Jean, thank you for your reply and for giving this a name!  I have been
skipping Lactnet digests and realized, as I was catching up, that this had
already been referred to, and that this was what it must be called - the
name describes it perfectly.  I have not seen/heard Kay Hoover's
presentation (but would love to). I learned the technique as a very new,
very inexperienced LC by observing one of the postpartum nurses in one of
our private clinics who was particularly skilled at latching the most
difficult babies - thank you Tsitsi!

Martha, I agree that babies whose mothers have had inductions or medication
during labour may be more likely to need that extra help with latching to
begin with.  And I agree with Jean's observation that before we lactation
experts came on the scene latching must have been mostly possible because
women learned from watching other women.  Mostly.  But not always, and we
cannot blame medical intervention for all the breastfeeding problems, nor
assume that women in simpler societies without them don't need help with
breastfeeding.

Latching difficulties can occur in hospitals where there are no medications
at all.  One of the most "unprofessional" things I've probably ever done was
help a mother latch a baby during a BFHI assessment!  It was a little clinic
where pain meds in labour are simply unavailable, I'd just finished
assessing the mother included in the random sample, and on my way out I
noticed this new mom patiently trying to latch her baby and failing again
and again.  The urge to just quickly show her how to make it easier was
irresistible, so I did!

The longer I work as an LC in this incredibly breastfeeding-friendly
country, the more I begin to wonder what proportion of infant mortality is
attributable to breastfeeding or latching difficulties that women cannot
resolve simply by watching other women. My European clients often bemoan the
fact that they can't breastfeed like the indigenous mothers, but it has been
an education to me to see how many of my ordinary African clients, whose
entire families breastfeed, experience exactly the same kind and range of
difficulties as their European counterparts.  Actually the very *worst*
problems I have worked with have involved African babies, no doubt because
everyone expects that breastfeeding will be successful and there is often
considerable delay before seeking help.  When you think about it, the
highest infant mortality rates occur in countries which also tend to have
the highest breastfeeding initiation rates, which might alert us to the fact
that it doesn't always go as well as we generally assume.
Certainly, in the developed world there are many medicalized and induced
births which make breastfeeding initiation more difficult, but even without
these constraints, I think that as breastfeeding rates start to rise in the
US and Europe we will see *more* need for lactation experts with their
pillows and pumps and special skills.

Pamela Morrison IBCLC, Zimbabwe

>Jean wrote, "Even though you were addressing a different post, you gave a
perfect description of the use of the "teacup" hold on the areola"..........
Before lactation experts and pillows and insights into the anatomy of the
infant mouth came to be, isn't it wonderful that latching must have
somehow been possible for a large majority of babies and mothers simply
because women learned from watching other women how to handle the breast
>as a feeding tool!"

>Martha wrote, "since I took my current hospital job, where the majority of
moms are medicated in labor, and many are induced weeks in advance of their
due dates, I find a lot more babies who need intensive hands-on help for a
few >feeds."

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