Nikki Mather, IBCLC, discusses the challenges of hands-on breastfeeding support.

#HandsOffTheBreast – I have revamped this blog, originally written about 7 or 8 years ago, to fit with current trends. Not an awful lot has changed, sadly.
“Velcro baby” or hands-on breastfeeding support remains as common today as it was then. Please, hands off the breast.

During my time training with La Leche League as a breastfeeding peer supporter, my second baby was just six months old. I felt puzzled about the ‘hands-off’ approach used to “teach me” how to breastfeed. How could I teach without physically demonstrating the techniques? I had experienced the rough manhandling, being squished together by my breast and my baby, had their head forcefully shoved by the back of their head into my heavy, painful breasts and been told I was doing it all wrong. I was left with the lingering afterthought that this hands on approach was the only way to do things. We trust the support, and fight back any instinctual urge to stop what is happening.

As a novice peer supporter, I avoided hands-on support during home visits. Yet the confusing and conflicting information whilst shadowing a Health Visitor, saw me fall into a trap of mimicking her actions after she invited me to help directly after observing her provide a hands on approach. Thankfully, I was reminded of my remit as a peer supporter – and I only wish I had the experience back then to call out the habitual, passive support being provided which would leave that new mother without any real tools to help once we closed the door behind us.

Reflecting on my own breastfeeding experiences, I had asked for help, and the only way midwives knew how was to grab a handful of my breasts and the back of my baby’s head, attempting to stick them together like velcro, and without consent to do so. This method didn’t empower me; instead, it fostered dependency. After a caesarean section, the post-birth routine included a buzzer, and each time I hit that red button, I would be berated for not understanding the last time.

During my training, I found that practical breastfeeding support could be achieved without physically touching a woman’s breasts. The emphasis shifted to using language effectively, describing positioning and attachment, and creating a comfortable space for the mother. Visual aids like knitted or crocheted breasts, handmade bottle top mouths, and breastfeeding dolls were used in ‘hands-off’ support.

The Royal College of Midwives advocates a ‘hands-off’ approach to encourage parents to learn the skill and respond to the baby’s cues. However, many Facebook groups are filled with stories of mothers sharing their experiences of midwives and health visitors resorting to hands-on demonstrations. Forceful techniques can cause issues like breast refusal and tension in the baby’s neck and shoulders. The importance of taking time to support dyads with breastfeeding in a gentler way cannot be emphasized enough.

A hospital experience prompted me to write about the need for respectful breastfeeding support. A midwife attempted hands-on assistance to a visibly upset and exhausted parent after a long labour, without seeking consent. This incident highlights the inadequacy of training in some midwifery courses and the need for a unified approach to breastfeeding support (I am reassured that in 2023/24, midwifery courses are much improved in terms of feeding support training for cohorts).

Breastfeeding support training varies, and not all hospitals have adequate resources. I hope that healthcare professionals collectively form a more holistic approach to support infant feeding in the future. In an ideal world, maternity services would be provided with more comprehensive training, increased funding, and robust support systems to ensure all families receive the needed support in infant feeding. The Infant Feeding and Inequalities APPG, formed in 2016, continues to work hard to improve services; updates can be found here.

#HandsOffTheBreast