To Kathy Warmbier and Diane Wiessinger

Thank heaven for your posts. I was really beginning to wonder if I was
hopelessly out of line and unaware of my personal boundary issues. Kathy,
you have taken it one step further than I ever dared to take it, as I
only had consenting roommates or maybe 3 mothers together when everyone
was being helped, assessed and nursing in plain sight of one another all
at the same time. Perhaps 20-25 years ago wasn't the cultural season for
that yet, before films of premi moms in other cultures expressing milk
together as a group!

My main experience with breastfeeding mothers began on the night shift as
the only postpartum nurse, or at other times the only nursery nurse,  for
as many as 25-30 patients "back in the good old days" as the "baby boom"
was winding down, but still with the same old routines, 3-5 day stays and
universal engorgement. After 9 years of having worked L&D, and later on
postpartum, before recovery rooms came to be, caring for mothers who all
had to stay in bed for 8-12 hours or more after delivery, of course,
touching a mother's breast  didn't seem the least bit invasive to me! As
I became more experienced, (and I KNOW that I had many overzealous
moments) I found so many mothers so appreciative, often saying "Why
didn't someone else show me that!"

A few years later,  I switched shifts and also began teaching the
hospital's CBE and baby care classes.  I tried to teach a few skills with
charts. (no video machines then, and no breastfeeding films to run on the
16 mm. movie projector. I suppose I gave a lot of pie in the sky from the
front of the room.) When  I met those same mothers a month or two later
on the postpartum floor,  I often told myself "She didn't understand a
thing I said!" I was very angry with obsetricians for not even LOOKING at
nipples during the 3rd trimester and for not teaching these things to
mothers when they were the ones with access to them prenatally!

I grew frustrated at trying to make changes within the system and so made
an "end run" around the doctors by going to the consumer. Through an
independent CE organization, I began to offer separate prenatal
breastfeeding classes which included voluntary private nipple
assessments. I saw mothers on the postpartum floor who seem to have
benefitted. (At least, I guess I wanted to believe they did. No formal
research, just a personal impression.)

The classes were so well received that 8-10 other instructors were
trained and the classes, including private assessments at the end of the
class, began to be offered in  5 locations in a 2 county area. I was not
the only one strongly  convinced of the value of 3 dimensional learning
by combining the simultaneous use of touch, sight and hearing. We were
highly flattered when Jan Riordan, and later, Sarah Coulter Danner heard
what we were doing, and each included a visit to us as part of their
early research and writing. I don't know how much they agreed with in the
end, but each seemed sympathetic to our efforts and supportive of our
goals.

My philosophy has been  that it is through her KINESTHETIC sense that a
mom  will EXPERIENCE any pain  and/or swelling that develops through a
poor latch.  Therefore, a little kinesthetic TEACHING she can choose
whether to PRACTICE now and then in the shower prepares her with some
skills that can "head (the pain) off at the pass" (just a phrase out of
old U.S. Western movies that expresses the idea of being prepared with
another plan if things don't go as hoped for.)

I have never subscribed to the philosophy that a poor latch is ALWAYS or
MAINLY the baby's problem or fault. I have seen too many cases when a
mother's subareolar tissue resistance is too much for the most
cooperative baby's best efforts.  I always emphasized to moms that we had
no advance understanding of what her labor or her "feeding partner" would
be like, and that we were training mom to be the baby's teacher in case
the two of them disagreed about how  they would cooperate in the SHARING
of her nipple! After all, it's part of HER  body, and I believe SHE
deserves some control over how it goes into the baby's mouth, how long it
stays in at any one time, and how it comes out!

I guess I feel a mom has a right to choose not to be a sacrificial victim
or a martyr, naively expecting the miracle of natural results when so
many unnatural interventions and/or complications can  get in the way in
even the best U.S. hospital system! Most expectant mothers have heard
horror stories "by the grapevine" that breastfeeding is VERY PAINFUL and
I sincerely believe this is one reason why so many refuse to even
consider trying.

I am certain that my philosophy developed in large part because of my own
personal memories of how disappointing and devastating to my ego it was
to stop at 5 days with my first three babies because of the excruciating
pain of cracked bleeding nipples. It just hadn't been fair. When I
finally "made it" past that stage (with the help of LLL) with my fourth
and discovered the rewards, I felt I had been gypped out of something
very special with the first 3. I was determined to try to do better by
the moms I could help by anticipatory guidance OR  postpartum or nursery
care, wherever it was that our paths crossed.

I later moved this anticipatory guidance from the CBE classroom to the
public health prenatal exam room as just one part of my prenatal
teaching. I knew I would not get to see these moms after delivery, but I
found them receptive when I told that them I had helped mothers in the
hospital for many years, and could show them some skills that would help
them get off to a comfortable start.

Sorry for the length, but I hope it helps the overall cause of providing
better breastfeeding experiences.

K. Jean Cotterman RNC, IBCLC
Dayton Ohio where it was nearly 70 degrees today!

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