From my home birth experience I have seen a few cases of sore nipples at the
outset, and one case of a galloping mastitis which led to early weaning,
which was mother's choice, not my recommendation.  I have not personally
experienced a non-latching baby, or even a baby who was the least bit
hesitant to latch, at a home birth.  (The only anesthesia we use in the home
is local infiltration after the baby is born, in the event that sutures are
needed.  Only labors that start spontaneously and progress satisfactorily
will lead to a home birth.  And since most of my colleagues have never
attended a home birth, they really don't know what it is they are trying to
simulate in the hospital when they claim to be striving for a home-like
atmosphere there.)

I see non-latchers daily in the hospital.  

One of the problems, I fear, is that the mother in the hospital is inundated
with people trying to "help" get the baby latched, and not all of them are
inclined to let the baby set the pace, nor do they pick up the mother's
signals that she might prefer some privacy alone with her baby.
But skin-to-skin is the word of the day where I work, and it really does
help.  If nothing else it relaxes mothers and they are enjoying their babies
more while they wait for them to show more interest in feeding.  And they
can always express more colostrum after extended skin contact with the baby,
which we can then feed to the baby, thus satisfying the anxious pediatric
staff who want to make sure the baby is getting fed.  I think what happened
with STS was that after several years of my talking incessantly about it as
a strategy for dealing with breastfeeding problems, enough of the staff
started trying it themselves, and the number of people who saw its value
reached critical mass level, and it just took over.  It is also our official
procedure for non-latching babies, right in our procedure book, which means
that doing anything else is deviation from procedure now.  He he.

I don't think Betsy is saying that the birth experience doesn't matter, but
that once it's a done deed, you can't do anything but work from there and
try to fix things.  It would be a complete declaration of professional
bankruptcy (and blatantly untrue) on the part of any breastfeeding supporter
to say that women who give birth in hospitals can't be helped to breastfeed
exclusively and satisfyingly, and I know none of us, least of all Betsy, are
arguing for that viewpoint!  I do think it's worth trying to educate people,
primarily staff, but certainly mothers too, about the relationship between
breastfeeding problems and various practices in labor and immediately after
birth, and since it is rarely the woman who makes ward policy, it's pretty
clear that she is not to blame for whatever unfortunate events occurred.

The analogy of crossing a street against the light has been used in the
context of why not all artificially fed babies are sickly and rife with
allergies, and it fits here too.  You will usually make it across without
being run over, if you're fast and watch out for cars, but you increase your
chances of getting across the street safely if you wait til the light is in
your favor, or use a marked crossing.  That doesn't mean we should teach
people how to run fast and dodge cars.  It means we should make sure there
are enough pedestrian crossings. 

Breastfeeding is such a necessary life process that it is robust enough to
tolerate a lot of challenges, but it sure doesn't hurt to set things up so
that breastfeeding is the obvious thing to do, rather than something that
only highly motivated women who are better informed than the health
professionals they have hired to care for them, can achieve. 

Rachel Myr
Who just checked and sees that it is nearly 10 years since I started going
on about skin contact as a way to start fresh when breastfeeding runs into
difficulties, which means I must be a lot more patient than I thought!!
Kristiansand, Norway

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