C-Hold To be ready to draw the baby’s mouth onto mother’s breast, as soon as the baby opens his or her mouth widely enough, the mother needs to have her hand supporting her breast in ready position. She can use various hand holds, but she needs to keep her fingers well behind the areola. One such hand position is called the “C-hold”.
In this hold, the thumb is placed on top of the breast near 12’ O-clock position and the other four fingers are placed on the underside of the breast near at the 6’ O-clock position (depends on mother’s hand size and length of fingers). The key point in is keeping the fingers at least 1 1/2” back from the base of the nipple as the fingers support the breast. Mothers are often not aware of where they place their fingers, especially on the underside of the breast. If the fingers are too far forward (too close to the nipple), then the infant cannot grasp a large amount of areola in her mouth and this results in a “shallow” latch. A shallow latch is associated with nipple pain and ineffective drainage of the breast.
U-Hold An alternate hand hold is the “U-hold” hand position. The thumb and forefinger are near the 3 o’clock and 9 o’clock positions in the breast again with the fingers at least 1 ½ inches back from the base of the nipple; the body of the hand rests on the lower portion of the breast. Using this hand hold, the mother’s arm position is down at her side rather than sticking outward as it is when supporting the breast using the C-hold position.
Scissor Hold The scissor hold is often discouraged because mothers (especially mothers with small hands) have a difficult time keeping their fingers off the areola or at least 1 ½ inches back from the base of the areola. Here, the mother is able to support her breast well without letting her fingers encroach onto the areola. The mother should be instructed to gently support the breast and not press too deeply, which can obstruct the flow of milk through ducts.
Rooting and Attachment Before eliciting the rooting reflex, it is important to have the baby in good alignment. When the infant opens her or his mouth to latch on, the goal is to achieve a deep, asymmetric latch attachment. The goal is not center the nipple on the mouth. The rationale for this is to optimize oral-motor function. The jaw is a hinge joint. The upper jaw is immobile; the lower jaw compresses the breast. The breast is efficiently drained if more areola is drawn into the baby’s mouth from the inferior aspect of the breast and a smaller amount drawn in from the superior aspect of the areola. Aligning the infant to the mother with baby’s nose facing mother’s nipple permits the jaw to be in a lower position. The next step is to let the infant drop his or her head back (head in sniff position), so that the infant leads into the breast with the chin.
To trigger the rooting reflex, use the nipple to stroke downward in a vertical motion across the middle of baby’s lower lip. Initially the infant may respond by licking or smacking. This is a normal response to the stimulus. Encourage the mother to keep stimulating the infant’s lower lip until the infant finally opens her mouth widely. If the infant is not responding at all, then the infant is probably too sleepy and may need help waking up. After trying wake up techniques, the infant may be ready to try breastfeeding again.
Be patient and wait for the infant to open their mouth. Continue to stroke the infant’s lip until the infant opens the mouth wider.