Lately I need to be reminded that normal, comfortable, pain free
breastfeeding exists. Just recently I asked a group of women to remind me that not
everyone suffers who breastfeeds! Seems when all you see are the 'problems' you
start to think nothing else exists but the problems! Haha. This thread of
hands off lactation support intrigues me. When I was strictly a volunteer
providing more phone help than in person help it was obviously very hands off.
However, over the years I have come to believe that I feel much better
'seeing' for myself and another set of hands helping makes a huge difference for
many moms who are learning a skill --- breastfeeding may come naturally to many,
but I think it is also something learned and sometimes the learning needs
direction.
I am neither all hands on or hands off. I am definitely both. By the time I
see a mom her baby has likely done some serious damage to her nipples or is
not gaining weight or some 'thing' is not going well. If all was well, she
would not be calling an LC. Perhaps if more women got to experience skin to
skin, patience, and trust and their babies were allowed to self attach after
birth and were not separated and a multitude of other things that interfere
with ease of breastfeeding I would not be needed at all. If those of you who are
working with dyads find that regardless of situation and regardless of
reason for the visit all you need to do is get them skin 2 skin and sit back all
is well, can you share if this works for every sore nipple situation, ever
slow weight gain, etc. OR are you talking about those early nursings when baby
is just getting started? When you are working with a mom with damaged nipples
or slow weight gain what is your starting place for assessment? When do you
do no more in your consult than skin 2 skin and wait? What factors do you
consider before you do touch a mother/baby in helping with breastfeeding or do
you feel there is never a time when an LC should touch? We often use the
learning to ride a bike analogy, and I remember clearly someone holding the
back of my seat until I was sure I would not fall. And then running beside me,
and then finally, backing off and letting me ride alone.
I would be so happy to know that all we know about positioning and latch are
irrelevant and we do not need to concern ourselves with this because the
baby will always know what to do and we just need to sit back and watch. I
agree that sometimes it gets too 'managed' and that for most women it is indeed
enough to get the baby in the right area and things go fine. I don't see
those women. Okay, sometimes I do. I need them to keep me balanced in my view
of breastfeeding...normal and doable for most women and babies. I am not
saying that hands off is wrong, of course, it obviously is working for those who
use it. But, the tone of the posts has me feeling that those of us who
touch are off base and doing it wrong. That there is no need to touch a mom or
her baby to assist her with breastfeeding. I am always open to ideas that
allow me to grow in this profession and to learn from others is why I love
Lactnet. Is it the experience that mothers and babies do not need any hands on
support regardless of situation, or are we speaking only of those early feeds
when indeed the lack of disruption would be the best support of breastfeeding.
Perhaps there is room for both thoughts. Personally, if a mom is in intense
pain and has damaged nipples I prefer to assess the baby, get an idea of
what may be causing this damage and if nothing is obvious such as a tongue tie
or extremely high palate, I offer to latch the baby once to see if it feels
better. Usually it does. Once she can feel for herself it can be done and
that there should be comfort, she is able to relax and learn to do it herself.
So, then we do it with her hands on mine, then, my hands on hers, and finally
her alone with me and a doll. Sometimes we skip a step or two depending on
the mom and the baby. And always before she leaves me I have her doing it
completely alone. I tell her to make believe she is home alone and the baby is
hungry. I step away, and only return when she lets me know she has latched
the baby. Most times unless there is something more going on, this works.
Mom leaves able to feed her baby comfortably. My visits are usually the
length of two feedings. The first we do together, the next she does alone During
the feedings I answer questions, reinforce how well she is doing, etc.
I don't really use any special lingo with moms. I don't talk to them like
they are air heads though. I don't see anything wrong with using the terms we
use with a mother. We are talking about her body and she should know how it
works and why. Sure, the mystery is lovely and the feeling is nice and warm
and fuzzy for most moms, but for many the knowledge of the function of
breasts is interesting and amazing at the same time. I think it is very important
for women to feel a comfort with their breasts that comes with knowledge of
how it works, why it works that way, and the best way to help the baby get
the most milk for the work. Knowledge of the 'technical terms' of
breastfeeding does not negate the emotional connection of nursing. Women are smart and
they should know about how their body works. I see no problem with knowledge
unless it used as way to make rules. I think knowledge explains why there
really is no rules. The comments about how and why mothers are using words
like assymetrical latch made me think of docs not wanting moms to have an in
depth understanding of the procedures for labor and delivery. Luckily internet
has provided women with a wealth of information and the ability to gain
understanding of many issues that use to be the things of 'now, now, mother,
trust me' . It is true that mothers do call me already aware and working on
things themselves. This proactive approach is a positive sign that women are
taking control of their health. I do not see the use of lactation lingo as a
negative thing. I am impressed with the knowledge of lactation that women have
today. Perhaps because I too was one of those young mothers who did not know
breasts make milk until I was having my own child. I too was one who never
saw a breastfeeding baby until I saw my own little one nursing! I never even
heard the words nursing or breastfeeding or lactation!
Breastfeeding is learned by mothers and babies. Sure parts are 'natural',
but even with some other things that are hormone driven and we do 'naturally'
we need some practice to really enjoy. Sometimes we even read a book or
watch a video to give us an idea of ways to make it more comfortable, more
pleasant, get my meaning?<grin> And, yes, knowing the terminology helps us know how
to be sure it is the best it can be...and the knowledge does not take away
from the pleasure. Yes, skin to skin works miracles and I encourage it and use
it when teaching a mother how to help her baby feed in a way that does not
hurt her, but it can't fix everything. Or can it? Is it really so wrong to
teach mothers the words for their breasts function? Is it really so wrong to
touch them to help them?
Without this turning into a judgment of how we each practice, is it possible
to share the balance in our work of hands on/hands off and when more hands
on is needed and when we really do not need to know any more about lactation
than trust the baby and skin to skin? I would be very interested in learning
from others to see if I should incorporate what I learn into my practice.
Take care,
Pam MazzellaDiBosco, IBCLC, RLC
Florida, USA
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