Cindi wrote, " ..I've been wondering about this since I first saw it
mentioned. ...we teach moms to think of what they want to go into the baby's
mouth as a sandwich and position it so that the baby can get a good mouthful
of the 'sandwich'. .. From the description given of the 'tea cup' hold it
sounds like the same thing.  Has anyone else heard of the 'horizontal
sandwich' technique (I swear I didn't make it up myself... got it from
somewhere)?  Is the 'tea cup' hold something different?"

Oh dear, this seems to be generating quite a lot of controversy!  Thank you
for describing the "horizontal sandwich", which sounds perfect and seems to
work most of the time (normal baby, normal breast, normal breastfeeding).  I
usually describe this to parents as Diane Weissinger's "Breastburger"
because it conjures up an image of a baby opening *very* wide to take a
large, delicious mouthful.  I seem to remember that Diane wrote about a
colourful hippo with a hinged jaw and a felt hamburger that she totes around
as a visual aid for this technique - what I imagined from the description
has stayed with me!

The tea-cup hold is something *different* and I only use it *if*

- neither the breastburger, nor anything else, works
- the areolar tissue is elastic
- the mother agrees

Furthermore, to answer others' concerns about fingers being in the way and
contributing to a short latch, leading to sore nipples - a very valid
concern - 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.  The breast has to be
well supported by the mother's middle, ring and little fingers; when she
does this herself she uses her thumb and index finger to create the handle.

And if anyone is worried about a short latch using this technique, I would
defend it by suggesting that any latch is better than none at all at the
beginning, that you only need to use this technique to achieve the latch for
2 - 3 breastfeeds (after which the baby seems to get the message), and then
the mother can offer the breast in the usual way, cupping the breast with
the index finger underneath, in line with the baby's smile (this is not my
term, and I regret I forget who, but am grateful!) ie parallel to the lower
jaw.

But if there is still concern about a short latch, another technique to
overcome this is to wet the nipple, the whole areola, and the baby's lips
with drops of expressed breastmilk just beforehand, and then to support the
breast very well just afterwards, and throughout the whole breastfeed.
Because everything is wet and slippery, the negative pressure of those first
few sucks takes the nipple to the back of the baby's throat where it can't
become damaged.  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 use the tea-cup very rarely actually, but as part of my latching
repertoire, like Rebecca Glover's "flipple" technique, I find that, when
nothing else has worked for the occasional desperate mom trying to latch a
frantic newborn, it can have the effect of a minor miracle!

Pamela Morrison IBCLC, Zimbabwe
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