I have a couple of concerns about the "BREASTS" checklist. One is that you
don't always hear a baby swallowing, even if he is, and that mothers often
mistake other noises (such as "clicking") for swallowing sounds. And I think
the timing of the feeding is very problematical - a baby can be getting tons
of milk in 5 minutes of good suckling, or practically no milk after 40
minutes of poor suckling. It also seems to me that you could have most of
these points (apparently) in place, and still have a baby who is not
drinking milk at the breast - which is the most important thing.

But it got me thinking about what I look for when I go to see a mother and
baby. I don't have a checklist, but I always start by watching the mother
feed the baby, and this is what I am mentally reviewing:

- breast or nipple pain. Sometimes women who think it is supposed to hurt
won't even mention the pain, so I watch for flinching, grimacing, etc. Even
if everything else looks good, pain means something is wrong.

- baby not just tummy to tummy but wrapped around the mother's body. Without
the "wrap" it's more likely that the baby will come to breast "nose-first."

- mother's patience in waiting for that wide-open mouth.

- baby gets a good mouth full of breast. I will sometimes tell mothers that
the nipple should be back as far as baby's ears - that gives them the idea
of how much breast baby should take into his mouth.

- sucking patterns that change. I used to describe this as changing from the
quick sucking that is meant to stimulate let-down to slow deep sucking. Now
I use the description I learned from Jack - the suck with the pause when the
mouth is fully open. Mothers can recognize this quite readily, even if they
can't hear any sucking, and the change in sucking is quite noticeable.

- baby lets go on his own and is calm. To me this is the indication of the
baby being "satisfied" at the breast.

If any of these are not in place, then I would check further. Now what I
need is a good acronym for this.

Teresa Pitman
Guelph, Ontario

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