Hi all I would like to share my experiences with using skin to skin and a little of My history. Pam and others ask if s2s is used for all dyads and if it only used in the First day or so. I do not see babies at all until most of them are a week at least and up to several months old. The most common age though is between 1 week and 9 weeks With mum suffering nipple trauma. The session begins with questions about the pregnancy, birth, the early days, behaviour, wet and pooy nappies in a 24 hour period, sleeping and feeding behaviours. This will often help me decide the level of investigation and observation that I need to consider. I also find out who she has been talking to in relation the baby and feeding and the Shallenges she is experiencing. I ask the mum to show me what is normally done to encourage the baby to feed That is the starting point. When she shows me, I ask her the types of positions etc that she has tried. I point out some good things that are happening (no mother gets it totally wrong). If the baby is getting upset I suggest ways to calm the baby - the most obvious being to place the baby so That his/her head is between her breasts. Often the mum has a shirt up high over her chest and at least one breast exposed so that she can show me clearly what has been happening. At this point I talk to the mum about the value of skin to skin and share stories of experiences where s2s has been helpful Explaining that it is most often a good place to start. One of the most powerful stories is one about a mother with a 4 week old who was screeming and mother had badly damaged nipples who was on the phone. English was her second language but Dad's was English. He was about to but formula. I suggested that he did but while he was gone encourage the mum to go skin to skin. I explained it Mum and Dad to ensure that they understood. Dad rang back when it was time to feed the baby again. I asked about how much ABM did they give. Dad replied that the was still unopened and mum had had a pain free feed. Then I give herchoice about trying it with me there or starting in the privacy of her home. The other stories that I share, are those experiences of mums with very damaged nipples who have been able to feed with comfort despite the damage. What I suggest next is very dependant on her response. I work under the assumption that there is no need to rush the baby to breast I give the mum space to make her own decisions. I explain that it is most Important to feed the baby and share the various ways that she can do this. I encourage and explain the need to express to establish and maintain supply saying that she can feed this to baby and that when she is ready at least her breasts will be full of milk and so be able to encourage baby to stay there at the breast when they are both ready. I encourage her to spend as much skin to skin time as she can with baby and explain that she should not be surprised to see the baby making his/her way to the nipple and attach her/himself. If it feels comfortable just let baby feed - if not you can break the seal and start again or offer expressed milk in another way. Skin to skin certainly can not hurt the baby or mother. It is always however, a choice of the mother. If she does not want skin to skin there and then, I consider various holds, or shaping, making sure that that baby remains close to the breast, is able to extend head, have chin touch the breast first, detach when ready. I talk about creating optimal breastfeeding environments. For some babies this involves various techniques depending on how well they are or physical challenges they may have. I personally do not touch the mother though nor put the baby on. What sometimes has worked for me though is, with mum's permission, hold her baby and give her some examples of how she could could hold the baby, give bub back and then let her try out different things for herself. Skin to skin at any age, seems to have the effect of empowering the baby to behave instinctually and innately. I do not know how or why it works when birth and the early days have been less than ideal - I just know that unless there is something wrong the baby , baby will attach if given time. The time line can be different for different dyads. I am not sure that we ever have a precise pathway or method for approaching all dyads because of cultural backgrounds, personal history, human emotions and idiosyncrasies. I can not speak personally about engorgement as I do not see much of here. The hospital is very baby friendly and they actively encourage baby to go frequently to the breast in the first days and we find that engorgement is less. I would expect that in these situations though, the mother would need to hand express till her breasts are soft enough for the baby to suckle. In relation to reluctance for mothers to experience skin to skin - I wonder Just how much of this is cultural. In some cultures - being skin 2 skin Implies some form of sexual contact or immodesty or even kinky. Some people Are uncomfortable with the idea for all sorts of reasons. Being naked with A baby is something that most people do not talk about. LC's are good at Though instill cultural change, drop by drop over time. We can share stories, share research and offer support to let seeds grow. We can encourage mothers to talk to each other. We can show video of mother's experiences eg "Mandy and Matt". We can talk about it at antenatal. We can discuss it at conferences. We can share it with HPs and get hospital policy changed. We can write about skin to skin through for new born, and old babies in child birth books, baby/child care books and in our hand outs. There is much that we can do. In summary - Skin to skin is appropriate for all ages as a tool for self-directed feeding not just the first day or 2 of life. I personally do not touch the mother at all to help with attachment. Utimately it is up to mother what she is prepared to do. Sometimes there is a need for mother to create a special optimal breastfeeding environment (e.g. Shaping the breast, supporting the hips and spine) There is no rush to get a baby to breastfeed in my opinion because a baby will self-direct their own feeding when they are ready. Kind regards to all Ruth Fiedler Australia *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html