Well, it worked again.  I haven't seen many clients since I got a copy of
Rebecca Glover's positioning video, but it sure seems to be working well for
them.

I'd gotten as far in my own thinking as realizing that, far from using the
nipple to stimulate any part of the baby's face, I actively withhold it,
aiming it up the baby's nose or away from his face, so that it's the last
part of the breast to enter the baby's mouth at latch-on, after he's taken a
nice big hunk of breast with his head slightly extended.

Rebecca takes it 3 steps further.  First, she has the mom hold the baby's
back and shoulders so that gravity allows the head to flop back into what
she calls the "instinctive position".  Second, she has the mom put a single
finger or thumb (depending on which hand the mom is using) practically at
the base of the nipple, on the side near the baby's nose, and press,
strongly tilting the nipple away.  Third, *using no other fingers anywhere
on the breast*, mom presents the resulting pouchy hunk of breast to the baby
(touching it to his forward-thrusting lower lip and chin if needed) and
brings his mouth straight onto that hunk, slipping her finger away at the
last moment as the nipple "brushes or folds under baby's upper lip" and
slides deeply into the mouth.  The nipple has no choice; it's attached to
that big hunk that the baby just took, and in straightening itself out, it
ends up far back in the mouth.

The first time I used her approach was with a baby with other issues, and it
didn't do much.  The second time, the baby went from a so-so latch to one of
the most gloriously wide latches I've ever seen.  Mostly I've had moms watch
at least part of the video with me, while I learn how to phrase and tweak it
reliably myself (there are times when it seems - at least for me so far -
that mom *does* need to stabilize and narrow her whole breast, as opposed to
using just one finger).  Two days ago was another big success, with a 2 1/2
month old who'd never managed any steady suck-swallows on his own, and whom
I was seeing for the first time.  (Mom's milk was quite far back in her
breast, for one thing, and apparently there were some other issues as well
that had been addressed by others.)

We used Rebecca's technique, modified somewhat to accommodate a wrist
problem.  And he did his first consistent swallowing *ever*.  He was able to
repeat it once or twice more here, and they had their best-ever day
yesterday.  Not perfect yet, but significantly better.

One of the glories of this is that it so obviously doesn't require anything
much in the way of a nipple.  Mom doesn't even *use* her nipple, not really.
It just slips in as an afterthought.  I haven't seen yet how it works with
an engorged or fluid-loaded mom, though I can picture combining it with Jean
Cotterman's Reverse Pressure Softening.  If you're looking for a good
positioning video, I'm sure impressed with Rebecca Glover's.  You can reach
her at [log in to unmask]  And no, I don't make anything from this.
--
Diane Wiessinger, MS, IBCLC, LLLL  Ithaca, NY
www.wiessinger.baka.com

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