The term breast sandwich has cropped up independently in lots of places.
The first I saw it, I think, was Barbara Heiser's version in the
Breastfeeding Answer Book, though it's not described there the way I use it.
 My own version came from watching my son eat a Big Mac and realizing what
different roles our two jaws play in accessing large hunks of food.  Lisa
Marasco has talked for years about making a breast sandwich.  So has Chris
Hafner-Eaton.  Chloe Fisher and Michael Woolridge put lipstick on babies to
demonstrate the different prints the left when they approached the breast
straight on or "from below", very much as if it were a sandwich, although
they didn't use the term sandwich.

I think we all came up with the term because it fits so well.  If a breast
were a peanut butter sandwich sticking out from the chest, moms'd know
exactly what to do and there'd be mighty few latch-on problems.  But a
breast is usually more of a soccer ball, they have no mental image for
mouthing something like that, and they offer it in a way that the baby just
can't figure out.  For a whole lot of women, making that soccer ball into
something of a sandwich means the baby doesn't have to do as much
interpreting and shaping; it's been done for him.

Earlier, Lisa Marasco, Norma Ritter and I had a "sub-conversation" about
just how we like to see a baby approach the breast, elaborating on the "chin
first" thread.  I was shocked last summer when a client told me "what you're
saying isn't what you're doing."  I thought that I encouraged a gape by
touching some part of the baby's mouth with the nipple (I wasn't sure what
part of the mouth, but hey, all the literature says nipple...)  But lo and
behold, I don't do that at all.  If this is one of those babies who just
doesn't latch with my hands in my pockets, I hold the breast-sandwich and
baby in such a way that the nipple is aimed *away* from the baby's face.
It's as if he's facing the side of a mountain, with the nipple as the peak -
a sort of Matterhorn with baby on the right face and the peak leaning to the
left.  In fact, now that I've gotten out a picture of the Matterhorn, it's
very much like that.  Make the Matterhorn the left breast.  First two
fingers of left hand indent the inner aspect of the breast, assuming a
sideways baby, and put that crimp in its right face.  Baby's lower lip is
positioned just above the crimp.  In that position his head extends and his
mouth just... opens.  If I dab with anything, I dab some part of his face
with a portion of breast well away from the nipple.

Once his mouth is open, I move baby or breast or both so that he essentially
"climbs the mountain" with his lower jaw, and the breast helps pry the mouth
open just a tad more.  It's definitely a prying motion, using the (usually)
inner aspect of the breast (the right face of the Matterhorn) to keep the
mouth open and keep the lower lip folded back.  Just as his upper lip goes
over the mountain top, I snug his shoulders in close.  But having him climb
the mountain, starting far from the nipple, seems to be important, and means
there's less need to time the latch exactly.

Heavier babies who aren't held sideways have the position of the
"sandwich/mountain" oriented to match their mouth at whatever angle it
assumes.

The motion is similar to what I see bottle-feeding mothers do sometimes.
They often don't just stuff the bottle straight in.  They aim the tip toward
the baby's nose, use the fat part of the teat to pry the baby's mouth open,
then tilt the nipple into the held-open mouth.  Lisa and Norma I believe
also do something similar.  Joan Fisher uses a different language and
slightly different technique but accomplishes the same thing.  Jack Newman I
*think* does something similar but uses different language.  Chloe Fisher's
videos show latches ending with the exact quick "stuffing" motion we use
when we tuck the last bit of a big sandwich bite under our relatively
useless upper lip.  And older babies who "rhapsodize" onto the breast do so
by nosing their way on, climbing the peak all by themselves.  But I've never
heard this prying motion of the breast  *described*, and would love to know
if it sounds right to others.

Someday we need to collect a few experienced (untraumatizable) moms with
young babies and have a bunch of us "do" latch after latch while we all
watch one another.  My guess is our techniques are all **very** similar, but
we're all still fishing around for static language that can describe
adequately and clearly what is a fluid process.  (How do you write about a
Grand Jette or whatever it's called so that a non-ballerina can perform it
based solely on the written description??)  The overall analogy that we all
keep coming up with independently is "sandwich".  The best image/description
I've come up with so far is at
www.wiessinger.baka.com/howworks/latchtalk.html.  I'd sure appreciate
feedback.

Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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