Julie's question:


<I have a completely unrelated question regarding asymmetrical latch.  The latch is supposed to be asymmetrical only before the nipple/areola go into the baby's mouth, right?  The nipple is centered in the baby's mouth afterwards because otherwise it will rub on the roof of the baby's mouth, right?  Or am I totally off?>

Julie seems to be describing what can be seen from the outside of the latch, but having trouble imagining the "unseen" inside goingson.


Janet's reply describes what she imagines the "unseen inside goingson" to be like:

<the nipple is enabled to be back far enough to be in that space just before the 
hard palate. It really is still a little asymmetrical, but that is less the 
focus than the nipple being in a comfortable spot for both mom and baby. see 
www.rebeccaglover.com >


The website yielded an empty domain "up for grabs" so Rebecca's insights didn't come up. So I wanted to put my inevitable $.02 in;-) For me, it beats "farmville" etc.


I believe Janet may have meant to say: "in that space just beyond the hard palate" instead of just "before the hard palate", since the hard palate extends from the very front of the maxilla on back to about 2/3 or more of the way back in the mouth befor it meets the soft palate. 


I agree with her that the external appearance of being asymmetrical is probably less the focus than that the nipple needs to be ending up in a comfortable spot for both mom and baby.


I would like to explore that "enablement" factor further, and direct the focus first of all to the pliability of the areolar tissue before latching, at least in the first 1-2 weeks. I think of the areola as part and parcel of the nipple-areolar complex (NAC), and never of the nipple as a separate entity from either the visible areola or the shallow and deeper subareolar tissues. "The physiologic unit of the NAC appears to function as a closely connected system. Forces acting on any one part of the NAC may cause other parts to compensate."(1) I see it as one of the main "responsibilities" of the combined areola and subareolar tissues to do much of the "enabling" for the nipple itself.


For me the point of the asymmetrical latch is to place the pressure of the tip of the tongue, supported by the power of the movable mandible, against the resistance from the stationary maxilla, so that force is exerted from back behind the lactiferous sinuses. (Or well back on to the subareolar ducts if you prefer that terminology). This gives the baby a chance to exert increased hydraulic pressure on the milk in them from behind. We all learned that principle from the use of the toothpaste tube by the time we were 8 years old. ( i.e.: Start pressing from further back behind the "fluid" to get more out more efficiently!) This hydraulic pressure from behind causes the milk to spurt forward through the narrow galactophores in the nipple, like the spray changes through a narrowed nozzle on a garden hose.


We'll assume:
1) that the tongue itself is able to function efficiently. and 
2) the subareolar tissues are soft and pliable and malleable before latching. (RPS and/or HE if necessary to soften well)
3) Then, the areola and its subareolar tissues will be able to undergo "warping", "temporary reshaping" and "taffy-pull, tissue give and take" involved in efficient suckling. 
4) This serves to automatically extend the nipple inward where it can push itself right into the center of the vacuum area that will occur near the protected junction of the hard palate with the soft palate and the back of the tongue. 
5) If the areola is soft enough, the nipple is free to push right into the vacuum and "do its thing" comfortably without any conscious attention to whether it is centered or being compressed against the hard palate.


That's the way I see it in my mind's eye.


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC    Dayton OH

1.) Cotterman KJ, Reverse Pressure Softening: A Simple Tool to Prepare Areola for Easier Latching During Engorgement, Journal of Human Lactation, May 2004, vol. 20, iss. 2, pp. 227-237. 

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