moms).

It’s also possible that have a baby who is latching well and to have some lingering nipple soreness, especially if there were wounds in the early days. As those wounds heal, it’s normal to continue feeling some discomfort, particularly in the first 30-60 seconds of the latch. If the pain subsides, that is an encouraging sign that baby is not continuing to latch in a way that is causing further damage.

If, despite these adjustments, pain continues and breastfeeding feels unsustainable, there may be other factors at play. A full assessment with a lactation consult, who may loop in mom and baby’s doctors, can be useful to determine the cause of the pain and possible treatments. 

​Positioning a newborn for breastfeeding can be an awkward affair. Their little bodies are wiggly and floppy. They love to put their hands by their faces and sometimes bat at the breast, sabotaging their own efforts to latch. After a few minutes of getting baby into the right spot and (presto!) achieving that latch, they come off the breast after a few sucks. And so the process starts again.

Once baby is finally sustaining the latch, a lot of moms still have a “pinchy” sensation. They usually consider two choices: A) unlatch the baby and start over, or B) grin and bear it. Neither option is particularly appealing, particularly if it took a lot of effort to get the baby on the breast in the first place. Let me offer choice C) snuggle and slide.
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This simple maneuver works in any breastfeeding position. All mom needs to do is put her hand on baby’s back (not the head, which can lead to arching and fussing), and slide her baby’s body in the direction the feet are pointing. Sometimes, baby just needs to move an inch or two in order for that pinching sensation to subside.

Why does this work? Bringing baby in closer to mom’s body often deepens the latch, and sliding creates a bit of space between baby’s chin and chest to allow baby to open wider. This move also gives baby a better airway and swallowing ability, both of which are essential for good drinking.
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Breastfeeding is a dynamic activity, an interaction between two live bodies, so it makes sense to continually adjust throughout the feeding. I encourage my clients to experiment with moving their babies’ bodies across or slightly up or down and course correct if that pinchy feeling returns. It’s an empowering and effective strategy that gets moms to drop into their own bodies and find their own ways to breastfeed comfortably. And lest you think that I coined the adorable term “snuggle and slide,” it actually comes from one of my favorite papers by Dr. Pamela Douglas and Renee Keogh in the Journal of Human Lactation.

Need in-person help with positioning? Book an appointment with me!

I’m excited to share a brand new resource that I’ve contributed to, More to Mother, which launched today! Check out my article, Fourth Trimester: Lactation Consultant, which explains why you might want to hire a lactation consultant, what to expect, and more.

More to Mother was created by two San Francisco-based women who saw a need for more resources on their journey to becoming parents. The site provides evidence-based guidance from preconception through the postpartum period.

Please follow along with @moretomother on Instagram, and sign up to get updates when they launch their City Guides (list of trusted practitioners and resources in various cities).

Do you live in San Francisco, Marin, or San Mateo county, CA? I'm your local breastfeeding resource! Book an appointment with me.

Looking to increase your milk supply? Want to pump more, and in less time? Breast massage and compression are your best tools. Invest in a pumping bra, or make one yourself by cutting holes in an old sports bra. The idea of going “hands-free” is very appealing so that you can text or unlock the next level of Candy Crush, but using your hands may make all the difference! Experiment with where and how you massage your breasts and see how your body responds. Some people need only a light touch to get the milk flowing, while others find that placing a fist on either side of one breast and pressing is most effective.

Depending on your anatomy and the fit of your flanges and pumping bra, it may be easier or more challenging to massage while pumping. I’ve had some clients who couldn’t massage without causing a break in suction while they pumped. They had good results massaging before pumping and then tucking heat packs into the pumping bra (such as these, or using a sock filled with dry rice).
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Wireless pumps such as the Willow and Elvie make it much more difficult to massage and compress while pumping. It can be done but again depends on the individual. Anyone who relies heavily on using their hands while pumping for a good breast draining may want to refrain from dropping a lot of money on one of these pumps. I encourage people to use the pump they can get through insurance and use these massage techniques instead.

​Need help with pumping? Book an appointment with me!