Problems From the Cross Cradle, Football, and Log Holds HSH = hand supporting the baby’s head or neck holds. These include the cross cradle, football, and log holds. A. Hand, wrist, arm pain. The HSH (hand supporting the baby’s head or neck) Holds; the cross cradle, football, and log holds, require that a mother support her baby on her hand, wrist, and forearm which can cause pain and lead to pillow dependence. Holding a baby in an HSH hold grows increasingly difficult as the baby grows and gains weight. Many mothers who use these holds complain of carpal tunnel-like symptoms in their wrists, achy arms, shoulders, back, and neck. Straining the hand / wrist muscles in any of the HSH holds is not a relaxing position. In the log hold, one of mother’s hands is holding baby’s head while her other hand pulls baby’s back into her stomach. There is NO hand left to support the breast, if needed. Cross Cradle Hold (HSH hold) - Caution Log Hold (HSH hold) - Caution Often Causes Problems Often Causes Problems The hand, wrist, and arm pain caused by the cross cradle, football, and log holds often leads to the following problems; 2. Dependence on pillows. These positions often lead to dependence on pillows. The pillows are needed to ease the strain on the mother’s forearms and wrists for the length of time a baby needs to nurse. Supporting the baby with pillows will only delay the problems that surface when a mother does not have a pillow and needs to nurse. In the cradle hold the baby’s heavy head is supported by the mother’s elbow area, which is stronger than the wrist which is used in the HSH holds. Mothers who have switched from the cross cradle hold to the cradle hold say the cradle hold feels more comfortable, more natural. The dependence on pillows while using an HSH hold continues for the length of time the mother nurses her child in the HSH position i.e. 1, 3, 6, ... months. Mothers say they can’t nurse comfortably without their pillow. This differs from the use of pillows for the first few weeks that some mothers do in the cradle hold. A question that comes to mind as special breastfeeding pillow sales increase, is why do so many mothers feel they need to spend money on something that they already have in their home? Pillows. Could it be because in the HSH positions the mothers need the wrist and arm support for as long as they nurse their baby while with the cradle hold the household pillows worked and aren’t needed for very long? 3. Leaning forward over pillow to nurse often causes back, breast, and nipple pain. Some mothers will lean over the breastfeeding pillow to nurse which can cause breast, back, shoulder, and neck pain. Leaning forward while nursing for any length of time, ‘inflexion’, weakens the lumbar / sacral area, the lower back. Some mothers will try to make their position fit the pillow rather than have the pillow work with their position. Babies and mothers body sizes will change as the weeks pass, mothers will return to pre-pregnancy size and babies will grow. One pillow cannot be expected to continue to work for any length of time under these circumstances, so why not use whatever pillows a mother has already in her home and adjust as needed? Milk transfer will be best achieved when the mother is comfortable. When mothers lean forward to nurse a baby lying on a pillow, the baby will often become a ‘cliff hanger’, meaning that he will latch on and will be tugging at the nipple from below the breast, rather than having a good mouthful of all of the nipple and some of the areola. Leaning forward can cause nipple soreness in addition to back, breast, shoulder, and neck pain. Leaning forward over pillow in the cross cradle hold, this is NOT recommended. Sitting up straight can cause discomfort and latching problems. Many mothers have been instructed to ‘sit up straight’ while nursing in the HSH holds. In the HSH holds, if using a special breastfeeding pillow on your lap, leaning back will require the mother to pull the baby up to her breast with her hand, thus losing the support of the pillow. So mothers are told to sit up straight rather than to lean back, but then the weight of the baby is totally on the arm and wrist or pillow. When mother sits back for comfort, the pillow no longer supports the arm and hand holding baby’s head in the football hold Here mother is trying to lift baby to breast with her hand supporting baby’s head in the football hold. Mother is sitting back for comfort but then the pillow no longer supports her arm. This is why many mothers end up leaning forward over the pillow, so their arm is supported, but then back and breast pain can develop. Mothers who lean back in an HSH position while trying to keep the baby on the pillow will be pulling her breast away from the baby. Some mothers end up holding the pillow rather than the baby. Mothers struggle to find a comfortable nursing position, searching for a chair ‘vertical enough’. This advice, to not lean back, contradicts evidence that has helped mothers succeed at breastfeeding. Mothers can lean back in cushioned chairs and sofas and nurse in the cradle hold without fear of pulling their breast away from the baby. This is because the baby’s head is more easily supported on the mother’s elbow area and as she leans back, gravity helps keep baby latched on properly. Mother can relax more easily with the couch supporting her back than she could sitting up straight. If you think sitting up straight to nurse is comfortable, try a test yourself. Hold an infant, or a 5 pound bag of flour in your arms, sitting up straight for 10 minutes in the cross cradle hold, without pillows. Now try holding the baby or the flour in the cradle hold, leaning back against the sofa. Which feels more comfortable? And if you think that you just have to build up your arm strength, as some moms have been told, remember that your baby will gain weight and the stress on your wrists and forearms will increase. The HSH holds are anatomically incorrect for breastfeeding, they cannot be ‘fixed’, they will cause problems. Please so NOT use them. Please switch to the cradle hold. The mother’s hand or fingers on the back of the baby’s head triggers the newborn instinct to turn towards anything that touches his/her face or head. 5. In the cross cradle, football and log (HSH) holds the baby gets 2 stimuli when trying to latch on. In the HSH holds the baby is trying to root towards the nipple with his mouth but is simultaneously being stimulated by the hand on the back of his head, to push back from the breast towards the hand. The baby will frequently pull off and turn his head towards the hand, then try to re-latch when he realizes that there’s no nipple behind him to latch onto. It looks to the mom like baby doesn’t want to nurse, pulling on and off or turning his head from side to side. Mothers report these issues in the HSH holds; -Baby pulls off a lot, bobs head on and off of the breast a lot -Baby turns head from side to side when trying to latch -Baby won’t open his mouth wide enough when latching -Baby won’t keep his mouth open for long enough when latching -Poor suck; baby will latch on but won’t suck for any length of time -Mothers are told their baby has a ‘latching problem’ This is not an ‘oral aversion’ as some mothers may fear. It is the instinctual response of the baby to the simultaneous double stimuli they are receiving to root to the nipple and to root to the hand. The hand on the back of the head distracts the baby from latching onto the nipple. This reaction of the baby to the hand on his/her head is a primary reflex called the TLR; the Tonic Labyrinthine Reflex. It is active during the birthing process where the baby retracts or pushes back his head, flexes or folds in his arms and extends or straightens his legs. This reflex can be felt in the newborn by simply pushing on the back of baby’s head. This primary reflex, the TLR, is a movement pattern which emerges during fetal life and is critical for the survival of the newborn as it helps the infant with rooting and sucking. When a baby is put into the cross cradle hold one can see the Tonic Labyrinthine Reflex in action. Baby will push his head back towards the hand holding his head and will often arch back from the breast. He looks like he does not want to nurse, but he is really just reacting to the hand on his head. The cradle hold does not create these problems. Keeping hands off the baby’s head while supporting baby’s’ head on the elbow area in the cradle hold avoids these issues. 6. Why not just keep the mother’s hand below the baby’s ears in the cross cradle hold so that this newborn instinct is not engaged? Keeping the mother’s hand below the baby’s ears will decrease the pulling on and off problem, but the other issues remain. Supporting a baby on the wrist and forearm in an HSH hold is more difficult than on the elbow area in the cradle hold. Mothers still complain about sore nipples, achy shoulders, wrists, forearms, necks, and backs when keeping their hand below the ears in the cross cradle hold position as well as reporting concerns about low weight gain, restrictiveness, dependence on pillows, and failed lactation. 7. Why not latch on in the cross cradle position and switch to the cradle hold? Mothers who use the cross cradle hold to latch on with and then switch to the cradle hold for nursing, still report carpal tunnel-like symptoms in their wrists. One mother said, ‘When my baby would throw his head back while latching in the cross cradle position, it killed my wrist’. She reported feeling much more comfortable latching on in the cradle hold with the bulls eye technique. See #8 about baby’s mouth closing on nipple rather than getting all the nipple and some of the areola, when using the cross cradle hold as a latch on technique. 8. Baby’s mouth often closes on nipple, causing pain, when using an HSH hold While using the cross cradle hold to latch on with, mothers struggle to determine when the baby’s mouth is open wide enough to push him onto the breast. In the cross cradle hold the mother is the one who determines when the baby’s’ mouth is open wide enough to latch. But his mouth could close at any moment ending with a poor latch as the hand on the back of his head is stimulating him to push back towards the hand. If the baby closes his mouth on the nipple and does not get all of the nipple and some of the areola, tissue damage can occur, producing pain. In the cradle hold the baby is an active partner in the latch on process. He is the one who does the final reach from mother’s arm to the breast, with mouth open wide because he is doing the latch and wants to latch, he is not being shoved onto the breast. Mother’s arm gives perfect support in the cradle hold, so baby can be at the correct level for the nipple and as an active partner in the latch on process, can make any needed adjustments of his head for a good latch. 9. Cause of Nipple Soreness Mothers using HSH holds often complain of nipple soreness. The repeated pulling on and off from the breast by the baby in an HSH hold can cause nipple soreness. Also, tissue damage can occur when the mother is lifting the baby’s head to her breast and the baby doesn’t open his mouth wide enough. Then he may end up clamping down on just the nipple. Trying to keep the baby’s mouth open wide enough and for long enough when latching is difficult in the HSH holds because the hand on the back of the head is stimulating baby to push back towards the hand, thus causing the baby to close his mouth and turn away from the nipple. Mothers report feeling their baby was refusing to nurse or was having a ‘latch on problem’. In the cradle hold the baby is an active partner in latching-on. From his mother’s arm he helps by reaching his head forward towards the nipple, properly flanging his lips at the same time. Mother doesn’t have to guess when his mouth is opened properly, he will keep it open because the only thing stimulating him is the nipple on his mouth. He is not being distracted by a hand on the back of his head. 10. Breast tenderness can occur from holding the breast in the cross cradle hold Some mothers complain of breast tenderness where they hold the breast in the cross cradle hold. 11. Pain Exhibited by Baby in Cross Cradle Hold Babies born by vacuum extraction or forceps exhibit pain when nursed in the cross cradle hold. These same babies settle calmly into nursing when nursed in the cradle hold. In the cross cradle hold the mother’s fingers may press on sore spots from the forceps or vacuum. 12. Low Weight Gain for Baby The cross cradle hold, football hold, and log hold (HSH Holds) are being linked to low weight gain for babies. We are concerned with the number of babies that are not gaining weight properly while breastfeeding in an HSH position. Many parents are reporting concerns over inadequate weight gain with many babies losing a pound or more of their birth weight. Mothers call us whose babies are losing weight, saying their doctor is concerned. They are using an HSH position and often were pumping and given an SNS (Supplementary Nursing System) because of latch on problems which lead to insufficient weight gain. The baby is not learning to nurse properly in the HSH positions, which often causes an insufficient milk supply. The nipple, wrist, arm, shoulder, neck and back pain caused by these holds can inhibit the mother from nursing long enough to bring in a full milk supply. What used to be a rare occurrence, insufficient milk supply with resulting inadequate weight gain, has become a common occurrence since lactation literature changed to teaching the HSH positions instead of the correct cradle hold. 13. Head Control Issues The HSH positions are described in lactation literature as being ‘better for head control’ than the cradle hold. When a mother first nurses the idea of being able to totally control the baby’s head sounds enticing. But, newborns are born with a reflex to turn towards anything that touches their face or head. This reflex helps a baby to become an active partner in finding his way to the breast by turning to the nipple when the nipple touches his mouth. The double stimulation from the nipple on his mouth and the hand on the back of his head in the HSH holds confuses the latch on process, often causing him to repeatedly pull on and off or to turn his head from side to side. See #5 for info about the Tonic Labyrinthine Reflex. Often, lactation personnel will push the baby’s head onto the breast or will hold it there, further aggravating the situation. One mom shared that her baby daughter just got wild when the nurse held her baby’s head to her breast. When a baby pulls off a lot in the HSH holds he is really just following the clues that he is being given to turn towards the hand on the back of his head. In the correctly taught cradle hold, the baby learns head control rapidly, usually within the first 2 or 3 nursing sessions. He actively participates in latch on by opening his mouth in response to the nipple stimulating his lips and reaches his head towards the breast from his mothers’ arm, which helps him to properly flange out his lips. 14. Latch On Interference, Opening Wide Enough and for Long Enough Latch on is strongly affected by the mixed signals the baby gets from the HSH holds. Baby won’t open his mouth wide for very long when the hand on the back of the head is telling him to turn away. Mothers complain that their babies won’t open their mouths wide enough or are getting a too shallow latch. Lifting the baby’s head to the breast in the cross cradle hold for each latch on rather than letting the baby help to get there himself from his mother’s arm in the cradle hold, actually interferes with the way babies learn to nurse. It is rare for a baby to not latch on well when the mother is using the cradle hold correctly and baby hasn’t been taught an HSH hold earlier. Mothers are being told that if they are in pain while using the cross cradle hold that their latch must be wrong. They are being told that any pain they are having is an ‘artifact of incorrect latch on, not a function of the hold itself.’ The mothers who come to us using the cross cradle hold are ‘latched on’ properly, they have all of the nipple and some of the areola in the baby’s mouth. Yet they still are having a lot of pain. The cross cradle hold may look like it works at first but time and follow up show that it actually interferes with the way babies learn to latch on. Babies learn quickly with the bulls eye method and cradle hold to open wide enough to latch on. Centering the baby’s mouth over the mother’s nipple as if it were a bulls eye target is effective in latching on. Keeping baby tummy to tummy with mom will aid correct latch on. Time is needed to learn and some babies need more time than others. 15. Neck Strengthening Baby’s neck is naturally strengthened each time he reaches for the breast with his head from his mother’s arm in the cradle hold. As his weight increases his neck continues to gain strength. This author is concerned about possible future issues that may arise when the baby’s neck does not go through this initial strengthening process. In the HSH holds the mother lifts the baby’s head each time to the breast, the baby doesn’t actively participate in getting to the breast the way they do in the cradle hold. One issue we have observed is difficulty in getting some babies to change from the cross cradle hold to the cradle hold. Could this be because their neck has not gone through the strengthening process that the cradle hold would have provided and now they struggle with being able to get to the breast without having their head lifted at their increased weight? 16. Lip Flanging In the correctly taught cradle hold, the baby’s lips naturally flange out as he reaches for the breast from his mothers’ arm and latches on when he is ready. In the HSH holds the mother is lifting the baby’s head to her breast, and tries to determine when the baby’s mouth is open wide enough for a good latch. This can cause the mother to mash the baby onto the breast, pushing in the lips rather than allowing them to flange out properly. Some will say that it is easier to see if the lips are flanged out properly in the cross cradle hold. Both the cradle and the cross cradle hold have the baby’s body lying in similar positions with only the mother’s hand positions differing. The mother’s view of the baby’s lips is the same. The mother can best tell when the lips are not flanged out properly by the way it feels, it hurts! When the baby is latched on properly, mother should be able to see some of the pink skin of the lip. If she doesn’t and she feels pain, she can help the lips to flange out correctly by using her finger to gently push the skin between the upper lip and the nose, up towards the nose. This will pop out the upper lip. To help flange out the lower lip, gently pull down on the chin skin. This will help the lips to flange out and mothers usually feel instant relief. Babies learn to flange out their lips correctly when using the cradle hold. One mother shared that she noticed a regression in her daughter’s ability to flange out her lips after she used bottles. Baby went from opening wide to nibbling her way onto the breast, while doing some feeds with bottles. (Baby was less than 5 weeks ). 17. Restrictiveness Mothers say they drag their pillow with them or don’t go out with the baby while using the cross cradle hold. How does a mother take a drink, help an older child, answer the phone, or nurse discretely in public in the cross cradle hold position? Mothers of twins are being taught to use the cross cradle hold. How does one nurse twins simultaneously in the cross cradle hold? It’s not physically possible, so these mothers listen to one baby cry while nursing the other in the cross cradle hold, each time a baby has to nurse. What does this do to the mother’s emotional state? What does this do to the baby waiting to nurse? 18. Need to Learn All Possible Breastfeeding Positions and Latch on Techniques? Some are saying that mothers need to have the opportunity to learn all possible breastfeeding positions, all possible ways to hold their breasts, and all latch on techniques. This will allow them to choose what works best for themselves and their babies. While this statement initially looks logical, it implies that all of the breastfeeding positions and latch on techniques will insure successful breastfeeding. Of the many, many mothers we saw, not one was successful in the cross cradle hold, or while trying a variety of holds when using any of the HSH holds. Many mothers had problems severe enough to cause them to keep seeking additional breastfeeding counselors because the information they had received didn’t solve their problems. Their problems were only resolved when they switched to the cradle hold. By saying that the mom should make the choice of position, takes the blame for lactation problems and failed lactation off of the breastfeeding counselor and puts it right on the mother. The mother, who has never nursed before, who doesn’t yet know what successful breastfeeding feels like, and in her vulnerable, postpartum state is listening to the experts around her, trying to learn to nurse so she can give her child the benefits of breastfeeding. This author asks; why teach HSH positions that consistently cause problems? Why disregard the millennia of evidence that exhibits that the cradle hold, correctly taught, is how women succeed at breastfeeding? Why are mothers and babies being taught holds and latch on techniques that promote product use, pain, and lactation failure? Home Positions that Hinder Movie Product and Technique Cautions Breastfeeding Positions Website Index Proverbs 10:10 He who winks at a fault causes trouble, but he who frankly reproves promotes peace.