Anna wrote"

< It's been my observation that the =
baby may indeed latch on okay in the hospital, but once home and the =
milk comes in, the shape of the breast changes and then it's another =
story.  The baby winds up on the nipple only and mother with sore =
nipples very quickly.  IOW, what happened in the hospital may not be =
what's happening at home.>

I think she has hit a very important nail on the head. I think that
nipple confusion really exists. Problem is, I don't see it being the
rubber nipple the baby is confused about. Many learn very quickly that
they can get a reward easily from something that is the exact same shape
and consistency every time.

On the other hand, when breast fullness increases, and especially when
edema is present from intrapartum overhydration, each feeding often
presents a new shape of both nipple and breast, a new consistency, a new
experience of tissue resistance.

And many times, even the most enthusiastic and efficient little eater
will recoil from the alien feeling he/she is experiencing with jaw,
tongue and chin; or struggle valiantly away, damaging tissue because of
the distorted way the breast, the nipple-areolar complex in particular,
is responding to the application of oral forces.

So many WIC mothers I speak to on the phone and in person, may have taken
a class but were only able to take so much in. They may have had some
small amount of instruction in the hospital. But I see so many mothers
who have no idea what a let-down reflex is, nor that it is the most
important factor in milk transfer. Nor do they know how to work with
their breasts as an efficient feeding tool to elicit a good MER in
conjunction with what they may or may not know about latching, baby cues,
etc.

So many have absolutely no idea that the breast will not remain the same
as it is on day 2 or 3 in the hospital. And when the 4th and subsequent
days surprise them at home, they do not realize this is a temporary
situation that will resolve in another week or less. That is when we
typically discover the need for office consults or home visits for latch
correction help.

Much of what they learn during this time is learned through their
kinesthetic sense. And I still believe it is possible to teach a lot of
it prenatally if we offer to instruct them through that kinesthetic
sense. I believe that hand expression, for those mothers interested in
learning the rudiments of the technique during late pregnancy or the
early postpartum period, can "save" many a painful, inefficient latch
during the early days and weeks.

Does this seem too medicalized and "nursified" to others who may deal
with latch help in a different way? Or are there others around the world
who find merit in this approach?

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


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