 So, this is part two and here we are going to discuss about how to hold the breast and how to latch the baby ok. So, again we already discussed about mother's readiness, understanding of early hunger cues and how to position the baby. So, we already discussed that now this is part two again we are going to discuss about how to hold the breast and how to latch the baby ok, extremely important points in cross-cattle hold or any kind of hold that you would prefer ok. So, here I am ready to latch the baby, here I am holding giving the position to the baby, this is called landing the baby ok to be to be to prepare the baby to breast feed ok. Now, baby is completely facing the breast not facing up please remember this I see it all the time, another hand the lower hand is around the breast under the breast ok and upper hand is here, now if baby is moving too much what you can do is to just wrap the baby ok and if baby is not moving and baby is ok you know you do not need to wrap really I do not prefer that you wrap the baby while breast feeding because I prefer skin to skin contact. So, if mother is kind of can open you know and keep the chest open baby's chest you will be completely touching mother's chest that is called skin to skin you know that is that is really I prefer that actually skin to skin contact ok. So, now here now baby is ready to breast feed see neck is little bit extended neck is little bit extended ok and here I am going to bring the baby so that the neck is right across the nipple ok. Now, I am going to hold the breast now this part is really really important now in this position before I go back to that breast again now remember now here is the baby ok here is me here is baby now I want to give you one example and this example just kind of watch it very carefully because this example will give you the concept of why we have to hold breast in a certain way ok and understand the concept do not understand then do not wrote learn it ok if you wrote memorize it then you will make a mistake in different holes. So, just understand the concept and then you will know in any hole whichever way baby is coming to the breast mother will know exactly where to hold the breast to make it smaller so it becomes easier for baby to open the mouth ok. So, here remember that I am sitting now if I am trying to eat something which is very big ok. So, for example in my example say I take an example of a big sandwich three layer sandwich ok and there are three breads in between two breads there is tomato and another two layers there is cucumber and cheese and chutney and butter ok and I am telling you or somebody is give me this big big sandwich and they are asking me to have a big bite ok. So, the way I am going to take a big bite of the sandwich I am going to hold the sandwich ok and I am going to basically press it and then I am going to eat it ok. So, this remember that here this is how we eat just think of anything that you may have some big thing that you want to take a bite of. So, in Gujarat we call it daabeli any of this fast food joint now that I want you to have any burger but just giving you example if you have a burger you know you basically hold the burger like this press it and then take a big bite but while you are eating a big bite you are kind of bending your neck forward remember you will never able to eat like this you will have to bend your neck sorry backward. So, bend your neck backward and then take a big bite and you are putting that bite on the lower lip you are not putting that bite on the upper lip why because when you put it on the lower lip that is when because your lower jaw is moving your mandible is moving. So, you will be able to take a big bite with the pressure you will be able to take a big bite. Similarly, now here is a baby and I am going to bring something which is very big I want to put it in baby's mouth so what I am going to do I am going to basically keep my fingers parallel to baby's lips the baby's lips are like this so I am going to put my fingers you know parallel to baby's lips and I am going to basically press it and then put it in baby's mouth in such a way that baby's mouth is little bit backward like this. Now suppose in this position I am going to put my fingers straight but if baby is sideways so what I am going to do I am going to again put my fingers parallel to baby's lips ok so here are baby's lips right I am going to press it right I am going to press it. Now suppose if this baby is this way ok again the lips are vertical so here in this position in this position lips are vertical right in this position lips are vertical and that is why I am putting my fingers vertical either I can put it from top or I can put it from down ok right now in this position just turn it around and here in this position also baby's lips are vertical ok so my fingers will be vertical too so either it will be from the top or it will be from the bottom ok just this is a very important concept that I want you to learn it is like whenever you contouring your breast your fingers should be parallel to baby's lips ok so in this position baby's lips in this position baby's lips are vertical right so either your lips are or your fingers are from down ok or they are from the top ok and remember that on day 3 when milk comes in your areola you know mother's breast becomes big even even in the beginning baby's mouth is really small so you want to contour it so it becomes easier for baby to have a lower area latch remember why lower area latch because we always put things food on the lower jaw so you want to have as much area as possible near the lower jaw like a lower lip so that baby will be able to press harder and get more amount of milk coming into the in the stomach ok alright so here it is now let's see now here this is the breast ok now baby is coming like this right so lips are vertical ok so what I am going to do I am going to of course here I am holding the baby lips are vertical so either I can hold it from top ok or I can hold it from below but I do want to hold it from top because if I hold it from top I would know when did baby open the mouth ok because I want to see if when baby opens a big mouth that's when I am going to put the breast in the mouth so here I am going to do I am going to hold the breast from below ok and this is how I am going to hold the breast now this also is another very important concept to learn is while I am bringing the baby while I am bringing my fingers to the breast remember there is a clock think about a clock ok think about a clock and think about nipple as the middle of the clock ok so you want to in this on left hand side this is 3 o clock this is 9 o clock this is 6 and this is 12 ok so you want to because your lips are parallel absolutely baby is coming in such a way that the upper lip is at 3 o clock and lower lip is at 9 o clock so you want to keep your fingers right there where the lips are ok so you want to keep the thumb near the upper lip which is that 3 o clock so you want to keep your tip of the finger just the tip don't put the whole finger if you put whole finger what will happen this fingers will come in the way you don't want the fingers to come in the way you want to just put the tip of the fingers but the 3 o clock many times what happens mothers do this they put fingers at 2 o clock and at 10 o clock position that's too high because if you if that's too high what will happen only nipple will go in the mouth and nipple milk will not come if you put only nipple nipple doesn't have milk in it ok baby has to have a lower area lage so baby is coming from here this part over here will go in baby's mouth so do not block that area at any cost ok so here if you have a big nipple or a big area I should say then put one finger thumb at 3 o clock position and another one tip of the finger and another one at 9 o clock position but this is another point I want you to remember that when you put the fingers tip of the fingers don't make don't put it too close because if you put it too close only nipple will go in the mouth ok you want to put it at least 3 fingers away so 3 fingers from this side and 3 fingers from this side this is where basically this is how it's going to be and remember the dip of the 6 right this is your dip now that dip of your U shape will come at 6 o clock position ok so here how would you know that it is 6 o clock because so so many times you know how mothers hold the breast they hold the breast like this so here what happens even though fingers are at 6 o clock and 3 o clock position or 9 o clock and 3 o clock position what happened the U the dip of the U is not at 6 o clock because the hands hand is a little bit elevated so you tell the mother to you kind of press the hand down when she presses the hand down automatically what happens this dip comes at 6 o clock position ok so this is really really important remember and just a tip of the finger not the whole thing and this is how you hold the breast ok now once she once she puts her finger tip of the finger at 3 o clock and 9 o clock position tell it to press it just like how we press the sandwich ok because if we don't press our burger it will not go in the mouth and remember baby does not have that big mouth ok so you want to press it kind of press it good amount suppose if the arilla is very small ok then what you want to do you want to make sure you know that arilla if it is small just take three fingers does not matter if the arilla is smaller big just take three fingers away ok and then press it hard ok and then basically it will control as soon as it becomes small you know when baby opens the mouth immediately last the baby now baby has already kind of extended the neck backward right so when the here the lower lip will be somewhere near the border of here border of the arilla ok and you want that whole arilla near the lower lip to kind of slide in the mouth ok this is really important concept that how to hold the breast exactly at 3 o clock in 9 o clock we call it cupping of breast cup it's like cupping of breast ok ok so here now we are done with how to hold the breast here I am bringing the baby ok so here is the position neck is a little bit backward ok near kind of near of the nose is facing the nipple ok so it's facing the nipple there you go so here it here is the position where near of the nipple is facing the facing the nipple do you see see the neck is extended backward it's not coming on straight like this it's I am pulling the baby little bit towards the other side and then extending the neck ok nipple is in front of the near ok now what is happening the lower part of the arilla this part is facing baby's mouth ok now I am going to open baby's mouth so how is baby going to open the mouth the way baby is going to open the mouth is basically what you do you kind of stimulate baby's upper lip with the nipple so when you stimulate baby's upper lip with the nipple what is going to happen within a minute some time it takes about couple of minutes but baby is going to open the big mouth how big it should be the mouth it should be minimum 120 degree because if it is only 45 degree only nipple will go in the mouth if it is only 90 degree not a good amount of lower arilla latch will happen ok you want the lower arilla latch lower means near the lower lip so you wait till baby opens 120 degree do not be in hurry please have patience this is the most important part ok because you may have everything correct but if you don't wait for baby to open the mouth you will not be able to latch this baby properly and there will be breastfeeding failure ok so please understand so again stimulate upper lip with the nipple wait for baby to open the mouth sometime it may take time to not give up ok and if baby is not opening the mouth after 4 minutes 5 minutes or maybe even 7 minutes let it go baby is not ready to breastfeed because baby is not hungry when they are not hungry when they are sleepy they will not open the mouth but if they are hungry they are you know ready to eat you know they will immediately as soon as you put kind of stimulate upper lip they will open the mouth sometime it may take time sometime it may take 3 minutes 4 minutes 5 minutes but do not give up ok alright now baby opens the mouth you have already made it small now you just immediately as soon as what you what I want you to do you are ready ok see baby is very close to me baby is kind of I have control full control of baby's neck right your baby's kind of neck back of the head and then very close I am waiting for baby to open the mouth as soon as baby opens the mouth immediately what I am going to do glide it in the mouth ok as soon as it glides in the mouth basically the latch is complete ok now what can mother do after the latch is done mother has to see it because unless she sees it unless she examines it she won't she won't know whether mouth is big enough or not where is the lower lip sitting where is upper lip sitting what is happening with the lower lip you know all that she needs to see there are four points that she needs to watch you know and then she has to examine that's when she'll know that okay latch is good now in what happens is many times is if doctors and nurses know this technique they will examine but you have to tell mother what to watch because at home she is not going to have any of this lactation consultant see the latch all the time so it's important that mothers understand ok so here now latch is complete what I am going to do I am going to release this hand from here this is possible if you have a small breast if it's a very big breast and if you remove it what happens it may slip from baby's mouth ok so if you have a small breast if it's not too heavy you remove the hand and then with the same hand you basically what you can do is near the lower lip you press the breast a little bit over here you press it because I want to see where exactly is baby's mouth ok so I'm looking for few things first thing I'm looking for how big is the mouth ok some looking I'm examining the latch some looking whether the mouth is 120 degree minimum 120 degree open or not if it's open that point is correct ok second what I'm looking looking for is where is the lower lip sitting whether it is sitting just near the nipple or whether it is sitting near the areola whether sitting here whether sitting where is where is baby's lower lip sitting ok so here what I'm doing is basically I'm looking at the latch ok and I'm seeing whether the lower lip is at the border of areola or not ok now if baby is sitting at the lower if the lower lip is sitting at the border of areola that means latch is good but if suppose the areola is very small then where what will happen that the lower lip will be sitting on the breast ok and where will be the upper lip upper lip should be sitting just above the nipple because if you have more of upper areola going in the mouth this area baby will not be able to press hard ok baby is not able to press hard is that section of the areola will not be able to suck so much milk ok and that's very important because you want as much as the lower areola in the mouth and the upper lip is sitting just at the border of upper nipple ok not not upper areola it should not be the full areola going mouth because there is a myth among lot of healthcare workers they always say poora kalabhaag moome jaana chiiya the whole black part should go in the mouth no it should not be the full black part going in the mouth it should be just the areola the black part which is near the lower lower lip ok so that's your latch is done ok now once you examine second thing would the third thing you want to examine you want to see where the baby has any dimple now that dimple if baby has a dimple then there are three points which could go wrong ok what are the three points which are wrong probably one is the nipple feeding so babies only have nipple in the mouth they will basically have dimple second point is if baby has much of upper areola in the mouth so more of upper areola if it goes in the mouth and not the lower areola that's when baby will have dimple ok and the third point is if baby is too far from the breast ok ideally what happens when you have a good latch the lips and the chin should not be visible because if the lips are visible that means kind of mother's mother's breast is too far like for example when you're drinking from a straw when you're drinking from too far what will happen you'll be doing this baby will get tired ok so you don't want that what you want you want to push mouth baby's mouth so kind of deep into breast that the full breast is pressing against the lip and especially the areola so that you cannot visualize baby's lips as well as chin this is the third point which is extremely important in your latch ok so what are the three points very important three points first of all baby's mouth should be 120 degree open second point is that the lower lip should be at the border of areola or on the breast ok and upper lip should be just about the nipple third point both you know lips as well as chin should be embedded into the breast ok should be deep kind of seated deeply embedded kind of pushed into the breast so that you can't see the chest you know you can't see the lips as well as chin ok and the fourth point which W H U recommend is the upper lip should be visualized and lower lip is not visualized because it's in the mouth which already mentioned ok so these are the four important points that you want to there is one more point which generally I don't see much of a problem which W H U do recommend that lower lip should be kind of turn outward ok it should not be turn inward because if it's inward we will not be able to kind of cause suction you know we will not be able to suck breast milk as much ok so that is important for as I said key you know if baby's landed well and if the latching is done correctly then by and large I don't see this problem of inward turning of lower lip ok so that is done so here now mother is ready to now you know continue start I mean she's already started latching started breastfeeding but now she can relax and you know just enjoy the session so here now once she examine she can remove her hand and then bring the hand ok like this ok so what I am doing now with my other hand I am just kind of again giving the support to the leg ok but remember I am not removing my fingers from the neck or from the lower part of the head ok because baby's neck is still not under control baby's still young so till one or two months of age you know I prefer that mother still hold the head because many times what happens we see it that a lot of time when baby's used to having nipple feeding what they do is as soon as you put the air in the mouth lower and lower they pull back they pull back so here you know you want to kind of control this neck I would say head position so the baby does not remove the kind of mouth from the breast ok that's important so this is your you know latching is over and you're kind of bringing your you know hand on the back of the body is finished now sometimes what happens that we do see that many times you know mother's breast is very heavy ok so in such situation what to do because as soon as you remove the hand from the breast you know it will slip off from mother's baby's mouth ok so in that situation what you want to do is you basically kind of bring your hand first you check for the for the latch once the latch is good then you bring the hand and then with the with the help of the elbow joint you just lift up the breast a little bit because when you do that what will happen it will give support to the breast and it will not slip off from baby's mouth ok so you can just lift up the leg you can see the shoulder so I'm kind of supporting my breast ok and that that's what you do now many times what happened like nowadays we see a lot of obese mothers and overweight mothers kind of breastfeeding and their breast is really heavy and big so in that situation what we do we tell mothers to continue holding the breast in a U shape ok and then what you can do you can just put kind of you know pillows over here so that she can get support so in my situation over here I have a support of the handle of the chair so you can just basically put the kind of you know support with the handle and then she can continue holding it so that mother does not feel tired and this when this is happening you know you want to make sure that many mothers are kind of lot of time do this you know lift the shoulders up like this you know they want to kind of make sure that they are a little bit uncomfortable you know in the beginning when they are learning so you want to make sure they tell her to put both this kind of shoulder back like this towards the body because if she is holding the baby with her shoulder relaxed and close to her trunk you know then it will be much easier for baby the mother also to relax and enjoy the breastfeeding session ok so here it is this is our session on how to hold the breast and how to basically attach the baby and also how to check the latch to make sure that you know the latch is good so this is the end of part 2 where we finished about holding the breast and latching the baby ok now in next session what we are going to do next part what we are going to discuss about is you know just the other important counseling points because there are about 45 points so we have finished almost half of them you know so now it will be the rest of them that what all things that we want to make sure that we know mothers know so that she can have successful breastfeeding ok all right thank you