I have been discussing this subject with Rachel privately during the past
week. Her post to LN was infinitely more subdued and diplomatic than our
initial discussions.

She made me think when she quoted this:

< I think it was Kathleen Bruce who called
this 'the corner of the pillowcase with no pillow in it' at a seminar in
Oslo, and I grabbed that analogy and began using it everywhere.>

Of course, I definitely agree with those concerns and the ones that
Winnie and Pamela have also raised about "pinching" and "shoving", and
about being careful to explain the gentleness factor if you are
role-modeling this for any other personnel.

And as I myself use it, the fingers are always out of the way of the
baby's lips, grasping the larger areola at very near the outside
circumference. I have seldom tried to use it on a mother with a smaller
areola, because the tissue far enough from the baby's lips but outside
the areola just doesn't seem to "gather in" in the desired way.


There are other things I consider when deciding whether this hold has any
advantages for a particular mother if the usual latching techniques are
not succeeding in getting the baby's cooperation.

It is simply a tool for early teaching, just until the baby catches on
about what to do. Like any other tool, it needs to be chosen carefully,
and understood clearly, and used only as long as needed, for the best
results.


I don't really find this hold valuable or applicable for any but a rather
pendulous breast.

I find the characteristics of the particular areola and the placement of
the milk sinuses important to assess.

Some breasts seem to have all layers of the areola and subareolar tissue
solidly bound together, and in fact, some are even "pithy" like a turnip
that's been in the vegetable drawer in the frig too long, and so would
not be good candidates at all for the "teacup hold".

Other areolas are closely attached to the milk sinuses and inner ducts,
with all those tissues bound together to form a very elastic "unit".

Still others have a very loose skin layer that slides

    forward easily, leaving deep milk sinuses literally as far as 2
inches behind.

I try to teach such mothers to locate their milk sinuses with their own
fingertips, so they realize that the nipple is being drawn forward only
incidentally, and that's it's really the milk sinuses we're trying to
place more deeply into the baby's mouth.

If the sinuses are deep, and the areola quite elastic, unless great care
is taken to instruct the mother in this way, I, too, found it is very,
very possible for the teacup hold to accidentally initiate that nipple-
damaging, "empty corner of the pillowcase", poor latch cycle, with just
the nipple, and not the sinuses, included in the latch.

This is where careful observation of breast support comes in, and the
mother must be taught what to look for. It is especially important for
the breast to be stabilized and securely supported (as with a rolled
towel) in advance of latching, so as not to "pull" itself out of the
baby's mouth.

Next, it is essential for the mother to understand she must follow up by
quickly drawing the baby very close, so that there is absolutely no
traction or in-and-out motion or "drag" visible at the place where the
baby's lips join the breast. I wait and watch for a while, and point out
any external signs of traction if I see them, to correct them promptly.

I have not yet heard what Kay Hoover has to say about the teacup hold in
her talks. It will be very interesting to see what she and Barbara
Wilson-Clay come up with in their next edition.

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

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