Virginia, what you wrote in answer to Jennifer's question about a latching difficulty caught my eye: "I notice that babies whose mothers have large, very soft = breasts and who have been given a bottle (with a ready-formed 'teat') = often don't seem to have a clue how to draw the mother's soft breast = into their mouths teh way they need to. They are used to having = everything pre-formed and are hard to convince otherwise, especially if = the teat is long-ish. They look at Mum as if what she is offering is = fake." A technique that I have found works to assist latching a baby to a large, soft breast is as follows: 1. Use cross-cradle/prem hold, with baby supported on a pilow, chest to chest with mother, ie if mother was offering left breast, she would support the baby's back/shoulders with her right hand, thumb and forefinger behind and below baby's ears, and proceed as follows: 2. Support left breast with left hand. If breast is *very* large, use rolled wash-cloth between chest and breast for extra support. 3. Cup the breast under/behind the areola with the *middle* and remaining ring and little fingers, in line with baby's smile, leaving thumb and index finger free. 4. Now ... with thumb and index finger mother takes a "pinch" of that very soft areolar tissue, just beside the nipple (that would be about 3 or 4 o'clock on the left breast) - this makes a kind of "handle" for the nipple, which can be stretched forward. 5. Dab baby's lips with the nipple to stimulate a wide gape, now use the "handle to *put* (stretch and place) the tip of the nipple up into the baby's palate. 6. As the baby feels the stimulation up in the palate he will "latch". Continue to support the breast underneath very well with the third finger, but when mother feels the baby "tug" the tissue as he sucks the nipple into the latch, quickly let go with the thumb and index finger, leaving just the nipple/areola in the baby's mouth 7. Voila - baby is latched on to that oh-so-soft breast tissue. This technique works best when the tissue is very soft (elastic). If I am helping a mother with these kind of breasts who just can't manage it herself, I often teach the baby first myself, and then show the mother what to do when she can see that it works. I stand on her right so that I can see the baby's lower jaw, and up into his palate, and I use my left hand to create the "handle", with my thumb underneath and my index finger on top, at about 9 o'clock on the areola. I use my right hand over the mother's left hand to bring the baby on to the breast as he gapes, and then stretch and place the nipple up into the palate, wait for that little tug, and quickly let go. Respectfully, of course, nothing should hurt, or be rough. The breast needs to be well supported from underneath or the baby will slip off. I usually find that the baby may only need this special help for several consecutive breastfeeds, and then he learns to create his own teat from that soft tissue and the mother can then just offer the breast in the usual way - cupping, stimulating gape and quickly bringing baby close enough to get a reasonable mouthful! Pamela Morrison IBCLC, Zimbabwe (who doesn't believe that nipple-confusion needs to be a problem if you can get the latching right!) *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html