Pamela, I agree 100% with your whole post, especially that the teacup
hold and the "sandwich hold" are two different tools.

I believe the sandwich hold as Diane has pointed out, has the fingers in
a "U" shape with the thumb, all of them much further back, away from the
areola, with the little finger actually touching the rib.

< I make a 'handle' of areolar tissue at the *side* of the nipple (where
the corner of the baby's mouth is going to be, not where the middle of
the upper and lower lips are going to be) and I use this handle to place
the nipple up into the palate to achieve the latch.>

And of course, when we are pointing the nipple up toward the palate, we
are simultaneously "pointing" a generous portion of the areola toward the
(hopefully) outstretched tongue, which will help the latch end up a
beautiful "off-center" one!

<Supporting the breast throughout the feed (imagine
"pouring" the whole breast into the baby's mouth) will stop the nipple
slipping back out and/or forward in the baby's mouth.  You can usually
tell
if this is happening because you can see stretching of the skin of the
breast or areola going in and out of the baby's mouth with every suck.>

I find that last point especially important. The movement is often very
subtle, thus the need to watch carefully for a moment, and point it out
to the mom, and let her see even the tiniest bit of traction disappear
when she draws the baby in closer.

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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