Breastfeeding Positions For Large Breasts

Introduction

The baby has a natural instinct to seek out the breast milk of their mother. There are many different positions that a baby and the mother can adopt during breastfeeding/chest feeding. Some of the positions will be more suitable for the pair, as they are both more relaxed and comfortable. To find these positions, it is important to be patient and experiment to find which position works best.

For women with larger breasts, some feeding positions are more commonly comfortable. These positions also help the mother to overcome some of the difficulties specifically associated with breastfeeding with larger breasts. The positions that will be discussed here for women with larger breasts include cradle hold, football hold, side-lying position, and reclining position.

Women with larger breasts experience breastfeeding challenges specifically associated with larger breasts but also the general challenges associated with breastfeeding.

Challenges of breastfeeding or chestfeeding

Challenges associated with breastfeeding/chestfeeding in general include:

• Sore or cracked nipples
• Insufficient breast milk
• Breast engorgement
• Difficulties in latching
• Excessive breast milk
• Thrush
• Blocked milk ducts
• Mastitis (breast inflammation)
• Breast abscess
• Tongue tie

Challenges specific to people breastfeeding with large breasts:

• Issues with latching
• More difficult to see and monitor whether the baby has latched properly
• Worries that the baby will suffocate
• Pain for the mother in their neck and back as they attempt to move the breast to make it easier for the baby

Understanding breast size and shape

Impact on breastfeeding experience

There are many myths surrounding the size and shape of the breast and the impact on and of breastfeeding.

Contrary to the common misconception, breast size is not related to the amount of milk that a breast can produce.¹ This is because breast size is related to the amount of fatty tissue within the breast, whereas the amount of milk produced depends on the glandular tissues within the breast - these two tissues are unrelated Breast size is also not related to the success of latching by the baby.²

Breastfeeding does not affect breast aesthetics or shape. Every pregnancy will increase the likelihood of breast ptosis (sagging), but breastfeeding does not contribute to this.²

Identifying common breast shapes

Breast size, shape, and consistency vary between women and even between someone’s own breasts. Breast shape is due to the amount and location of connective tissue in the breast - this is different to the fatty tissue (breast size) and glandular tissue (amount of breast milk) that we have already discussed! Because there is so much variety within breast shapes, breasts can be characterized in different ways, including common breast shapes, breast geometry, and breast placement.

Common breast shapes:

• Asymmetric
• East-west
• Bell-shaped
• Athletic
• Pendulous
• Slender
• Tear-drop
• Round

Breast geometry: 

• Drooping
• Small/flat
• Upwards
• Large/inward

Breast placement:

• Low/open
• Medium
• High

Preparing for breastfeeding

Choosing a supportive nursing bra

Buying a nursing bra might be an important purchase if you have decided to breastfeed. This is because these bras are specifically designed to allow easy access for the baby to the breast for breastfeeding. These nursing bras may have a zip down the side of the cup which can be undone to allow for breastfeeding. Mothers may prefer to wear a nursing bra if they plan to breastfeed in a public place and can increase their confidence in doing so.

It is also important to buy a nursing bra that is supportive. This is because, during pregnancy, the breasts get larger and heavier as the glandular tissue required for milk production grows and then begins to produce milk. A nursing bra that does not fit properly can increase the likelihood of neck and back pain for these women as they compensate for holding heavier breasts.

Nursing bra companies suggest that women try a rib size and cup size larger than their pre-pregnancy bra as a first port of call when trying nursing bras on for size. It is important that the bra is not too tight because this can result in blocked milk ducts which leads to mastitis.

Using breast pads for leakage control

Milk leaking from the breasts is something that is common during breastfeeding, particularly at the beginning. Leakage will generally happen when the breasts are very full of milk or when the body thinks breastfeeding is about to occur or is occurring, which sends a reflex to the breast to excrete milk. For some people, the leakage will cease when breastfeeding has been going on for a length of time but for other people they may continue to experience leakage until breastfeeding ceases.

Some breasts leak milk so much that it may appear on outer clothing. Breast pads can be used for leakage control. Breast pads can be found in maternity bras or cropped tops. 

Cropped tops or sleep bras with breast pads can be used during the night for women with leaking breasts or breasts that feel uncomfortable during the night. Breast pads come in different materials, shapes, and sizes to suit a wide variety of breasts.

Creating a comfortable nursing environment

It is important that the mother and baby both feel comfortable during breastfeeding. Therefore, some people like to create a dedicated space where the mother and baby both feel at ease, without stresses such as those associated with bright lights or noise, where the baby can be nursed. 

Some people have a special room or special chair which they feel most comfortable breastfeeding their baby. Any equipment that may make breastfeeding more comfortable should be located nearby and be ready to be used in the location dedicated to breastfeeding (e.g. any nursing pillows or cushions).

Breastfeeding positions for large breasts

Cradle hold

Instructions:⁴

1. Lie the baby on your lap facing you
2. Place the baby’s head on the forearm with its nose facing the breast
3. Move the baby’s lower arm beneath your own
4. Ensure the ear, shoulder, and hips of the baby are in a straight line

Other tips:⁵

• Sit in a chair with armrests or a bed with cushions around you
• If you sit in a chair, put your feet on a stool to prevent you from leaning forward
• This is not so popular with mothers who had a caesarean section because the baby will lie on the scar which may be uncomfortable
• Placing the hand across the baby’s shoulders can encourage a deeper latch, reducing the chance of sore nipples

Football hold

Instructions:

1. Place the baby under your arm of the side that you want to feed from
2. Support the baby’s neck with the palm of your hand
3. Move so the baby’s hips touch at a similar place to your own hips
4. Move the baby so that its nose is at the height of the nipple
5. Guide the baby’s head to the breast

Other tips:

• Useful for twins as they can be fed simultaneously
• Useful for caesarean delivery of the baby as it prevents the baby from touching the scar

Side-lying position

Note that his position is NOT RECOMMENDED if you are tired.

Instructions:

6. Lie yourself and the baby on your sides, facing each other
7. Lie so your tummy is facing the baby’s tummy
8. Ensure the ear, shoulder, and hips of the baby are in a straight line
9. Support the back of yourself and the baby (e.g. use cushions/baby blanket)
10. Make sure no cushions are in the way of the baby’s head, which can prevent latching
11. Use your arm on the top of your body to guide the baby’s head to the breast

Other tips:

• Useful for nighttime breastfeeding
• Useful for caesarean or difficult delivery of the baby

Reclining position

Instructions:

1. Recline (not lie flat) on a sofa or bed and support your back and neck with cushions
2. Lie the baby’s tummy on your tummy
3. Ensure you are upright enough to see the baby’s face without straining your neck
4. Guide the baby’s head to the breast

Other tips:

• Useful for caesarean delivery of the baby
• If lying tummy to tummy is uncomfortable for either of you, place the baby on their side
• Encourages a deeper latch - reduces the chance of sore nipples

Overcoming challenges

Engorgement and oversupply

Engorgement and oversupply of milk within the breast commonly happens within the first week of breastfeeding but it is possible that this happens anytime that milk is not being effectively removed.

Engorgement is prevented by ensuring that the milk supply within the breast does not build up to a significant extent. Therefore, it is important that the milk is effectively removed from the breast. 

There are strategies to prevent this: 

• Frequent feeding by the baby
• Ensure latching is effective
• Avoiding methods that replace breastfeeding (e.g. infant formula)
• Avoiding methods that reduce breastfeeding (e.g. use of dummies)
• Changes to feeding strategy
• Complementary medication
• Pump milk directly after feeding
• Express milk by hand (technique should be learnt for an emergency)

Hand expression techniques may be used in an emergency when breast pumping is unavailable or your baby is absent. Some people prefer this method to breast pumping.²⁷

Technique: 

1. Wash your hands
2. Find a container with a wide mouth to collect milk
3. Lean forward and find a position where you feel comfortable 
4. Make a C-shape with your fingers with your thumb above the nipple and fingers 1-2 inches below the nipple
5. Press the fingers and thumb towards your chest
6. Compress the fingers and thumb towards each other in a pinching motion
7. Release the pressure
8. Repeat steps 5-7 until the milk flow stops
9. Repeat on the other breast

Other tips for hand expression:

• Warm the breast before beginning 
• Alter the position of the fingers around the breast to remove more milk
• Imagine you are feeding your baby
• Relax
• This technique should not hurt

Nipple pain and soreness

Nipple pain and soreness usually comes about due to poor positioning of the baby at the breast.

Self-help methods:

• Ensure the baby is properly latched
• Try new positions to increase comfort
• Wear a cotton bra
• Change breast pads at each feed
• Avoid nipple shields
• Continue to feed the baby as they require

Blocked ducts and mastitis

Mastitis is when there is inflammation and pain in the breast - it can feel like a lump in the breast that is hot and tender. This comes about due to blocked milk ducts within the breast not being cleared properly. Mastitis can make you feel like you have the flu with a high temperature

Preventing blocked milk ducts:

• Avoid wearing tight clothes/bras
• Frequent feeding

Treating blocked milk ducts/mastitis:

• Continue breastfeeding on the affected breast
• Warming the breast (e.g. warm bath)
• Massage the lump whilst the baby feeds
• Rest
• Take paracetamol and ibuprofen

Contact a healthcare professional if you are not better within 12-24 hours. It is very important to treat mastitis because it will lead to breast abscess if left untreated.

Additional tips and considerations

• Use nursing pillows or cushions for support
• Explore different positions for comfort
• Seek guidance from a lactation consultant if needed

Summary

In summary, women with large breasts are susceptible to the challenges faced by all breastfeeding women, but they also have additional challenges associated with their larger breasts. These additional challenges include lack of visibility of the baby to ensure proper latching, sore neck and back, worries about suffocation, and latching by the baby to the breast. 

Using certain breastfeeding positions such as the reclined position, side-on position, clutch position, and football hold position, can be used to relieve some of the associated challenges as these positions provide greater support to the mother's neck and back and increase her visibility of the baby to ensure latching is good and to lessen the worry of the baby suffocating on the breast.