Step 5:

1. List the key elements of positioning for

successful and comfortable BF
2. Describe how to assess a BF
3. Recognize signs of positioning and
attachment
4. Demonstrate how to help a mother learn
to position and attach her baby
5. Discuss when to assist
6. List reasons why a baby may have
difficulty attaching to breast
Positioning how the mother holds the
baby to attach well to the breast

If baby is poorly attached help mother

to position well attach better

If well attached and suckling effectively

do not interfere
1. Sitting on the floor or ground
2. Sitting on a chair
3. Lying down
4. Standing up

Comfortable with back supported

Feet supported
Breast supported
 Along mothers arm
Under mothers arm
Along her side

demo
 7/1

4
1
>In line
>Close
>Supported
>Facing
3

Breastfeeding Counselling: a training course,

WHO/CHD/93.4, UNICEF/NUT/93.2
Babys body needs to be
In line with ear, shoulder and hip
in a straight line,
Close to mothers body
Supported at the head, shoulders
and if newborn, the whole body
Facing the breast
 Mothers position is
important

Sit with back and feet

supported

Bring the baby level with the

breast using rolled up towel or
clothes, cushion or pillow demo
 Mother to lie on her side
Rolled pillow under her head &
between her knees
Her back needs support
Can support babys back
Can support breast
(if necessary)
--Dancers hold

demo
 To
identify and praise what mother
and baby are doing well

See current difficulties with BF

Highlight
practices that may result
in problems later if not changed.
 Watching what a mother & baby are
doing
Listening what mother tells you.

WATCH THE BABY FEEDING rather

watch what the mother is doing

Use Breastfeeding observation aid

 BREASTFEED OBSERVATION AID 7/2
Mother's name _______________________________ Date ___________________
Baby's name _________________________________ Baby's age ______________
Signs that breastfeeding is going well: Signs of possible difficulty:
GENERAL
Mother: Mother:
Mother looks healthy Mother looks ill or depressed
Mother relaxed and comfortable Mother looks tense and uncomfortable
Signs of bonding between mother and baby No mother/baby eye contact
Baby: Baby:
Baby looks healthy Baby looks sleepy or ill
Baby calm and relaxed Baby is restless or crying
Baby reaches or roots for breast if hungry Baby does not reach or root
BREASTS
Breasts look healthy Breasts look red, swollen, or sore
No pain or discomfort Breast or nipple painful
Breast well supported with fingers away from nipple Breasts held with fingers on areola
BABYS POSITION
Babys head and body in line Babys neck and head twisted to feed
Baby held close to mothers body Baby not held close
Babys whole body supported Baby supported by head and neck only
Baby approaches breast, nose to nipple Baby approaches breast, lower lip/chin to nipple
BABYS ATTACHMENT
More areola seen above babys top lip More areola seen below bottom lip
Babys mouth open wide Babys mouth not open wide
Lower lip turned outwards Lips pointing forward or turned in
Babys chin touches breast Babys chin not touching breast
SUCKLING
Slow, deep sucks with pauses Rapid shallow sucks
Cheeks round when suckling Cheeks pulled in when suckling
Baby releases breast when finished Mother takes baby off the breast
Mother notices signs of oxytocin reflex No signs of oxytocin reflex noticed
Notes:
 7/3

UNICEF C107-5
UNICEF C107-5

7/4

UNICEF C107-7
 7/5

UNICEF C107-9
 7/6

UNICEF/HQ91-0168/ Betty Press, Kenya

 The aim of HELPING the mother is :
so SHE CAN position and attach her baby BY HERSELF.

It does not help the mothers confidence if

the health worker will do it for her
1. Always OBSERVE before you
offer a help. Offer help only when
there is difficulty

2. Help in a HANDS OFF manner

3. Talk about the key points that a

mother can see
1. GREET the mother, introduce
yourself,
2. Ask her if you may see her
breastfeed her baby
3. Sit down yourself
4. Observe BF
5. Say something encouraging
6. Explain and help
 GO THROUGH THESE STEPS

SAY SOMETHING ENCOURAGING,EXPLAIN

and OFFER HELP.

Help her do each suggestion before you

offer the next suggestion or instruction.

Be sure the mother sits in a comfortable and

relaxed position
Demonstration # 1
Mother sitting on a chair or
bed.

Demonstration # 2
Mother breastfeeding her
baby in lying position.
1. Touch the babys lips with
the nipple.

2. Wait until the babys mouth

open.

3. Then move the baby onto

the breast.
Babys mouth needs to be wide open to
take a large mouthful of breast.

Aiming the babys lower lip well below the

nipple, so that her chin and lower lip
touch the breast first before the upper
lip. (nose to nipple technique)

Bring the baby to the breast, and NOT her

breast to her baby.
 In the FIRST hour
Few hours later after delivery
If baby was exposed to
sedation during labor,
preterm or SGA, or at risk of
hypoglycemia, after 3-4
hours3
Reluctant Nurser - Baby
who has difficulty in
attaching to the breast

Name some reasons why baby may seem to be

reluctant to breastfeed.
1. Baby may not be hungry at this
time.
2. Baby maybe cold, ill or small and
weak
3. Baby in poor breastfeeding position
4. Mother moves or shakes the breast
5. Breast is engorged
6. Breastmilk flowing too fast

cont
7. Baby has sore mouth or blocked
nose
8. Baby maybe in pain.
9. Baby has Nipple Confusion
10. Baby does not like new smell of
mother
11. Milk supple is too low
12. Sometimes baby refuses the
other breast
1. Look for the cause and manage
accordingly

2. Encourage skin to skin contact in a calm

environment when baby is not hungry

3. Do not force the baby to the breast when

crying.
In many instances breast refusal
could be prevented by:
Early and frequent STS
Help mother to learn correct
attachment and positioning
Being patient while baby learns to
feed
Caring for the baby in a gentle
confident manner.
 Positioning for
breastfeeding
Assessing a breastfeed

Help mothers to learn to

position and attach her baby
Baby who has difficulty
attaching to the breast