 So, this is part 2 and here we are going to discuss about how to hold the breast and how to latch the baby, okay. 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 2, again we are going to discuss about how to hold the breast and how to latch the baby, okay. So, here we have the important points across little order, any kind of hold that you would prefer, okay. 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, okay, to be, to be, to prepare the baby to breastfeed, okay. Now, baby is completely facing the breast, not facing up, please remember this, I see it all the time, another hand, lower hand is around the breast, under the breast, okay and upper hand is here, now if baby is moving too much what you can do is to just wrap the baby, okay. And if baby is not moving and baby is okay, you know you do not need to wrap really, I do not prefer that you wrap the baby while breastfeeding 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 should be completely touching mother's chest that is called skin to skin, you know that is really, I prefer that actually skin to skin contact, okay. So, now here now baby is ready to breastfeed, see neck is little bit extended, neck is little bit extended, okay and here I am going to bring the baby so that the net is right across the nipple, okay. 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, okay here is me, here is the 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, okay and understand the concept, then do not wrote learn it, okay. 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 hold 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, okay. So here remember that I am sitting, now if I am trying to eat something which is very big, okay. So for example in my example say I take an example of a big sandwich, three layer sandwich, okay 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, okay and I am telling you or somebody give me this big sandwich and they are asking me to have a big bite, okay. So the way I am going to take a big bite of the sandwich, I am going to hold the sandwich, okay and I am going to basically press it and then I am going to eat it, okay. So just 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 off, 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 be 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, okay and I am kind of 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, okay 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, okay 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, okay, 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, okay, right, now in this position just turn it around and here in this position also baby's lips are vertical, okay, so my fingers will be vertical too, so either it will be from the top or it will be from the bottom, okay, just this is a very important concept that I want you to learn, it's like whenever you're contouring your breast, your fingers should be parallel to baby's lips, okay, so in this position baby's lips, in this position baby's lips are vertical, right, so either your lips or your fingers are from down, okay, or they are from the top, okay and remember that on day 3, when milk comes in, your areola, you know mother's breast becomes big, 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 areola latch, remember why lower areola latch because we always put things food on the lower jaw, so you want to have as much areola 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 stomach, okay, alright, so here it is now let's see, now here this is the breast, okay, now baby is coming like this, right, so lips are vertical, okay, so what I'm going to do, I'm going to of course here I'm holding the baby lips are vertical, so either I can hold it from top, okay, or I can hold it from below, but I don't want to hold it from top because if I hold it from top I would know when did baby open the mouth, okay, because I want to see when baby opens a big mouth that's when I'm going to put the breast in the mouth, so here I'm going to do, I'm going to hold the breast from below, okay, and this is how I'm going to hold the breast, now this also is another very important concept to learn is while I'm bringing the baby, while bringing my fingers to the breast remember there is a clock, think about a clock, okay, think about a clock and think about nipple as the middle of the clock, okay, 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, okay, 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, okay, so you want to keep the thumb near the upper lip which is at 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 at 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, okay, baby has to have a lower areola latch, so if baby is coming from here this part over here will go in baby's mouth, so do not block that areola at any cost, okay, so here if you have a big nipple or a big areola 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, okay, 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, okay, so here how would you know that it is 6 o'clock because so so many times we 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 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, okay, 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, okay, now 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, okay because if we don't press our burger it will not go in the mouth and remember baby does not have that big mouth, okay, so you want to press it kind of press it good amount suppose if the area is very small, okay then what you want to do you want to make sure you know that area if it's small just take it three fingers does not matter if the area is smaller big just take three fingers away, okay and then press it hard, okay 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 and like backwards right so when the here the lower lip will be somewhere near the border of here border of the area, okay and you want that whole area near the lower lip to kind of slide in the mouth, okay so this is really important concept that how to hold the breast exactly at 3 o'clock and 9 o'clock we call it cupping of breast cup it's like cupping of breast, okay, okay so here now we are done with how to hold the breast here I'm bringing the baby, okay so here is the position neck is a little bit backward, okay, near kind of near of the nose is facing the nipple, okay 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 pulling the baby a little bit towards the other side and then extending the neck, okay nipple is in front of the near, okay now what is happening the lower part of the area this part is facing baby's mouth, okay now I want 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's going to happen within a minute sometime 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's only 90 degree not a good amount of lower ila latch will happen, okay you want the lower ila latch, okay 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, okay 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 breast feeding failure, okay 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, okay 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 breast feed because baby is not hungry when they're not hungry when they're 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'll open them out sometime it may take time sometime it may take 3 minutes 4 minutes 5 minutes but do not give up, okay 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, okay 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'm waiting for baby to open the mouth as soon as baby opens the mouth immediately what I'm going to do glide it in the mouth, okay as soon as it glides in the mouth basically the latch is complete, okay 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 a mother what to watch because at home she's not going to have any of this lactation consultant see the latch all the time so it's important that mothers understand, okay so here now latch is complete what I'm going to do I'm good 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, okay 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, okay so I'm looking for a few things first thing I'm looking for how big is the mouth, okay so I'm 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, okay 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 ariola whether sitting here whether sitting where is where is baby's lower lip sitting, okay so here what I'm doing is basically I'm looking at the latch okay and I'm seeing whether the lower lip is at the border of ariola or not, okay now baby is sitting at the lower if the lower lip is sitting at the border of ariola that means latch is good but if suppose ariola is very small then where what will happen that the lower lip will be sitting on the breast, okay and where will be the upper lip, upper lip should be sitting just above the nipple because if you have more of upper in the going in the mouth this area baby will not be able to press hard, okay and baby is not able to press hard means that section of the ariola will not be able to suck so much milk, okay and that's very important because you want as much as the lower ariola in the mouth and the upper lip is sitting just at the border of upper nipple, okay not upper ariola it should not be the full ariola going mouth because there is a myth among lot of healthcare workers they always say 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 a ariola the black part which is near the lower lower lip, okay so that's your latch is done, okay now once you examine second thing what the third thing you want to examine you want to see whether baby has any dimple now that dimple if baby has a dimple then there are three points which could go wrong, okay 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 a upper ariola in the mouth so more of a upper ariola if it goes in the mouth and not the lower ariola that's when baby will have dimple, okay and the third point is if baby is too far from the breast, okay 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 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 okay 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 ariola so that you cannot visualize baby's lips as well as chin this is a third point which is extremely important in your latch, okay 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 ariola or on the breast okay and upper lip should be just above the nipple third point both you know lips as well as chin should be embedded into the breast okay it 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 okay and the fourth point which WHU recommend is the upper lip should be visualized and lower lip is not visualized because it's in the mouth which already mentioned okay 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 WHU do recommend that lower lip should be kind of turned outward okay it should not be turned 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 okay so that is important but 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 her lower lip okay so that is done so here now mother is ready to now you know continue start I mean she's already started latching still 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 okay like this okay so what I'm doing now with my other hand I'm just kind of again giving the support to the leg okay but remember I'm not removing my fingers from the neck or from the lower part of the head okay 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 okay 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 okay 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 okay 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 okay so you can just lift up the let you can see the shoulder see I'm kind of supporting my breast okay 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 okay 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 a kind of you know support over 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 their 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 okay 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 okay so this is the end of part 2 where we finished about holding the breast and latching the baby okay 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 will things that we want to make sure that you know mothers know so that she can have successful breastfeeding okay all right thank you