Heather,

When you receive the study and digest it, please let us know your
conclusions.

<There is quite an old study (1984) which I haven't read but seen
referenced which says a short bedside teaching intervention in
hospital improves bf incidence at one month (Jonson CA, Garza C,
Nichols B, J Nutr Educ 1984; 16:19-22).>

"Positioning" still means many different things to many different people,
I fear. I know that in 1984 I thought I knew a whole lot about putting
babies to breast. I certainly didn't know then what I know now!

At the time, it was thought that most of the compression of the sinuses
was accomplished with the jaws, and many diagrams back then show the
tongue not covering the lower jaw. I even have such a diagram that
depicts it this way in an article by Edward Newton (the OB-GYN who is the
son of pioneer lactation researchers Niles and Michael Newton).

In 1984, I myself was very "hands-on", concentrating mainly on teaching
moms to soften the areola so the baby could "grasp" it better. In the
process, more often than I realized at the time, I was triggering MER
prior to putting the baby on the breast. That in itself, was a help.

Some of the things I did then work just as well now as they did then.
Some of them, I am even deliberately emphasizing more now than I did
then.

But the paradigm of the off-center latch with the tongue coming out over
the gums, and covering more of the areola than the upper lip/jaw covers
was a whole new set of insights for me.

When I could finally humble myself to put away my own biases and
preconceptions long enough to open my mind to that key difference is when
it finally "hit" me what everybody must have been referring to when they
said "positioning" was so important.

(As you quote that splendid article in the BMJ in a later post, Heather:
"As such, the
experience of shame helps to explain why improvement which ought to be
a 'no brainer' is generally such a slow and difficult process.")

So many comments on "positioning" that I have seen in professional
articles speak mainly of the position of the baby's BODY in relation to
the position of the mother's BODY (not shouting, just trying to
emphasize).

Though positioning of the mouth is greatly effected by the relative
positions of the mother's and the baby's bodies, in the long run, it is
specifically the "positioning" of the mouth on the breast that is the
important component.

Bodies can be "positioned" exquisitely with mouths still positioned quite
ineffectively on breasts. I often think of this when moms say to me "They
(hospital staff, MD's office staff, etc.) checked my "positioning" and
said it was ok.", when it's obvious to me from observing the mother and
baby that no one really had a clue.

That is still not generally well-understood today. It may not have been
well-understood by those making that 1984 study. If not, then their use
of the word "positioning" would have had a totally different meaning from
today's use of the word as it refers primarily to the relationship of the
lower jaw/tongue to the areola/breast, the off-center latch.

Or maybe they did know, and it has taken nearly 20 years for the word to
spread!

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

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