I came from a LLL background and have spent the last 9 years working in
hospitals of varying sizes as an IBCLC. (IBCLC since 88) Not only is it
possible to sit for the exam and pass without "hands-on", I know MANY people
who have. I think it's a good idea to require more education and clinical
experience  for potential IBCLCs. It will protect our profession and the
client's we work with.
    Anyway, responding to the smooshing issue: I think it's essential to
offer some hands-on assistance in the hospital. I always ask before I touch
and always say, I'm going to guide your hands or the baby's head or what
ever. I've noticed that women like to push the nipple down into the baby's
mouth -- they also don't bring the baby in close enough to feel the nipple in
his mouth -- usually bring the breast to the lips and baby turns and "fights"
trying to get there. When we "lift" up the breast from underneath (I joke and
say "look- just like a good underwire bra") and point out how the nipple then
points up and out, it makes sense. Then if she does bring the baby in far
enough, I place my hand under the baby's head or on mom's arm and bring him
in closer. I point out that they need to feel the nipple on the tongue to
begin suckling. They always say "but can he breathe??"  These little tips
have made a big difference in most of the mom's I help. If I had a dime for
every time I have said, the nose and chin must touch the breast (with chin in
a little deeper) I'd be rich!! I have taught a few nurses the "tea cup hold"
and it works like a charm 90% of the time. I agree with whoever said that
moms expect and need help from the nurses that involve touching! How could
you check a fundus if you didn't touch the abdomen? How can you check for
colostrum (showing mom yes you do have milk) if you don't touch the breast?
The key is learning from someone who knows how, who is gentle and has good
people skills. To those of use who learned from the RAM school (which I abhor
and never used) it's a hard switch. I guess there will always be those people
from a "no hands" school who are very successful or think we are
interventionists.  But in a hospital we don't always have the time..and if I
hear the nurse say, "he's got to eat or he'll need formula" I will do what it
takes to get a baby to the breast. I always tell the mom that it takes
practice and some help...love to use the analogy of learning to drive a stick
shift.
Sorry for rambling,
Mary Kay Smith, IBCLC (and LLLL for 20 years)
Romeoville IL near Chicago

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