Jaye
Sounds like you're offering this mom a whole slew of info, and she's
lucky to have you in her corner.
From what you describe, the only other suggestion I'd have is to try
again with techniques to latch direct, without the shield at all.
Sounds like the short shield is too short, but the combination of a
longer shield with a baby who is not 'getting it' right now to really
suck hard may be leaving a space between the nipple and the end of
the shield so that the nipple isn't drawn into it, and everything
flops about ....? I've found that soft squishy breasts (as you
describe) go really well with a baby who can't seem to latch if you
can ensure that the nipple gets right to the 'S' spot - the junction
between the hard and the soft palate, right at the back of the baby's
mouth. It's much easier to get this to happen with squishy breasts
than with firm ones. The trick is a tea-cup technique with the
areola. Do it for the mom first, yourself. Then teach her how to do
it. Imagine you are trying to latch the baby to the left breast.
1. Baby is lying across mom in the cross-cradle, head at the level
of the left breast. She supports baby's head behind and below ears
with her right hand.
2. Mom supports left breast with her left hand, using little, ring
and middle fingers to support breast, leaving finger and index thumb free.
3. With the index and thumb she takes a little pinch of the areola
BESIDE the nipple at about 3 o'clock as if she's holding the handle
of a teacup (in line with the baby's smile, ie the pinch of tissue
will be parallel with the corner of the baby's mouth)
4. Tickle baby's lips very gently to stimulate gape.
5. Once baby opens, mom PUTS the tip of the nipple up IN to the
baby's mouth, ensuring that the nipple tip is placed high up into the
palate, as far as possible into the baby's mouth. If a baby cannot
seem to gape very wide, you can push slightly down on the tongue/jaw
first, and then up to the palate.
6. Stimulation of the palate causes the baby to latch down on to the
nipple/areola mouthful
7. As soon as mom feels the baby make that strong suck inwards she
LETS GO of the handle she has on the areola, to allow the rest of the
breast tissue 'teat' to be drawn in. This is quite a quick movement,
timing is everything.
8. As she let's go of her handle, she MUST continue to support the
rest of that soft squishy breast very well - as if she is pouring the
whole breast into the baby's mouth from the back near the ribs (not
too much from the front near the areola, or this will break the latch).
9. Voila! - Here's where the mom must just watch and wait and not
attempt to hurry the baby. Most moms just hold their breath at this
stage ...the baby may take an exploratory suck, a pause, another,
waiting for the let-down to be triggered. Once he/she obtains a
little milk, the sucking starts to become deep and even in
bursts. Baby must be allowed to proceed at his own pace. Mom can
use breast compression at the back of the breast to trigger further
letdowns as necessary, but she must be very careful not to disturb the latch.
10. Once the baby learns to form his own teat, and learns that he
has to 'draw' the nipple into the mouth (learned by being helped to
do this several times) then mom can simply offer the breast in the
usual way and not need the tea-cup routine to provide the extra help.
I've found that babies can learn very very quickly - perhaps after
only a few 'assisted' latches, and occasionally after only one.
I hope this is explained OK. I find that it's better to teach the
mom how to do this at first yourself, so she can see that it really
works, and then get her to do a return demo. If you, the LC, were
doing the above for the mom, you would of course be standing/sitting
to mom's right, you would be supporting the baby facing the mom with
your right hand, and your tea-cup hold on her areola would have to be
on its right-hand side, using your left hand, with your thumb
downwards (mom helps by supporting the breast well back from the
areola, so she can just continue supporting her breast once you've
got the baby latched.
Seeing this brave woman has twins, probably each with their own level
of competence, I hope she isn't trying to do simultaenous nursing
just yet. They each need to become very competent at the breast on
their own, before this will work. But reassure the mom that very
soft breast tissue is the very easiest to work with. Sounds to me
like these are just normal babies who haven't yet become very
competent - probably a little nipple confused.
Please let us have feedback of what you find eventually works.
Pamela Morrison IBCLC
Rustington, England
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