___ Baby is interested, even if still very sleepy: wiggles, hands go to mouth, mouth moves

___ Clothing out of the way– yours and baby’s

___ Make yourself comfortable holding baby’s head at the natural level of your nipple

• Footstool?  Back support?  Arm rest?  If lap pillow used, it should support your arm, not the baby. 

___ Support your Baby

• Baby’s weight is supported mainly by your torso and arm, not your lap.
• Baby is horizontal, with head, chest, navel, and knees all facing you.
• Baby’s chin not tucked; nose near your nipple, not chin near nipple.
• Your hand supports base of baby’s head; fingers don’t touch cheeks or press on back of head.
• Baby’s lower body pasted to your torso, body to body.
  
  

• Hand and fingers flat on ribcage, index finger in the crease under your breast.
• Rotate hand so that breast rests in U between thumb and fingers – thumb and fingers point up.
• Bring fingers onto breast only if needed to stabilize it.
• Squeeze breast to make a sandwich oval that will go corner to corner across baby’s mouth.
• Index finger well away from areola – farther away than you think is necessary. 

___ Beginning of latch-on

• Angle nipple away from baby’s mouth, so mouth faces the inner side of the breast, not the nipple.
• Land baby’s lower lip well away from the nipple, farther away than it will end up.
• If baby’s mouth doesn't open on its own, dab it lightly with the inner side of the breast. 

___ Latch-on

• Use breast to pry baby’s mouth further open, roll breast onto baby’s tongue, not against tongue.
• Move breast or baby so that baby’s upper lip goes “around the corner” of your nipple. At that time,
• Bring baby’s shoulders extra close (don’t press on head. Bring shoulders close, head will follow). 

___ Comfortable?

• If not, press breast below lower lip to exaggerate the lower-jaw part of the sandwich shape,
• OR, take baby off (slide finger into corner of mouth between baby’s gums) and start over
• Baby’s cheeks should touch breast, hiding mouth.
• Corner of baby’s mouth, if you could see it, is very wide, about 140 degrees, not a mere 90 degrees.
• Lower lip, if you could see it, is rolled back toward the chin.
• Lower lip, if you could see it, is farther from nipple than upper lip is.
• If you tug carefully at corner of lower lip, baby’s tongue is visible cupping breast.
• Baby’s head is slightly tipped back, in the position your head assumes when you sniff.
• Chin is firmly planted on breast, nose is usually only lightly touching or is free of breast. 

____ Effective Nursing

• Short, chopping jaw motions to start the milk, then…
• Slow, deep, steady jaw motions, about 1 per second.
• Jaw hesitation or “hic” sound when baby swallows, usually with every 1-3 jaw strokes.
• Occasional rests or return to short strokes, followed by more deep, steady strokes
• Offer “on whim” – baby’s or mother’s – which will probably be 1-12 times every 2-3 hours during the day, less often at night.  Frequent, efficient milk removal is key to a good supply.